Prolotherapy

I came upon the subject of prolotherapy almost a year ago when I was still in school studying occupational therapy. I had a patient with subluxation of the shoulder – a common side effect in stroke where the weight of the arm without appropriate muscle tone pulls the shoulder joint out of alignment – and my preceptor and I were looking for exercises or activities that this patient could do after discharge from the hospital. As a first step, I did a Google search for “treatment shoulder subluxation” and the first page I saw was for prolotherapy: blind to its limitations and better than everything else ever. That’s a formula for win! Right?

What is prolotherapy
Prolotherapy, in a nutshell, is the practice of injecting an irritant solution (usually containing dextrose, cod liver oil, phenol, glycerine, or lidocaine) into ligaments and joints to induce an inflammatory response that’s supposed to tighten the joint and stimulate tissue growth. Prolotherapy was originally popularized by Gustav Hemwall for ankle, knee, elbow, and lower back pain. Notice that none of these are complex joints (hips, shoulder) – more on that later. But what’s good for one thing is, of course, good for everything else. Right?

Prolotherapy is available in some naturopathy clinics (for example), but so far is not considered a mainstream treatment for joint pain. It is notable that although the concept of injecting irritants for healing has been researched since the 1950s, there have been no significant advances since the early 90s – around the time that the main proponent of the therapy retired. As a result, prolotherapy is not covered by most health insurance companies.

Evidence
According to the wiki for prolotherapy, there are some clinical trials underway. As for available publications, searches for “prolotherapy subluxation”, “prolotherapy shoulder”, and “prolotherapy stroke” on PubMed each returned no results. A search for “prolotherapy” returned 61 results (18 of which were reviews). Most articles were about lower back pain, a few were about other topics – mostly epicondylitis, groin pain, foot pain, and chronic pain. None were about ball-socket joints (hip and shoulder), which is significant because these 360-degree joints may not respond to prolotherapy in the same way as other joints due to the complex arrangement and number of ligaments. Based on what was available on PubMed, prolotherapy studies so far are of poor clinical quality (missing control groups, lacking appropriate variable control, using other therapies in conjunction, etc.) and results tended to get less promising as study design improved.

I also searched Cochrane Reviews and found two results. Both focused on lower back pain and the results weren’t thrilling. One described conflicting evidence due to clinical heterogeneity and the presence of co-interventions, concluding that prolotherapy was not effective as a lone treatment. The other (a more general review of injection therapy) concluded that there was insufficient evidence to support the use of injection therapy for back pain. So even the intended use of the therapy (back pain) is questionably effective, leading me to seriously question extrapolating to other conditions like shoulder subluxation.

In sum, the research regarding prolotherapy for shoulder pain is nil and, in my opinion, it’s inappropriate to promote prolotherapy for shoulders without researching that specific application. In fact the only “evidence” I could find regarding shoulder pain were testimonials from pro-prolotherapy sites. But that doesn’t stop them from making some fantastic claims.

Claims
The attractive public websites accessible via Google (I discuss the top results below), assure me that prolotherapy is awesome. Caring Medical (Illinois, USA) is #1 after a search for “shoulder subluxation”. Vancouver’s “Dr.” Hal Brown (who isn’t on this list of prolotherapy “doctors” – the only Canadian listed is a different naturopath) appears in the top 10 for “prolotherapy”.

Remember how I just demonstrated that research on shoulders and hips was lacking and there was some research on various joint pain conditions, but that most research focused on back pain? It may surprise you to find out, then, that according to these sites, prolotherapy is 85% effective in the treatment of everything:

Hip pain [??], knee pain, ankle pain, foot pain, wrist pain, elbow pain, shoulder pain [??], headaches [how?], TMJ (jaw) pain, post-injury/trauma pain, fibromyalgia, myofascial conditions, sports injuries, loose joints, tendonitis, post fracture treatment, rib pain, and more. In fact any joint, ligament or muscle tendon in the body that is experiencing pain can be treated with prolotherapy. [ref] I also saw carpal tunnel syndrome [makes no sense given that median nerve pain is caused by compression under the transverse carpal ligament], osteoarthritis, migraines, RSD pain, sciatica, herniated discs, degenerated discs, degenerated joints, chondromalacia patellae, Osgood-Schlatter disease, ligament sprains, plantar fasciitis, back pain, neck pain, hand pain, finger pain, and toe pain. [ref] Also arthritis. [ref]

That is unprecedented versatility. Or we could consider the research and conclude responsibly that these benefits are greatly exaggerated and the risks are overly downplayed. The promotional websites ignore other treatments or describe them incorrectly (including some scare-mongering about surgery). These claims are irresponsible and not objective.

