4. Conclusion

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].

76 Anatomy, Posture, Prevalence, Pain, Treatment and Interventions of Musculoskeletal Disorders

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

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

due to ligament injury and its subsequent weakness/laxity.

Figure 2. The biology of prolotherapy.

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 musculoskeletal pain: joint instability.
