A joint injection technique to stimulate the body’s own ability to heal chronic pain, joint and other musculoskeletal ailments.
What is Prolotherapy?
Prolotherapy, also known as Regenerative Injection Therapy (RIT), is an effective technique for treating many types of joint or musculoskeletal pain. Prolotherapy is a series of injections in and around the joint structure that stimulate the body’s own mechanism to grow and strengthen joint tissues.
Why Does Prolotherapy Work?
Through the wear and tear of daily life or acute trauma, ligaments and tendons surrounding joints are often stretched. This causes joint instability and improper movement of the joint structure. Over time, this improper movement leads to joint degeneration and subsequent pain. Prolotherapy addresses the cause of this pain by strengthening the surrounding ligamentous structure and restoring joint stability.
What is PRP?
PRP stands for Platelet Rich Plasma and is an advanced form of prolotherapy. Given that the goal of prolotherapy is to stimulate the body’s ability to heal, PRP is a way to accelerate this process. Rather than using a dextrose solution that triggers the body to heal the joint, PRP uses a concentrate of the patient’s own blood that is injected back into the joint. This concentrate contains a high amount of platelets and other growth factors in the blood which can provide a more accelerated healing process.
Conditions Treated with Prolotherapy
• Tennis Elbow
• Knee Pain
• Hip Pain
• Golfer’s Elbow
• ACL/PCL Injury
• Frozen Shoulder
• Rotator Cuff
• Thumb, Wrist, & Hand Pain
• Shoulder Pain
• Ankle Sprain
• Foot Pain
• OA of the Knee
• Thrower’s Elbow
• Plantar Fasciitis
• Patients wanting to avoid joint surgery
Is Prolo For Me?
If you have any type of unresolved joint pain, Prolo is worth considering. Through a history and physical exam, Dr. Wilkinson can make an appropriate assessment.
What is in the Prolo Solution?
The primary ingredient is dextrose (glucose) to stimulate tissue healing. This is combined with an anesthetic such as lidocaine, and other ingredients to stimulate tissue growth such as vitamin B12 or glucosamine.
How does Prolo Work?
The dextrose acts as an irritant to localized ligaments, tendons, and joint capsule. This stimulates blood flow and release of growth factors that synthesize joint collagen. This starts a process of soft tissue remodeling and strengthening of the joint structure.
How is PRP Different from Regular Prolotherapy?
Regular prolotherapy uses a dextrose solution to stimulate the healing. PRP uses the patient’s own blood to provide these healing factors directly to the tissue. This typically allows for a stronger and quicker healing response.
How is the PRP Solution Prepared?
When a patient comes in for a PRP treatment, first their blood is drawn. The amount of blood drawn depends on the size and number of joints treated, but is typically 30-75 cc (5-10 tubes). The patient’s blood is then spun in a special centrifuge for 10 minutes which separates the blood into layers. After spinning, the tubes are taken to a sterile hood where Dr. Wilkinson manually pipettes the layer of blood that is rich in platelets. For every 10 cc of blood there is about 0.5 – 1.0 cc of this platelet rich layer. This layer is collected from all the individual blood draw tubes to form the PRP solution. This PRP solution is injected into the joint. This prep process takes ~1 hour prior to the actual PRP injection procedure. Patients typically wait in the Arthritis Health lobby during this time.
How Do You Choose to do Regular Prolo vs. PRP?
Because PRP requires extra time for the blood draw, centrifuge, and preparation, it costs more. For most patients (>75%), regular dextrose prolotherapy is sufficient. However, if a patient does not get a satisfactory response after a couple of regular prolo treatments, PRP is the next option. Additionally, if the joint pain is more severe and/or the patient wants relief faster, PRP can always be chosen first. Because PRP accelerates the process, patients will often require 1-2 fewer total treatments when compared to regular dextrose. Note – Because of the special centrifuge and sterile hood for PRP preparation, Dr. Wilkinson only does PRP at the Arthritis Health office in Scottsdale.
Why don’t Tissues Heal on their Own?
First, ligaments and tendons have poor blood supply which limits the body’s ability to bring in healing nutrients. Second, when people have chronic joint pain, they often use NSAIDs such as ibuprofen that relieve pain, but inhibit the body’s normal healing process.
Is Prolo similar to Steroid Injections?