Examples of bold, unsupported, misleading statements:

  • Prolotherapy offers the most curative results in treating chronic pain” and “Nearly all pain conditions can be successfully treated with Prolotherapy” following some deviously-worded and, in some cases, incorrect information about pain treatments in general. [ref]
  • Another standard practice of modern medicine is to inject steroids or to prescribe anti-inflammatory medications. However, in the long run, these treatments do more damage than good. … Plus, long-term use of these drugs can lead to other sources of chronic pain, allergies and leaky gut syndrome.[ref]
  • When all else fails, patients who experience chronic pain as a result of shoulder subluxation may be referred to a surgeon. Unfortunately, surgery often makes the problem worse. [ref]
  • A better approach is to strengthen the ligamentous and shoulder capsular structures with Prolotherapy. In fact, shoulder subluxation or instability is one of the easiest conditions to treat with Prolotherapy. … The safest and most effective natural medicine treatment for repairing tendon, ligament and cartilage damage is Prolotherapy. … Prolotherapy offers the most curative results in treating chronic pain. It effectively eliminates pain because it attacks the source: the fibro-osseous junction, an area rich in sensory nerves. What’s more, the tissue strengthening and pain relief stimulated by Prolotherapy is permanent! [ref]

I find it telling that, rather than provide a list of peer-reviewed references to support their rather bold statements, they poison the well for other treatments, exaggerate their own benefits, and link to case reports and testimonials rather than peer-reviewed research. They have no basis upon which to make such bold claims for the treatment of shoulder pain – because there’s no research to support them. The mere possibility of effectiveness absolutely does not justify misleading people about other available therapies or exaggerating the supposed benefits of prolotherapy.

Why this is irresponsible

Caring Medical (as an example) charges $250 per shoulder for each treatment – given every 2-6 weeks until symptoms improve. Charging people huge sums of money for case-”supported” try-out treatments used to be called snake oil. Now it’s offered in health clinics. Apparently the thinking is “prolotherapy kinda works for X, so why not everything else?” This lazy science the only way I can explain these unsupported claims without assuming skulduggery.

Using a therapy for everything despite lacking research ignores basic anatomy and the differences between the types of joints. Consider the difficulty associated with injecting substances into the many tiny ligaments (of which some may be lax and some not – how do they test this?) of a ball-socket joint like the shoulder vs. a hinge joint like the elbow – these differences are important and need independent research, not assumptions:

Exaggerations confuse “consumers” about medical treatments, how science works, and how medical treatments are investigated and tested (e.g., the meaning and significance of clinical trials). It’s hard enough for patients to sift through all of the medical information relevant to their situation, let alone to pick out objective options when people are trying to sell them something. Irresponsible claims can cause strife where there needn’t be if grand promises of relief fail to come true.

I suppose the allure of being the sole proprietors of “the” treatment for X is hard for some people to resist. But when we’re talking about people’s health (and in the case of athletes, their jobs too) and pain, we’d better be sure. Their zeal wastes my time as a professional and has the potential to affect patient care if they are convincing enough to fool people who do not have the necessary training to interpret the science.

It’s hard for professionals to sift through the chaff with their limited time and large caseloads. We do it, of course, because it’s our job to ensure patient safety and a high quality of care, but it does add needless stress. It’s much easier to evaluate the merits of a treatment when the information about it is honest and supported by evidence.

Take home
If prolotherapy has weight to it, great, but those who promote prolotherapy don’t say “this a treatment that is currently gathering evidence that might work for you and here are our sources so far”, they say “traditional treatments will hurt you so you should do this”. Evidence? What’s that? I take issue with these misleading methods because these therapies are expensive, carry unacknowledged risks (infection, etc), and are not science-based.

