What is Prolotherapy?
Prolotherapy is a nonsurgical regenerative injection technique that introduces small amounts of an irritant solution to the site of painful and degenerated tendon insertions (entheses), joints, ligaments, and in adjacent joint spaces during several treatment sessions to promote growth of normal cells and tissues. Irritant solutions most often contain dextrose(d-glucose), a natural form of glucose normally found in the
body, but may also contain combinations of polidocanol, manganese, zinc, human growth hormone, pumice, ozone, glycerin, or phenol. In severe cases, autologous cellular solutions may also be needed, such as platelet-rich plasma (PRP), bone marrow, or adipose tissue. A major goal of prolotherapy in chronic musculoskeletal conditions is the stimulation of regenerative processes in the joint that will facilitate the restoration of joint stability by augmenting the tensile strength ofjoint stabilizing structures, such as ligaments, tendons, joint capsules, menisci, and labral tissue. Th most common prolotherapy agent used in clinical practice is dextrose, with concentrations ranging from 12.5% to 25%.
Dextrose is considered to be an ideal proliferantbecause it is water soluble, a normal constituent of blood chemistry, and can be injected safely into multiple areas and in large quantity. Hypertonic dextrose solutions act by dehydrating cells at the injection site, leading to local tissue trauma, which in turn attracts granulocytes and macrophages and promotes healing. Dextrose proliferant has been approved for injection by United States Food and Drug Administration but not for prolotherapy; thus, it is currently used in prolotherapy as an off-label substance.