A Review of the Evidence for Regenerative Injection Therapy (Prolotherapy).
Jonas Skardis DOM, DAAPM, CNAARIP., E J of Age Management Medicine. July 2007.
“Regenerative Injection Therapy, also known as prolotherapy, is a relatively
simple, minimally invasive intervention for the rebuilding of axial and
peripheral joint connective tissue. Various substances, most prominently
dextrose, can be utilized, via injection, to stimulate regeneration of injured
and/or degenerated ligaments, tendons, and cartilage.”
“Injection Therapy for Enthesopathies Causing Axial Spine Pain and “The
Failed Back Syndrome:” A Single Blinded, Randomized and Cross-Over Study.
Wilkinson H., Pain Physician, 8: 167-176, 2005
This singe-blinded, randomized and cross-over study by a neuro-surgeon on the
staff of Mass General characterized prolotherapy as a “minimally invasive”
therapy aimed at periosteal trigger points at sites of enthesopathy. Success
rates were similar to other studies at 80%.
“Randomized Prospective Double-blind Placebo-controlled Study of Dextrose
Prolotherapy for Knee Osteoarthritis With or Without ACL Laxity.”
Reeves KD, Hassanein K, Alternative Therapies March 2000, 6(2):68-80
In concentrations greater than 10%, dextrose has long been utilized as an
osmotic shock agent – a thicker substance to burst some cells in a locale and
spill inflammatory eicosanoids and other substances. This simple act signals an
immune response that results in a 3-5 day inflammatory cascade, followed by 2-4
weeks of fibroblast activity.
“CONCLUSION: Prolotherapy injection with 10% dextrose resulted in clinically and
statistically significant improvements in knee osteoarthritis. Preliminary
blinded radiographic readings (1- year films, with 3-year total follow-up period
planned) demonstrated improvement in several measures of osteoarthritic
severity. ACL laxity, when present in these osteoarthritic patients, improved.”
“Randomized, Prospective, Placebo-controlled Double-Blind Study of Dextrose
Prolotherapy for Osteoarthritic Thumb and Finger [DIP, PIP, and
trapeziometacarpal] Joints: Evidence of Clinical Efficacy.”
Reeves KD, Hassanein K. Journal of Alternative and Complementary Medicine
“Retrospective Case Series on Patients with Chronic Spinal Pain Treated with
Hooper AR, Ding M., J of Alternative and Complementary Medicine 2004;
“Long Term Effects of DextroseProlotherapy for Anterior Cruciate Ligament
Reeves KD, Hassanein KM., Alternative Therapies May/June 2003; 9(3):58-62
“Conclusion: In patients with symptomatic anterior cruciate ligament laxity,
intermittent dextrose injection resulted in clinically and statistically
significant improvement in ACL laxity, pain, swelling, and knee range of
Note: There are several studies that conclude that prolotherapy is no
better than placebo. These are hotly debated in the prolotherapy community due
to significant design flaws in the studies.
For instance, there is a study that injected ligaments associated with leg pain
that excluded patients with leg pain from the study! Not surprisingly, it was
concluded that there was no difference between placebo overall.
Another study that is often referenced to dispute the effectiveness of
prolotherapy used a saline injection as a placebo. It is widely known that
saline injections will stimulate a healing response. Comparing two therapies
that initiate a healing response cannot be used to maintain that one of the
therapies doesn’t have an effect compared to no therapy at all. Even with this
ineffectual research, several individual markers showed that prolotherapy was up
28% more effective.