Generally, and especially in medicine, if something sounds too good to be true (promoted vociferously without objectively acknowledging caveats), it probably is. There are always pros and cons that need to be considered – maybe sometimes more of one than the other, but both must be verified carefully with evidence. Ignoring information for the sake of promotion is not responsible medicine – so I must conclude that prolotherapy is not responsible medicine.

I won’t recommend an invasive treatment on a patient that at worst could cause harm and at best could do nothing when there are other available science-based methods. If there’s no evidence either way, I’ll try something low risk, but in this case there are acceptable alternatives. Given the current evidence, I would not recommend prolotherapy for shoulder subluxation, nor should anyone else until there is research to back it up.

*The opinions in this article reflect that of the author only and do not necessarily represent the views of employers, regulatory bodies, or professional associations. The author strives to promote science-based health care in all fields and advocates for a client’s right to honesty.

36 Responses to “Prolotherapy”

  1. Lee says:

    I disagree with the article. I am a beneficiary of this treatment for various arthritis pains in my left knee, finger joint, for bursitis, etc., and it did work very well. It's true that Dr. Hauser's fees are kind of high, and I told his this. However, everybody can charge whatever he/she wants, as long as there are people willing to pay for. I found other doctors in Detroit area, willing to charge a decent price. I am going to continue this treatment for other locations. As you know, the older you get, the more pains and aches you have in various joints. I definitely advice people to try, perhaps discuss with the doctor the fees, including potential discounts, since the treatment is not complicated or requires hospitalization or rest.

  2. Kimberly Hebert says:

    I take issue with the generalization of poor quality back pain research to the shoulder and other joints. In my opinion, it's inappropriate to charge patients hundreds of dollars for something that has no evidence of efficacy (i.e., shoulder treatment). They are skipping important steps in efficacy research.

  3. Walter says:

    Thank you for this information. Does this mean steroid injections are the way to go for shoulder (rotator cuff) injuries?

    • Satisfied says:

      Steroids leave scar tissue. Eventually scar tissue screws up your rotator cuff. Find an ART guy — active release technique.

  4. Broken Heart says:

    Just would like to share with you my painful experience going thru the Prolotherapy injs, I was injured from fell down the stair, I continue to work but my ft kept hurting then i finally met a doctor who perform the procedures, he told me it will be min of 6 to7 sessions & each session he inj my rt ankle /ft which already diag with RSD. I went to work after the injs & slowly my pain get even worse it went all the way to my whole rt side even my head felt like a balloon going to blow up i dtop the inj but my cond went from my rt side to my lt side of my body it hurts so bad. At times I would like to end my life!Hope no one will end up like me!

  5. Satisfied says:

    Prolotherapy saved my knees. It didn’t work on my shoulder. I will try it again as my lower back worsens. It involves no pain and is worth the cost considering how well it works.

    • Nick says:

      How long have your knees been ok after prolotherapy? Was it performed by Dr. Hauser. Thanks in advance.

  6. G. Mack Bentley says:

    Prolotherapy has totally turned my life around. I had constant lower back pain for over 20 years. After 7 doctor visits for prolotherapy my life has been changed forever. I’m honestly totally pain free for the first time in over 20 years.
    The only negative comments I have ever heard have all come from those that are ignorant of prolotherapy and it’s success rates. Shall I round up a couple of thousand people that will tell you the same thing?

  7. Robert says:

    I disagree with the article. After having frozen shoulder with impingement, and tendinosis in various parts of the rotator cuff my shoulder was in constant pain and effectively useless. Physical therapy as prescribed by an orthopedic surgeon only made the shoulder worse. I was scheduled for surgery then I had second thoughts and cancelled the surgery. Then I tried prolotherapy to the shoulder. After 6 prolo sessions I began to see a marked improvement. Today the shoulder is 95% healed and fully functional. I am back on the golf course without pain. Conventional medicine had no answers and prolotherapy definitely worked for me.

    • Kim Hebert says:

      I hope you can appreciate why personal anecdotes aren’t evidence that something works. What about the people who tried prolotherapy and it didn’t work? Or worse, what about people who tried it and developed complications such as infection? I’m glad that your injury healed, but it’s unclear whether your injury healed as a result of prolotherapy or whether you feel better due to time or perhaps the placebo effect. Your personal anecdote is not evidence enough for someone else to try this therapy because there is no reason for them to trust it over an anecdote with a negative outcome. Because anecdotes could go either way, it’s better to rely on objective evidence.

