Prolotherapy, originally termed sclerotherapy, is a technique that has been around the medical community for many years.
Prolotherapy, originally termed sclerotherapy, is a technique that has been around the medical community for many years. The first recorded usage in humans occurring as early as 400 BC by Hippocrates. Hippocrates was reported to utilize a hot poker in the axilla for treatment of pain associated with a dislocated shoulder.
Years later, a physician by the name of Alfred Velpaeu successfully improved pain from a hernia by injection with iodine. However, it was not until the early 1930’s that conventional prolotherapy was discovered. This occured after a physician by the name of Earl Gedney sustained a ligamentous injury to his thumb that was thought to end his surgical career.
Gedney wrote the pioneering article reviewing two successful case studies involving a knee and low back “irritant” injections. Hackett, considered the father of current day prolotherapy, is credited with proposing the three stages of prolotherapy: inflammation, granulation or proliferation, and maturation. Biological Explanation Prolotherapy involves injecting an irritant sometimes accompanied with a needle tenotomy into a previously damaged muscle or tendon.
Prolotherapy involves a wide array of injectates with dextrose being the most common. Other injectates discussed in the literature include the following: ozone, hypertonic normal saline, phenol, zinc, manganese, bone marrow stem cells, and adipose-derived stem cells. Typically, this is performed on tissue that demonstrates chronic changes via ultrasound from improper healing of their injury or tendinopathies refractory to other therapy.
Most studies evaluating prolotherapy have used a concentration ranging from 12.5% to 25% of dextrose injectate. It has been suggested that at least 10% is needed to create an inflammatory process; concentrations less than 10% are thought to be non-inflammatory. The greatest therapeutic benefit in patients is likely those with chronic tendinopathies involving neovascularization, an ultrasonographic finding of increased vascular markings in musculotendinous portion of the tendon which is normally a poorly vascularized tissue.
If you are experiencing symptoms that may be related to a dextrose prolotherapy and clinically-based evidence for usage, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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