No. Steroid injections stop an acute inflammatory process. Unfortunately, if used long term, steroids can weaken joint tissue. Prolotherapy stimulates the body’s own healing mechanisms to restore joint integrity.
How Many Treatments are Needed?
Treatments are typically done 1-3 weeks apart. Even though some patients can experience significant benefit after a single treatment, full healing typically requires 3 to 6 treatments. PRP typically requires 2-4 treatments.
Does Prolotherapy Hurt?
Prolotherapy is an injection technique so there is some discomfort. However, a small gauge needle is used to minimize pain. When the prolo solution is injected there is often a feeling of fullness to the joint. After treatment, most patients state the treatment was less painful than they anticipated. For 1-3 days after treatment there can be some achiness to the joint as the healing process begins. With PRP, because the healing process is accelerated with the platelets injected directly into the joint, this 1-3 days of achiness can be a bit stronger.
Is Prolotherapy Safe?
Yes. Prolotherapy was developed in the 1930’s and has been administered safely to hundreds of thousands of patients by MDs, DOs and NDs. However, since this is an injection procedure, prolotherapy has the same risks of any medical procedure using needles. These risks are kept to a minimum by adhering to standard sterility and needling techniques.
Articles on Prolotherapy
Simple Explanations – Patient Friendly
A simple explanation of Prolotherapy that appeared in the NY Times – Prolo Basics NY Times
Another basic explanation of Prolotherapy written by a physician specializing in Prolo – Prolo Basics
INM Prolotherapy Brochure (similar to info above, but in a pdf that is easy to print) – INM Prolotherapy Brochure
Former US Surgeon General C. Everett Koop, MD Endorses Prolotherapy – Dr. Koop
An article about Prolotherapy that appeared in the Mayo Clinic patient newsletter – Prolo at Mayo
A review of evidence and studies showing the benefit of Prolotherapy – Evidence for Prolo
A good review of Prolotherapy – Sweet Relief by Dean Reeves, MD – Prolo Sweet Relief
Technical Explanations – for patients that want a deeper understanding of the science of ProlotherapyProlotherapy for Knee Pain by Donna Alderman, DO – Prolo for Knee Pain
Prolotherapy for Back Pain by Donna Alderman, DO – Prolo for Back Pain
A technical explanation of the physiology of Prolotherapy by Dean Reeves, MD – Prolo Physiology
Prolotherapy in Sports Medicine by Dean Reeves, MD et.al. – Prolo in Sports Medicine
Prolotherapy for Musculoskeletal Pain by Donna Alderman, DO – Prolo Musculoskeletal Pain
Knee Instability – 72 yo female
About 25 years ago I injured my knee while skiing. Ever since then my knee has not felt right. As I grew older my knee became unstable and felt like it waffled if I stepped on it wrong. I increasingly felt like I would fall if I wasn’t careful how I moved my knee. I went in to see Dr. Wilkinson and he told me he thought prolotherapy would help. I had 3 treatments over about 2 months and nearly all the weakness and instability of my knee is gone. I have gone in for an additional treatment about every 6 months and my knee continues to feel good. Thanks to Dr. Wilkinson I am moving with ease.
Thank You Dr. Wilkinson!!!
San Jose, CA
TMJ Pain – 23 yo female
I have been suffering with TMJ for 10 years. I have seen a dentist that prescribed a night guard, which I wore every night with little to no results. After chatting with Dr. Wilkinson and explaining to him my situation, he thought that prolotherapy would greatly improve my pain. I was hesitant at first, because I am terrified of needles, but after thinking about it I realized I had no other options and nothing to lose. Getting over my fear was the best decision I could have made! I felt an improvement after the first treatment and after three my life has considerably changed. Thanks to Dr. Wilkinson I currently have much less pain in my jaw and vastly fewer migraines.
Chronic Elbow Pain – 38 yo male
Prolotherapy with Dr. Wilkinson provided greater than 80% relief in my chronic elbow pain from sports injuries.
Chronic Back Pain – 48 yo female
I injured by back water skiing many years ago and have had nagging pain in the middle of my back ever since the accident. I was a bit hesitant about needles and prolotherapy when Dr. Wilkinson recommended it, but I gave it a try. Wow!!, was I amazed. After a single treatment my back pain is completely gone.
Thank you Dr. Wilkinson, your prolotherapy treatment has been wonderful!