      As I said in the article, I will gladly change my mind regarding my perception of this therapy, if given the appropriate objective evidence. But so far the evidence has been inadequate. I don’t think that position is unreasonable, given the circumstances.

  8. Marianne says:

    Thank you for your article and analysis. I thought “snake oil” too after my experience with a doctor who was promoting prolotherapy. The claims for cures were based on videos of anecdotal evidence – an easy way to sway people into believing of a miracle cure. But without proper scientific studies, these claims are at the least self serving and at the worst, bad medicine.

  9. Hypermobile says:

    Kim – what is your recommendation for someone who has congenital hypermobility/ligament laxity, is 46 years old, and is experiencing sever pains in both shoulders, so much that it wakes me up in the middle of the night. My shoulders constantly dislocate when I sleep and I shift from side to side all night. Overhead motions are near impossible. I tried PT with little to no results. I do not want surgery as my Ortho says its a temporary fix and the ligaments will go loose again over time. Prolotherapy seemed like an alternative, but I, like you, am skeptical and do not want to waste the time and money, much less risk infection or complications. What are the options?

    • Kim Hebert says:

      I cannot provide therapeutic advice as I have not met or examined you, so what I will suggest is that you discuss your options with your family doctor or physiotherapist and weigh the long term pros and cons carefully. Two gaping cons for prolotherapy as an option is the lack of robust supporting evidence and heavy promotion from a single proprietary source. Those are never a good sign, especially when combined. Sorry I could not be of more help.

  10. Hernan Flores says:

    I found the article very superficial, partial and provocative. Maybe Mr Hebert should contact the Hackett-Hemwall Foundation or the AAOM and see all the scientific info and the benefits of Prolotherapy in trained hands, a Certified MD or DO.

  11. Russell says:

    I am scheduled for minimally invasive hip replacement next Friday ( 1-27-12 ). One of my customers, who is a chiropractor, has urged me to seek prolotherapy treatment. MY chiropractor says that it is worthless and will provide temporary relief at best. A local guy who holds an MD as well as being a chiropractor heavily promotes his practice as a ” vitamin coach ” and natural healing center. They charge $450 per session for hip injections! Having a science background, I concur with your thoughts on the lack of significant trial evidence and heavy promotion. Just out of curiosity, do they claim any success with hips? These guys always say that surgery does more harm than good. I have TWO shoulders that have had cuff repairs and at 62 I am 100%– back to all work, workouts, etc. My wife had spinal fusion and correction for spinal stinosis in August and is 100% back to walking half-marathons! Rgn

    • Kim Hebert says:

      Its unfortunate that they feel they have to undermine surgery in order to sell prolotherapy. Surgery has its risks, certainly, but its not the monsterous hacking of tissues that they apparently would have potential customers believe.

      I didn’t see hip claims while I was looking into this. There may be less “success” with hips if they’ve tried it, compared to shoulders, given that a hip is a fully weight-bearing joint.

  12. lulu says:

    It seems that reputable medical establishments would run reputable scientific studies to clarify this topic if there is any reason whatsoever to believe that it is a viable treatment. I am trying to figure out any subversive reason to undermine the validity of this treatment and can not. As a resut, I find it difficult to know why the medical establishment has not yet put it on their direct agenda. New drugs come out every day, many of which have questionable efficacy with some being downright dangerous. This is puzzling or I am missing something in this equation? My wonder after 3 treatments is whether or not improvement is due to time as opposed to the prolotherapy.

  13. Mike says:

    I have had pain in my right wrist for a couple of years. I had a steroid injection, which worked well. Except it only lasted a few months. I have tried other modalities such as laser therapy, ultra sound, electrical stim. None of these did much. I have now undergone 3 prolotherapy treatments over the past 6 weeks. So far there is no improvement at all. My doctor is telling me that it takes at least 4 – 6 treatments to know if it will work for me. At this point, with no improvement after 3 treatments, I’m not very hopeful.

  14. Deb W says:

    Thank you Kim for your article. I have become so desperate to get rid of the pain in my knees that I have been scouring the internet looking at options and I came across prolotherapy recently. I am always a little cautious with self promotion and testimontials to “sell” something, in this case a treatment. It was good to come across an article which has now given me a balance of counter issues to allow me to consider my options more openly.

