Prolotherapy Frequently Asked Questions

What is the basic idea behind prolotherapy? The basic idea behind prolotherapy is that some forms of chronic pain are actually a result of ligament or tendon weakness, and that prolotherapy strengthens the ligament or tendon—fixing the problem and alleviating the pain.

What is a ligament? A ligament is a tough piece of tissue that holds all bones together.

What is the difference between a ligament and a tendon? Ligaments hold bones together. Tendons attach muscles to bones. If you were to attach a rope to a door in order to pull it open, you would be the muscle, the rope would be the tendon, and the hinge holding the door to the wall would be the ligament.

How does ligament injury cause pain? Two basic concepts are important for understanding how ligament injury causes pain. The first is that ligaments are not designed to stretch—they are to hold bones in place. The second is that ligaments are very sensitive structures with lots of nerve endings—when they are stretched, they cause a lot of pain. When a ligament is injured and does not heal properly, it will stretch a small amount when a force is applied against it, causing the nerves to send pain signals to the brain.

So how does prolotherapy help with this? Prolotherapy involves injecting a mild irritant solution directly into the ligament attachment site, stimulating an inflammatory reaction. The inflammatory reaction calls in cells, called ‘fibroblasts’ to the site of the injection. These cells act like miniature construction workers, laying down more fibrous material in the ligament, making it strong again, so that it will not stretch and cause pain.

Are there any risks that go along with the procedure? As with all procedures, medical or otherwise, there are inherent risks to prolotherapy. There are general risks surrounding the insertion of a needle thru the skin and injection of a medicine, no matter where in the body this takes place. There are specific risks regarding where in the body the injection is done. And there are individualized risks based on the person that is injected—because we are all different individuals.

Have you ever had prolotherapy done on yourself? Yes, I have. I have had it performed on my neck, middle back, right wrist shoulder and knee. Prior to having prolotherapy I had chronic pain in all of these areas. Since having it, my pain in most areas has been approximately 90% resolved. It is ONLY because I have had such good results that I learned this procedure and desire to share it with others.

Has prolotherapy been scientifically studied? Yes. Of course that all depends on what we mean by 'scientific'! Many observational studies have shown that most individuals with chronic pain due to ligament weakness will experience 50-80% improvement in their pain. However, many of the more rigorous ‘double blind randomized placebo controlled’ studies have shown conflicting results. That is – some show benefit and some do not. The reason for this remains unclear, but most prolotherapists will point out design flaws in the studies showing no benefit. A very well known prolotherapist has recently catalogued all of the studies and scientific evidence in regard to prolotherapy, and this amounted to 2 large volumes, both about 3 inches thick.

What are the chances it will work on me? It all depends on the patient. If indeed your pain is from ligament weakness, most prolotherapists will answer by saying that, on average, around 50% of their patients will experience at least 50% improvement. Some will experience 100% improvement (even after just a few injections), but then some others experience little, if any, after many treatments. The reason for this also remains unclear. Alternatively, it is always possible that the diagnosis of ligament weakness is not the correct one and there is something else causing the pain, in which case prolotherapy will not be helpful.

How do I know if the pain is coming from ligaments and prolotherapy might help? This can only be determined by an office visit. We will sit down and talk about your pain and do an examination. If it seems that ligament weakness is a reasonable diagnosis, then prolotherapy will be offered. That being said, pain that comes from the ligament is classically described as a deep, aching pain that worsens inactivity (prolonged sitting, standing, or lying down), and is reduced with activity (walking, running, etc). The reason for this is quite simple – when we are moving, our muscles are contracting and this helps to support the ligaments (the muscles are in effect doing part of the ligaments work). When we rest, the muscles relax and all of the strain then goes onto the ligaments, which then (if they are weak) stretch and cause pain.

Will my insurance cover it? Your insurance may cover the treatment. However, we do not bill insurance companies for this service. We can, however, provide you with a receipt, which you may submit to your insurance company for reimbursement.

How much does it cost? See the Services page.

How frequently are the injections given? Injections are typically given every 4 to 6 weeks. Most patients will require 4 to 6 treatment sessions to experience substantial pain relief. Some patients notice such significant relief after a single treatment they feel no need for further treatment, and this is fine. A small number of patients will experience no improvement after the standard 4-6 sessions. In this case the likelihood of future benefit is small. However, it must be understood that some patients with severe conditions may need many treatments (i.e., more than the standard 4-6 treatment sessions) in order to improve. This would be considered if you (the patient) have severe enough pain and other clinical options have been exhausted.

What is the Hackett-Hemwall Foundation? The Hackett-Hemwall Foundation is a non-profit organization dedicated to educating physicians about prolotherapy. They have been traveling to Honduras for over 40 years and are enthusiastically welcomed back by the local government every year.