A growing number of victims of car accidents and sports injuries, as well as sufferers of chronic pain caused by injury to ligaments and tendons, are being healed by a medical technique called prolotherapy.

The treatment is not new — primitive versions of prolotherapy were used in the late 1800s — but it is finding new applications as baby boomers seek to prolong their active years. Prolotherapy involves injecting into the affected area a solution that stimulates the body’s natural healing response. Many suffering from back pain, disappointed by the short-term effectiveness of therapies such as chiropractic treatment, acupuncture, physiotherapy and massage, are finding prolotherapy can bring about a permanent cure as it triggers the regeneration of damaged tissue and rebuilds support for unstable joints.

Prolotherapy can be used to heal injuries in a wide variety of body parts, from jaw to toe. Such stubborn ailments as a sprained ankle, tendonitis, damaged knee ligaments, sciatica, carpal tunnel syndrome, tennis elbow and a torn rotator cuff may respond well to prolotherapy, so the patient often can avoid surgery.

“A lot of people could benefit from prolotherapy to heal their injuries,” says Mark Tsai, director of Woodbine Physiotherapy in Markham, Ont. “The problem is that they and their health practitioners don’t know about it. When the pain is due to a joint instability problem, prolotherapy is highly effective.”

Prolotherapy takes its name from its ability to produce cellular “proliferation.” It works by producing an inflammation response in the injected area, which then triggers the body’s natural healing mechanism — including the production of collagen, a healing protein that is naturally incorporated into tendons and ligaments, making them thicker, stronger and more elastic. The body increases the blood supply to the area, and several types of growth factors that repair and rebuild the injured area are released over a period of several months, restoring tautness and support to weak tissue.

Ligaments and tendons are the support systems or “stays” that hold bone to bone or attach muscle to bone. They have little elasticity and poor blood supply. And when they are torn or weakened due to injury, trauma, or wear and tear, they have difficulty healing and often lose their strength. Injured or weakened ligaments and tendons are therefore unable to maintain joint stability, which can lead to abnormal motion of the joints, resulting in problems such as arthritis and muscle spasms in the surrounding area as the body attempts to compensate.

Prolotherapy uses a variety of injection solutions as the “proliferator” or catalyst for healing, including dextrose (sugar water), lidocaine (an anesthetic), glycerine and cod liver oil extract. However, the latest technique, called “platelet-rich plasma” prolotherapy, or PRP, involves injecting platelets extracted from the patient’s own blood into the injured area to turbocharge the healing process.

A vial of blood from the patient is spun in a centrifuge that causes the plasma to separate from the red blood cells. This plasma has a high concentration of platelets, which release proteins and other growth factors that stimulate regeneration when they are injected into the injured area. The platelets also send signals to other cells in the body, drawing them to the injected area to assist with repair and the formation of new blood vessels.@page_break@Some athletes have discovered PRP as a way to speed up the healing of injuries. It has been used by Pittsburgh Steelers football stars Hines Ward and Troy Polamalu, as well as Canadian figure skater Patrick Chan and golf legend Tiger Woods.

“PRP is the future gold standard,” says Dr. Gordon Ko, a medical doctor, prolotherapy specialist and founder of the Canadian Centre for Integrative Medicine in Markham, Ont., who has benefited from PRP in his own sacroiliac joint. “It works faster,” Ko says, “and results can be achieved with fewer injections. Patients are injected with their own body fluid, which means there are no allergic reactions.”

After a few prolotherapy treatments, the patient can expect increased function and stability in the joint, followed by decreased pain and a relaxation of muscle tension in the surrounding area. Anti-inflammatory drugs are not to be taken during the treatment period, as they counteract the healing process that prolotherapy initiates.

The response to treatment varies with the individual and depends on age, physical condition, degree of injury and the presence of other contributing factors beyond soft-tissue damage, such as diabetes, arthritis or nerve damage. Some people require only a couple of treatments, while others could need more. PRP injections are typically repeated every four to six weeks, but other, less potent injection solutions may be administered more frequently.

Ko says prolotherapy is particularly effective for patients whose lower back pain is caused by instability of the sacroiliac joint, located just below the waist. Often the surrounding ligaments have been stretched or strained due to high-impact injuries or overuse, and the muscles in the surrounding lower back, hips and buttocks will overcompensate, creating stiffness and spasms. When the ligaments become thicker and stronger after prolotherapy, the overworked muscles can relax.

“The sacroiliac area is my favourite area to treat, and it has the highest success rate,” Ko says. “But the therapy is effective in any area in which there is ligament damage, including the collarbone, shoulder, ankles and wrists.”

Prolotherapy has been the subject of many research surveys, with some showing 80%-90% effectiveness in alleviating pain caused by connective tissue damage. Risks are low and are primarily related to the injection stage, when there can be inadvertent damage to arteries and nerves or subsequent infection. Post-injection stiffness and soreness are expected and are necessary for the healing process to begin.

Costs range up to $750 for one PRP session, although other injection solutions are less expensive. Prolotherapy is not usually covered by private health insurance plans.

“Prolotherapy has huge potential for healing soft-tissue injuries, even for patients who have suffered years of pain,” says Tsai. “We need more awareness, education and assessment.” IE