  15. Diane says:

    Thanks for the objective, scientific discussion of this therapy.
    It is much appreciated.

  16. richard says:

    have had prolo many places – always helps-thumbs usable no pain- plantar faciatis
    2 treatments gone standard treatment did not work.elbow- can now use a hammer
    nerve pain down arms –c5 disc gone–better in 12 hours still have some but it is
    not bad.–foot pins and needles better after 1 treatment i can live with the level of
    discomfort — had 5 more treatments . also hips which tended to dislocate seem ok
    now–both shoulders severe arthritis helps now usable– spring ligament in foot
    ok now . bottom line prolo strengthens ligaments and tendons. i am 75 and other
    treatments do nothing. that includes ART. tennis elbow little better. prolo is cheap
    verses the knife– pills are bad . best therapy ive found. arod and kobe bryant went
    to germany for prp prolo many pro athletes have it done-see ny times article- what else is there?

  17. Dave says:

    Kim, your article is very interesting. I have been trying to learn more about the research and scientific evidence behind prolotherapy myself. I was recommended to try it by a very good doctor who has seen success (he did not do the treatment).

    For me, it has helped but not “fixed” a knee with osteoarthritis, it really help a strained wrist, and I’m now trying it on my shoulder.

    I don’t disagree with your conclusion, but I challenge the concept in medicine of scientific evidence. Most of the research in medicine is directed to follow the money. Prolotherapy is not a highly profitable business (like orthopedic survey and implants), therefore there is little economic reason to perform large studies. If you look at something like back fusions performed in real hospitals at high rates for a long time, they have been extremely unsuccessful but the surgeons and device companies have made a fortune doing them.

    My point isn’t that prolotherapy works or is proven. But it is very important to follow the money when studying research. Research is sadly driven more for economic reasons (profit) than it is for patient outcomes. When is the last time that you saw a hospital or surgeon follow their patients to measure outcomes?

    Prolotherapy is one of many options. In reality, the infection risks and side-effects are very low and it is a cheaper and easier option than surgery. I’ve had a few knee surgeries and I wish I would have tried prolotherapy first.

    My prediction? We will eventually find ways for the body to heal itself (such as the stem cell work being done in Colorado). Prolotherapy is a crude form of this.

    My advice for anyone wanting to try prolotherapy? First make sure the doctor has done it for a long time and has solid references. Second understand it is an alternative approach and may well not help you. If one or two treatments do not help, then save your money. But also be cautious of the surgeon who just wants to cut. Surgery should be the last option.

    • Kim Hebert says:

      Economic reason? I would hope that ethics would be enough of a reason to gather enough evidence to properly justify an invasive medical treatment, but hey, to each his/her own.

    • Jason says:

      I would agree with the old adage that when the only tool you have is a hammer all the problems you see are nails, and that surgeons may fall victim to this mentality at times ….. all the problems are solved by surgeon. However, my skin just crawls all the times when I hear the drool and what I consider almost immoral argument that relies on the greed function when it comes to medical treatment, research, surgeons, big pharma. et al. Brrrrrr.

      How blessed we are to stand upon the shoulders of giants before us and criticize the very foundation on which we stand. Regarding the nature to slam medical science in relation to corruption and greed I would love to read more and if anyone has any good material they think would be interesting, I would love to hear from you.

  18. Dave says:

    I’m a bit surprised that in a skeptical-based post, that there is no questioning of our modern medicine and ethical behavior by surgeons.

    I’m sure you may think I’m a random wing nut from the Internet, but in truth I work for an insurance company and have years of data and research. A few cases in point.

    1. Back fusions – we have proof of surgeons who do back fusions even though evidence now shows they not only usually do not work, they actually worsen the future for the patient. This is based on studying outcomes and following patients for 20+ years. We can show specific doctors who continue to do fusions while many others have pulled back. All this while studies continue to come out showing the bad outcomes from fusions.

    2. Pharmaceutical companies continue to play games with medications to fend off generics. This is usually a minor tweak that allows them to re-patent and announce a new and improved version that is really no better than the first generation of the drug. I’ll also reference the Vioxx/NSAID issues back in 2004 which caused a number of medications to be pulled from the market (Merck sold $2.5B in Vioxx the previous year). Note that previous to this, our own internal data showed little improvement from Ibuprofen to Vioxx/similar NSAIDs in most patient outcomes.

