Prolotherapy involves the injection of an irritant solution, for example dextrose, into weakend/damaged tendons and ligaments to strengthen the connective tissue and relieve the pain.
The mechanism is unclear by now, but first clinical trials showed that prolo most likely leads to local tissue inflammation, and therefore immigration of tissue-building cells. Prolotherapy is supposed to regenerate the tissue, and not, how it was thought in the past, build up scar tissue.
The most commonly used substances are dextrose (sugar), lidocaine or procaine (local anesthetic) and natural substances, which enhance the healing.
It is very important that the therapist is experienced with prolotherapy, especially on the cervical spine, because prolo could also cause damage.
All kinds of ligament laxity/damages, or capsular damage, which lead to pain or instability, can be treated with prolotherapy. But keep in mind that prolotherapy has limits as well. The cervical spine in particular has ligaments and tendons that cannot be reached due to their anatomical location. There is only one therapist who injects into the alar ligaments.
Prolotherapy is still an alternative method – described as experimental – and there are few clinical studies about its success.
Everyone needs to be aware of the fact that prolotherapy may have side effects, for example ligament ruptures or infections, and that the cervical spine is one of the most complicated regions for any therapy.
You can find my prolo experience here.
And here are experiences written by others.
PRP – platelet rich plasma
Platelet rich plasma (PRP) is extracted from the patient’s own blood plasma, and centrifuged to concentrate the platelets. The platelets release growth factors and other cytokines that stimulate healing of bone and soft tissue.
MSC – Mesenchymal stem cells
MSCs are cells that can develop into whatever cells they want to be. This mechanism is used in scientific experiments to grow different tissues outside of the patient’s body. In some clincial trials MSCs were utilized to heal bone fractures. And now there is also a prolotherapy with stem cells. The principle is almost like the PRP. The MSC binds to another cell and secretes cytokines and growth factors which stimulates, again, the healing.
MSCs can be isolated from almost all tissues, but most commonly bone marrow (hip) or fat tissue is used; the latter one is easer to access.
Stem cell therapy is also an experimental therapy, but draws more and more attention from researchers all around the world to it’s potential benefits. There are not many physicians who use this kind of therapy for cervical spine injuries.
BMPs – bone morphogenic proteins
BMPs belong to the group of growth factors (cytokines). In new studies it was found that BMPs can induce bone and cartilage formation. Some doctors use it for enhanced healing after spinal fusion surgery. (Also like PRP or stemcells)
Hyaluronic acid, orthokin, prolozone (ozone prolo) etc.
At the moment there is a huge increase of methods and therapies that are highly similar to prolo, but with a few changes to the ingredients – to be more innovative and better. It makes it really hard to differentiate what therapy works best for what injuries.
In my opinion, it is very important to be careful with those kind of therapies and to chose your therapist with caution. All those therapies can potentially cause further damage to your spine, which is why you should be informed as much as you can. Contact the doctor and ask about studies or experiences from other patients.
Helpful information about prolo with dextrose, stem cells and PRP:
An overview of the US therapists:
Therapists that use the Hackett Hemwall technique:
Other US therapists:
Blog of a CCI patient:
The following pictures that explain the mechanism of prolotherapy are used with permission of Caring Medical Regenerative Medicine Clinics, Fort Myers Florida and Oak Park Illinois.