If we begin the discussion of healing with the premise that the penultimate goal is to encourage the body to heal itself, then any practice that facilitates that healing is to be held in high esteem. That is what prolotherapy is recognized to do.
In its simplest description, prolotherapy initiates a series of cellular responses that repair, strengthen and tighten structural tissues. These tissues include tendons, ligaments, fascia and fibrocartilage. The technique involves the injection of dextrose solutions of various dilutions along with local anesthetics. The solution is injected at the site where the ligaments or tendons attach to the bone or into a joint capsule to affect the cartilage in the joint.
Although the public’s awareness of prolotherapy is quite recent, its modern use began in 1937 with Dr. Earl Gedney and was expanded on by Dr. George Hackett whose teachings are the basis for current techniques.
The attractions of prolotherapy are its relative safety and its effectiveness. The effectiveness rate hovers around 80% for prolotherapy. The risks are related to the puncturing of tissue with a needle and are rare, but can include possible infection, nerve injury, or bruising. Some pain is expected by virtue of the mode of treatment but this varies greatly depending on the patient and the area being treated. The brief discomfort is greatly outweighed by the lasting relief that can come from the successful treatment of a stubborn injury. The possibilities of such an approach to treatment come to light with a patient's story.
Paul was a 42-year-old unemployed outdoor instructor on disability for chronic back pain. He had been treated unsuccessfully by a variety of modalities and at the time of our visit was only able to get relief from pain medications. He complained that the area of pain was in the muscle belly to the side of his spine but when I examined him it was not actually painful to direct palpation. I then started pressing on the ligaments between the vertebrae to see if they were tender. Paul jumped when I pressed on the middle thoracic ligaments, clearly painful. He was surprised, as was I, at the degree of pain.
I recommended that he let me inject the sensitive ligaments with a local anesthetic to see if it would relieve the pain, if only temporarily, in his muscle to the side of his spine. This can occur when there is referred pain; by treating the site of injury the area of referred pain will often be relieved of pain. He agreed to give it a try so I proceeded to inject the injured ligaments and sent him home to return in a week with a report.
When he returned a week later I heard what I had hoped for. The pain had relented for several days (even though the anesthetic would only numb the pain for an hour or so). He could sleep on a bed for the first time in years. In quizzing Paul about an injury history from 20 years previously, he recounted with a grin the multiple spills he took while riding motocross as a sport in his teens and early twenties, anyone of which could have created the injury.
I now knew that I needed to treat the injured area of his spine with the dextrose solution of prolotherapy to stimulate repair of the damaged fibers. The first treatment gave dramatic relief for two weeks with the symptoms gradually returning the week prior to the second treatment. This pattern continued for two more treatments but by the fourth treatment he was able to return to all activities that he once enjoyed, especially riding his motorcycle again (much to my chagrin).
Paul's cycle of back pain has been gone for a year now and no more treatments have been necessary. Paul's response to prolotherapy exceeded both of our expectations given the long history and the distracting information that obscured the cause of pain.
Prolotherapy fits well into the guiding principles of naturopathic medicine, the "vis medicatrix naturae" (by the healing power of nature). Application of this principle varies in practice with the variety of modalities available, but with the understanding of the mechanism and the promise of healing potential, an emerging treatment is gaining recognition. Prolotherapy is here to stay but whether it will rise to become a routine tool in conventional treatment or if it will be defined as a niche alternative therapy will be of great interest in the future.
Mark James has been practicing naturopathic medicine in for 23 years. His practice is an eclectic use of naturopathic modalities including Chinese Medicine, Clinical Nutrition, Homeopathy, Botanical Medicine, intravenous therapies, as well as prolotherapy, and bee venom therapy for pain relief.