    3. I have plenty of other examples. Happy to provide them.

    All that said, I truly believe that the MAJORITY of medical providers are solid and ethical people, trying to do the right thing. They are caught up in a system that is difficult to work in with ever more difficult patients. Ditto for most of the medical companies out there.

    Now a true skeptic would also question the motives of insurers. Fair enough argument and in many cases warranted. I’m fortunate that our drive is outcomes of insureds. I would agree that there are many insurers that only make matters worse.

    Which takes me back to prolotherapy (our original topic). Again, I’m not arguing pro or against it. But it is very difficult for a multi-million dollar studies to occur (with private funding), there just isn’t the profit potential to cover the cost. Prolotherapy uses cheap off the shelf items. I’m sure we will see more research in advanced areas like stem cell treatments. Where am I skeptical about prolotherapy (even though I’ve used it) — are the providers who do it selling snake oil?

    What changed my opinion a bit is work done by Mayo Clinic (yes they offer prolotherapy) and the University of Wisconsin who not only teaches it, but is also in the middle of a large study. Here is an article that discusses it –both pros and cons:

    http://online.wsj.com/article/SB10001424052702304410504575560214236534310.html

    Finally for the person who suggested I was slamming “science”. Science is a pretty loose term. We have modern western medicine and also what is still practiced in other countries. Chinese medicine continues to have an active following and sure wouldn’t qualify much as science.

    Kim my point in responding was to generate discussion. I think we are similar in that we agree that following the data is a great tool for evaluating treatments. My original post wasn’t specific enough and I should have opened more of a discussion.

    • Kim Hebert says:

      You didn’t see me address those things in detail because that’s not what the article was about. There are many issues with the medical system, but none of those issues make prolotherapy an effective treatment for shoulders.

  19. richard says:

    left shoulder dislocated 40 years ago. also have moderate arthritis . sleeping on it
    would cause pain in morning. I would stand on me left hand and pull it out then ok.
    had prolo — no more problem. also cuff pain — when palpatated–had prolo with
    ultrasound– almost gone. if problems relate to ligaments and tendons prolo is very
    effective. it probably will not make you like new– but what will. who said bad medical
    system made prolo good. straw man i think. in a relative sense vs standard medical
    practice it is far better because it treats the cause. do doctors hype it– yes. for many
    problems there is nothing else. low back pain can have more than one cause–
    prolo is not a cure all and should not be given for the wrong reason. that mayo study
    opinion– loose logic. go talk to people that have been treated. much good done.

  20. cliff says:

    After seeing 10 practitioners for loose ligaments and crushed bersa resulting in an inability to walk for prolonged periods of time, including 3 chiropractors, 2 medical doctors, several accupuncturists, a herbalist and a naturopath have found nothing else to give long lasting results, have certainly gotten benifits from nutritional, herbal protocols and relief from adjustments

  21. cliff says:

    But nothing has afforded actual healing and relief until prolo injection. This joker can keep going with his half ass internet research but results speak for themselves

    • Kim Hebert says:

      This joker is a she who can read scientific literature reviews and did not go to Google University. Neither my research, nor that of the scientists who have published on the subject, were half-assed. The conclusions just don’t happen to match yours.

