3. Prolotherapy: the right treatment for resolving joint instability and chronic pain

Prolotherapy, also referred to as proliferation therapy or regenerative injection therapy (RIT), is a technique in which substances that promote growth of normal cells or tissues are propagated through the injection of small volumes of an irritant solution into painful ligaments, tendon insertions, joints, and in the surrounding joint spaces over several treatment sessions [74–76]. This stimulates the ligaments and tendons to proliferate and grow at the injection sites, naturally promoting the rejuvenation of new tissue. Dr. George S. Hackett, who was the pioneer of prolotherapy and coined the term Prolotherapy, described the procedure as such: "The treatment consists of the injection of a solution within the relaxed ligament and tendon which will stimulate the production of new fibrous tissue and bone cells that will strengthen the 'weld' of fibrous tissue and bone to stabilize the articulation and permanently eliminate the disability" [78].

(generally recognized as safe) by the FDA. Other solutions that can be used in prolotherapy include pumice, P2G (phenol, glycerin, glucose), sodium morrhuate, polidocanol, sodium tetradecyl sulfate, manganese, zinc, and human growth hormone, as well as platelet-rich plasma, bone marrow, and lipoaspirate, which are forms of cellular prolotherapy and used for severe

Joint Instability as the Cause of Chronic Musculoskeletal Pain and Its Successful Treatment with Prolotherapy

http://dx.doi.org/10.5772/intechopen.74384

77

The pioneering work of Dr. Hackett during the 1950s established a clear link between ligaments and joint pain by identifying ligaments as the main source of chronic musculoskeletal pain and then formalized prolotherapy as a viable therapeutic strategy to treat ligamentous laxity and related musculoskeletal conditions [77]. Today, prolotherapy is known to relieve pain by initiating healing and repair via an inflammatory healing cascade, wherein growth factors are released [80–87]. The release of these growth factors by prolotherapy induces ligament and tendon hypertrophy and strengthening [88–91], reduces neurogenic inflammation [92–94], and stabilizes unstable joints [89–91, 95, 96]. Prolotherapy is effective in reducing,

Prolotherapy is a natural injection therapy that stimulates the body's response to injury and jumpstarts the repair process, resulting in the proliferation of cells that regenerate and strengthen ligaments, tendons, and other soft tissue structures associated with joint instability and chronic pain. The outcome of prolotherapy is the repair of tissues and strengthening of the jointstabilizing structures, after which chronic pain subsides. There are several types of prolotherapy: comprehensive or Hackett-Hemwall prolotherapy, D-glucose or dextrose prolotherapy, and cel-

A review of the published literature indicates that prolotherapy is one of the safest and most effective treatment options for the billion or more people suffering from chronic musculoskeletal pain today. Unlike other pain therapies, prolotherapy strengthens and tightens ligaments that have become loose or lax and restores stability to unstable joints, relieving people of their pain and allowing them to return to an active lifestyle. The authors stand by their premise that prolotherapy is the best type of treatment for resolving the real cause of almost all chronic

and often eliminating, musculoskeletal pain in the joints of the body [77, 97–108].

lular prolotherapy, including bone marrow aspirates and platelet-rich plasma (PRP).

\*

1 Caring Medical Regenerative Medicine Clinics, Fort Myers, Florida, USA

ligaments injuries.

4. Conclusion

Author details

musculoskeletal pain: joint instability.

Ross A. Hauser<sup>1</sup> and Barbara A. Woldin<sup>2</sup>

\*Address all correspondence to: barbwoldin@comcast.net

2 Caring Medical and Rehabilitation, Fort Myers, Florida, USA

The injected substance (proliferant) used in prolotherapy is intended to mimic the body's natural healing process by initiating a local inflammatory response, which triggers a healing cascade characterized by the release of growth factors and collagen deposition, leading to proliferation, ligament tissue remodeling, and strengthening of new tissue (Figure 2) and resulting in a return of function and joint stability; with this course of treatment comes a reduction in pain [78, 79]. Prolotherapy treats the enthesis, which is where ligaments and tendons attach to bone; the fibroosseous junction is the area where the injection is administered. Comprehensive prolotherapy refers to treatment of all of the significant stabilizing structures of the joint, as well as the ligaments and addresses what is at the core of chronic musculoskeletal pain: joint instability due to ligament injury and its subsequent weakness/laxity.

The most common proliferating solution used in prolotherapy is dextrose, a sugar found naturally in the body as D-glucose, which cells need to survive. Dextrose offers many benefits as a proliferant for musculoskeletal conditions and pain: it is a normal component of blood chemistry, it is water soluble and readily available, it has a high safety profile and is considered GRAS

Figure 2. The biology of prolotherapy.

(generally recognized as safe) by the FDA. Other solutions that can be used in prolotherapy include pumice, P2G (phenol, glycerin, glucose), sodium morrhuate, polidocanol, sodium tetradecyl sulfate, manganese, zinc, and human growth hormone, as well as platelet-rich plasma, bone marrow, and lipoaspirate, which are forms of cellular prolotherapy and used for severe ligaments injuries.

The pioneering work of Dr. Hackett during the 1950s established a clear link between ligaments and joint pain by identifying ligaments as the main source of chronic musculoskeletal pain and then formalized prolotherapy as a viable therapeutic strategy to treat ligamentous laxity and related musculoskeletal conditions [77]. Today, prolotherapy is known to relieve pain by initiating healing and repair via an inflammatory healing cascade, wherein growth factors are released [80–87]. The release of these growth factors by prolotherapy induces ligament and tendon hypertrophy and strengthening [88–91], reduces neurogenic inflammation [92–94], and stabilizes unstable joints [89–91, 95, 96]. Prolotherapy is effective in reducing, and often eliminating, musculoskeletal pain in the joints of the body [77, 97–108].

Prolotherapy is a natural injection therapy that stimulates the body's response to injury and jumpstarts the repair process, resulting in the proliferation of cells that regenerate and strengthen ligaments, tendons, and other soft tissue structures associated with joint instability and chronic pain. The outcome of prolotherapy is the repair of tissues and strengthening of the jointstabilizing structures, after which chronic pain subsides. There are several types of prolotherapy: comprehensive or Hackett-Hemwall prolotherapy, D-glucose or dextrose prolotherapy, and cellular prolotherapy, including bone marrow aspirates and platelet-rich plasma (PRP).
