Institute for Healing Arts Research : Director, Andrew Kochan, M.D.
Clinical Specialties: Prolotherapy
About Prolotherapy

 What it is and how it can help you

Prolotherapy is one of the most promising and safe alternative approaches to managing chronic pain caused by injured ligaments or tendons. In the 1950s, George S. Hackett, MD coined the term prolotherapy for a non-surgical injection technique to treat back and related ailments. The term "prolotherapy" means "proliferation, or growth treatment".

The procedure evolved from sclerotherapy, an injection therapy used by physicians in the 1800s to treat inguinal hernias. However, the origins of prolotherapy can be traced back to ancient Greece around 400 B.C. It is said that Hippocrates, the Father of Modern Medicine, used a forerunner of prolotherapy to treat soldiers and javelin throwers suffering from dislocated, torn shoulder joints. He would thrust a hot poker into the tissue surrounding the unstable joint. While this technique may seem extreme, it increased the body's ability to heal.

Today, prolotherapy is also known as non-surgical ligament reconstruction therapy (LRT) or regenerative injection therapy (RIT). The term sclerotherapy, or sclerosant therapy is now reserved for a cosmetic injection technique used to eliminate varicose and spider veins. Prolotherapy stimulates the formation of new ligament tissue in areas where it has become weak. In several studies published in reputable medical journals, researchers report that prolotherapy is beneficial for healing connective tissue injuries of the musculoskeletal system especially injuries that have not responded well to conventional therapy. According to some surveys 85% to 90% of patients using prolotherapy have had good-to-excellent results in pain relief.

Prolotherapy is well-suited to conditions caused by over-stretched or weakened connective tissues such as ligaments and tendons. Ligaments act like "wire cables" by holding bone to bone with little or no elasticity. Ligaments have poor blood supplies so when they are torn or weakened after an injury they have difficulty healing completely. If they do not heal properly they never regain their normal length and strength. As a result, ligaments which have been injured are often unable to maintain joint stability. Over time, the excessive abnormal motion of the joints can cause arthritis. Additionally, nerves in the ligaments can transmit pain from the strained and traumatized ligaments.

Tendons are the elastic connective tissues that attach muscles to bones. As in the case of ligaments, they may be painful when injured, stretched or their blood supply is reduced.

Prolotherapy promotes the growth and hypertrophy of the tendons and ligaments by making them stronger. It does this by increasing the amount of collagen in tendons and ligaments.

How does prolotherapy work?

During prolotherapy, a solution of dextrose (sugar water) or another irritant is injected into the ligament or tendon where it attaches to the bone. This triggers a healing of the injected structure by causing an injury to the tissue injected. The body “knows” how to heal tissue injury. The injury causes cells in the area to break apart and releases chemicals into the area which leads to a response by the body with both chemical inflammation and a cellular response. White blood cells called macrophages “eat up” the debris produced by the injection of proliferant. The macrophages continue the healing process by attracting and directing fibroblasts which are connective tissue building cells to lay down new collagen in the injured areas.

In addition, as the injected area becomes “inflamed” there is an increased blood supply with an increased supply of nutrients. The nutrients help heal the tissue by triggering the growth of new blood vessels and increasing the circulation thus bringing in more nutrients for collagen production. As the new collagen matures and becomes stronger over time, it regains its usual function of controlling normal joint movement.

Thus the type of inflammation in the injured tissue caused by injection of a proliferant is actually a healing response.

Painful musculoskeletal conditions reported to be helped by prolotherapy:

  • Whiplash, degenerative disk disease of the neck, thoracic spine or low back
  • Instability of the neck and back
  • Chronic strain of the neck and back, knees, ankles, wrists, elbows and shoulders
  • Osteoarthritis of neck, shoulders, elbows, wrists, thumbs, fingers, hips, knees, ankles and toes
  • Bursitis and tendonitis of the neck and back, tennis elbow, rotator cuff strain, knee ligament strains, recurrent ankle sprains, plantar fasciitis
  • Areas that require repeated chiropractic adjustments or repeatedly “go out”
  • Arthritis,
  • Fibromyalgia,
  • Sports injuries,
  • Degenerated or herniated disks
  • Sciatica.

How long is the course of treatment?

The length of treatment varies with each individual and the severity of his condition. Most people require 6 to 8 treatments every 2 to 3 weeks to reap the full benefits of this therapy. In some cases, 10 or more treatments may be needed. Dr. Kochan reviews each patient's case individually and develops a treatment plan and follow-up that best suits the patient’s needs.

Are there side effects?

There may be mild swelling, joint stiffness, and soreness for a few days after treatment. These symptoms are temporary, however, and can be reduced with ice packs. They are a normal response that shows that the treatment is working and the proper strength of proliferant solution is being used.

How does prolotherapy differ from anti-inflammatory drugs like aspirin and ibuprofen?

The difference between prolotherapy and anti-inflammatory medications such as aspirin, ibuprofen, and cortisone is that anti-inflammatory drugs, although they might provide short-term relief from pain, do not repair the cause of the pain- the damaged connective tissue. In fact there is evidence that over-the-counter and prescription anti-inflammatory drugs can block some of the natural chemicals that stimulate the repair of the underlying injury.

Prolotherapy, on the other hand, works by promoting the self-repair of connective tissue. It triggers the growth of new tissue for tighter and stronger ligaments and tendons that are ultimately needed to stabilized the joint. Once the joint is stable the pain greatly decreases and often disappears. This process of self-healing explains why prolotherapy has been so successful for the vast majority of people who have complied with the full course of their treatment plan.

Are all health care providers qualified to practice prolotherapy?


Dr, Kochan is one of only a few hundred physicians, primarily MD's and DO’s, in the United States who are qualified to give prolotherapy injections. Dr. Kochan received his first training in this technique more than 20 years ago. Inspired by the tremendous relief that prolotherapy brought so many of his patients, Dr. Kochan soon made this treatment the major part of his chronic pain clinic. Over the past two decades he has performed thousands of prolotherapy procedures. Dr. Kochan has the clinical expertise to choose the right regimen which includes the correct solution, dose of dextrose, frequency of treatments, and length of therapy for each patient.

Are there any restrictions on diet and lifestyle while going prolotherapy?

Prolotherapy works best when anti-inflammatory drugs are avoided during the full course of treatment. These substances will interfere with the effectiveness of the therapy and prolong the course of treatment needed. Ice and non-anti-inflammatory pain medications are recommended for the discomfort following prolotherapy. Vitamins and specific nutrient supplementation are recommended to optimize the healing process. Vigorous exercise is discouraged but normal activity and stretching is encouraged especially during the early stages of healing. See AFTER PROLOTHERAPY TREATMENT ADVICE for more details.

Related Links

The following are links to various published papersand organizations of interest:

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