  22. TL says:

    I am pretty sure I have had more prolotherapy than anyone on the planet and it absolutely gave me my life back. It’s very upsetting to me that a significant number of people could greatly improve their life with this treatment (less pain, more mobility) and yet the medical community refuses to properly understand it (not covered by insurance so it’s ignored)
    I have laxity problems in every part of my body. Like some, my Ehlers Danlos symptoms didn’t start until my early 30s and then kept increasing (4 months away from wheelchair). No drs could ever diagnose me as I didn’t present typical EDS – only symptom was extreme muscle tension/spasm (my body trying to stabilize ligament laxity). However, based on my symptoms I embraced every possible option for years and years: PT (many types traditional and alternative), body work / muscle release, chiropractic (which was the worst thing I could have done), acupuncture, Chinese medicine, supplements, you name it. Over time each provided temporary relief at best and I just kept getting worse.
    Thank God I finally found prolotherapy because it gave me my life back (areas treated: shoulders, elbows, ribs, neck, hips, knees, feet, SI, spine, jaw). Initial treatments brought the pain down, and continued treatments improved my joint mobility (muscles finally released). I have been treated by several outstanding prolotherapists in the NY area and each definitely has their own style/technique. So I know for a fact that not all prolotherapy is the same. Based on my experience (and others I know), I suggest the following for the best results:
    (1) Pick a highly experienced dr. that focuses specifically on injection based pain management treatments. Experienced prolotherapists understand the need to target multiple structures (tendons, ligaments, trigger points) over the entire area – and not one large dump into a joint (i.e. orthopedic surgeons doing PRP). I don’t have disc problems, but I was told for the best results you treat the areas above and below the problem disc as well. Only experienced prolotherapists would understand this.
    (2) Only go to drs who use imaging. Fluoroscope was great for certain areas (knees) and ultrasound for others (to avoid nerves – sacroiliac/glutes, spine, neck). Since I get injected often, I now stick to ultrasound to avoid radiation.
    (3) Ultrasound lets the dr. see the condition of the tissue which helps target the damaged areas. This also gives you an opportunity to ask questions and get more information about your particular problem. What do you see? Is it inflamed? Does the tissue/fiber look damaged/shredded/thinned/stretched? Is the joint space wide?
    (4) Poke around on the area yourself because tender spots indicate problem spots. Based on these tender spots, I actually mark myself up with a pen before appointments to better help the dr. target the problem spots.
    Because of EDS, I had tight, wasted muscles and I looked like a skeleton. You could practically put a finger through my shoulder. When I started prolotherapy, the injection needles went right into my joints with absolutely no resistance – including shoulder and hip capsule. Over time this has changed. The dr. can see it in the imaging (big gaps in multiple shoulder structures are gone, capsule is tighter, inflammation gone) and most importantly I can see it in my stronger healthy muscles and increased range of motion (almost fully restored). Also, neck instability which caused neuro problems – now gone. I can kneel, I can squat, I could go on and on. I realize that I will need maintenance injections going forward, but the worst of my problems are behind me. I know others with hypermobility (as well as those with other joint issues/conditions/diseases) and they have had similar results.
    One of my drs. often had other drs/surgeons from a nearby hospital observing during treatment (not to train but to educate). Twice I heard these observing drs. say to my dr. “You get consistently higher results than we do. Which is even more impressive, because you get the problem people that no others drs. could help”.
    In speaking to others, I have learned that prolo works well on most but some do better with PRP (platelet rich plasma) and others a combo of the two. And yet some may get no results and some may still need surgery – it all depends on the specific condition. But unfortunately there is no way to know until you try it. Making a statement that prolotherapy does not work based on inadequate and most likely bad research is wrong – even more so when empirical evidence clearly suggest otherwise. Maybe go speak to some patients yourself or better yet go to a drs office and observe.

    • Kim Hebert says:

      Yes, how dare the medical community insist upon proof before injecting people with things and taking their money. We should let people inject patients with whatever they want, lack of justifiable evidence be damned.

      I’m glad you found relief, but please don’t throw people under the bus whose job is it to protect the public just because of a disagreement between personal experience and reasonable skepticism.

  23. TL says:

    YObviously you are only interested in the very limited available research. You (and the medical community in general) refuse to understand that it depends on the specific condition being treated(not a cure all for All pain) as well as the prolotherapists injection technique. You certainly aren’t interested in speaking to any patients who are significantly better.

    • Art Tricque says:

      You say above “and most likely bad research is wrong – even more so when empirical evidence clearly suggest otherwise.” Speaking to patients who have undergone the treatment is collecting anecdotes / case reports, it is not empirical research. Without proper research, how do you know you aren’t consigning the folks whom you counsel to try the “therapy” to further injury, pain or worse?

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  • Kim Hebert

    Kim Hébert is an occupational therapist. She is interested in the promotion of science and reason, particularly regarding therapeutic health interventions. She blogs occasionally about occupational therapy and other health topics at Science-Based Therapy. Her hobbies are art and astronomy. **All views expressed by Kim are her personal views alone, and do not necessarily reflect the opinions of current or former employers, associations, or other affiliations. All information is provided for discussion purposes only, and should not be used as a replacement for consultation with a licensed and accredited health professional.