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What is it?

Prolotherapy is also known as proliferation therapy or regenerative injection therapy. It involves the injection of an ‘irritant’ solution into the area where connective tissue has been weakened or damaged through injury or strain. It appears to work by causing a local, inflammatory reaction which tightens up and strengthens the ligaments. It has been called the regeneration injection therapy because this method causes inflammation which stimulates the natural healing, growth and repair of tissue at site of damage and pain. These changes result in the deposition of new collagen which is the material from which tendon and ligaments are made. As the collagen matures it shrinks and this in turn tightens the ligaments so they appear to be stronger than before.

Prolotherapy is used in the treatment of injured or damaged tendons and ligaments. These tissues have different and specific jobs to do. A tendon attaches muscle to the bone and enables movement within a joint. A ligament connects two bones and plays a crucial role in the stability of a joint. Both forms of tissue are usually served by a poor supply of blood. This means that when ligaments or tendons are injured, healing is sometimes incomplete such that these normally strong bands of connective tissue become relaxed and weak. When the tissues atrophy in this way, it can lead to chronic pain.

Is it just used for treating pain in PGP?

Prolotherapy is said to be very effective in treating all kinds of long-term musculoskeletal pain without resorting to invasive surgery (where a scalpel would be used to make an incision). As a result, it isn’t only used to combat pain in PGP although this is one of the conditions which apparently respond very well to Prolotherapy. So you will find that it is used to treat all sorts of chronic pain,for example, neck pain, back problems, knee stiffness, arthritis, sports injuries, tendonitis, tears to tendons, ligaments and cartilage, sciatica and disc problems.

What is this ‘irritant solution’?

Many solutions are used, of which the most common in the UK seems to be sucrose but can include a commonly used local anaesthetic, phenol, glycerine, or even a form of cod liver oil extract. The idea is that this substance in itself isn’t important but it must be a non-active irritant that serves only to cause a local inflammation so that the blood stream is stimulated to produce growth factors and healing. The injection is made into the joint capsule or where tendon connects to bone. These kinds of injections shouldn’t be confused with corticosteroid injections which are also used to treat problems such as tendonitis arthritis. Strictly speaking corticosteroid injections are not intended to be pain relievers they are meant to be used to reduce inflammation. Once the inflammation has been reduced, pain often reduces as a result. By contrast, in prolotherapy the aim is to cause local inflammation as a way of stimulating changes in the local area which appear to promote healing and strengthen ligaments.

At what stage would prolotherapy be considered in treating PGP?

It is difficult to generalise about when prolotherapy might be considered for relieving pain in someone who has PGP. So much depends on an individual and how the symptoms of PGP affect them. The Pelvic Partnership encourages all women who have pregnancy-related PGP to seek treatment immediately they experience the typical PGP symptoms, from a manual therapist such as a physiotherapist, an osteopath or a chiropractor who is experienced in treating PGP. For some women just a few treatment sessions are sufficient to free stiff or stuck joints and return the pelvic joints to their correct position so that the pelvis no longer appears to be slightly asymmetrical. This can be enough to promote better mobility and reduce or remove the attendant pain. For other women, manual therapy can help to promote better pelvic alignment and less pain but the beneficial effects of the treatment do not last particularly long and once they return to normal activities again, the pain and problems resume.

Prolotherapy may help where women have had long term problems with PGP despite having courses of manual therapy from experienced and skillful practitioners. The reason why the pelvis cannot maintain its position once it is realigned may be due to a true instability at the pelvic joints where the ligaments have been overstretched and cannot return to their normal tension and length. When they are weak and inefficient, pain can recur.

What does prolotherapy treatment normally involve?

Prolotherapy treatment sessions may vary because of the different needs of different patients. Some patients have reported relief in pain after just one session. However, the average person requires more than one session of treatment. The treatment in the UK usually entails an injection once a month for three months. These can be given with sedation if requested to reduce the pain of carrying out the treatment. There might be bruising after a session and patients are encouraged not to do too much too soon to allow the treatment time to work effectively.

Has this approach been around for a while?

This doesn’t seem to be a completely new procedure. One website suggests that the origins of this approach go back to the methods of the ancient Greek physician, Hippocrates. Literature featuring him mentions that he would heal wounded soldiers who presented with torn or dislocated shoulder joints. His treatment was to promote inflammation by pushing a hot poker (!) into the joint, which would then heal normally.

More recently, an injection to promote healing was used in the 1880s to repair hernias.In the 1940s George S Hackett developed the technique and Gustav Hemwall was a more recent pioneer who was working from the 1950s right up until the mid 1990s on this. More recently, there have been debate and studies carried out on prolotherapy which have been published in the mid 2000s.

Is it safe and well respected?

The procedure is supported by many hospitals in this country and abroad but it has probably got as many critics as it has supporters. A Cochrane Review of the medical literature which was conducted in 2004 found there was conflicting scientific evidence regarding the efficacy of prolotherapy. There are research reviews published on the internet which can help you to understand the pros and cons of this procedure. Many are shown on websites originating in the USA but there are also websites about prolotherapy published within the UK. For example the NHS has an ‘NHS evidence’.(See http://www.library.nhs.uk/musculoskeletal for information on prolotherapy injections for chronic lower back pain). If you want to look you will probably find some scare stories on the internet about the problems of prolotherapy but there are women who have had prolotherapy and found that it has helped them to maintain pelvic alignment and to resume a level of activity more in keeping with life before they experienced PGP.

This article was written after consulting the following websites; thank you for help with terms, information and details on the procedure. Wikipedia (see http://en.wikipedia.org/wiki/Prolotherapy), A Californian clinic via http://www.prolotherapy.com, http://www.medicinenet.comhttp://www.prolotherapy.org;

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