What do arthritis, tendinitis/tendinosis, and low back pain have in common? Well aside from low back pain they can affect many different areas of the body and they are all quite difficult to effectively treat. Currently, the standard of care for most of these is a watch and wait approach (wait around and see if it gets better on it's own), corticosteroid injections (which effectively deal with pain management but little else), or physiotherapy (helpful, but has it's limitations). The majority of these approaches are effective at dealing with pain in these conditions but do not really help in the healing of the damaged tissues. Even the pain management seems to be somewhat short lived.
Enter prolotherapy. In short, it is an injection based therapy where a solution of sugar (hypertonic dextrose) is introduced into the area of pain. From here on out the exact reason for how this works is a bit unclear but the strongest theory is that this causes inflammation to the area which then in a way, forces the body to begin to heal a part of itself in which it essentially has forgotten about. Now this isn't the same type of inflammation you get during an allergic reaction or cut on your skin, rather it's quite mild and only serves to reactivate the healing process.
So here we have an alternative to the current standards of care but how does it stack up when compared against them? Quite well actually. Research has shown that not only is prolotherapy comparable to corticosteroid injections for reducing pain, but it can also return the individual to proper function and strength quicker. Additionally, the effects it has last over a longer period of time than any of the comparable treatments! So it works as effective or better than the current treatments, and it's effect lasts longer.. too good to be true? No, not really. I mean as long as you're ok with needles, the only side effect seen after treatment is some soreness at the site of injection. That's pretty incredible considering the alternatives. And just to be clear, I'm not against the standards of care in any way, they are the standards for a reason. I just think it's important to have choice and know all the options before receiving a treatment.
So why is prolotherapy not more widely known and used? Well, if you live in Ontario or many other provinces and states across North America, prolotherapy is not actually allowed to be practiced by Medical or Naturopathic doctors. Because the research coming out is so new and the participant sizes in the studies are relatively small, many governing bodies are hesitant to allow prolotherapy to flourish... for now. With a growing body of research supporting it's uses and relatively no negatives against it, it may only be a matter of time before it makes it's way into more of North America.
Dr. Rob Raponi,
Rabago, David, et al. "Hypertonic dextrose and morrhuate sodium injections (prolotherapy) for lateral epicondylosis (tennis elbow): Results of a single-blind, pilot-level randomized controlled trial." American journal of physical medicine & rehabilitation/Association of Academic Physiatrists 92.7 (2013): 587.
Bernard, BP. Musculoskeletal disorders and workplace fractures: a critical review of the epidemiological evidence for work-related musculoskeletal disorders of the neck, upper extremity and low back. National Institute for Occupational Safety and Health; Washington D.C.: 1997. NIOSH Publication 97-141
Hudak PL, Cole D, Haines T. Understanding prognosis to improve rehabilitation: example of lateral elbow pain. Arch Phys Med Rehabil. 1996; 77:586–593. [PubMed: 8831477]
Bisset L, Beller E, Jull G, et al. Mobilization with movement and exercise, corticosteroid injection or wait and see. BMJ. 2006; 333:939. [PubMed: 17012266]
Maynard JA, Pedrini VA, Pedrini-Mille A, et al. Morphological and biochemical effects of sodium morrhuate on tendons. Journal of Orthopaedic Research 1985;3:236–248. [PubMed: 3998899]
Verhaar JA: Tennis elbow. Anatomical, epidemiological and therapeutic aspects. Int Orthop 1994, 18:263-267.
Krogh, Thøger Persson, et al. "Comparative Effectiveness of Injection Therapies in Lateral Epicondylitis A Systematic Review and Network Meta-analysis of Randomized Controlled Trials." The American journal of sports medicine 41.6 (2013): 1435-1446.
Petrella, Robert J., et al. "Management of tennis elbow with sodium hyaluronate periarticular injections." BMC Sports Science, Medicine and Rehabilitation 2.1 (2010): 4.
Scarpone, Michael, et al. "The efficacy of prolotherapy for lateral epicondylosis: a pilot study." Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine 18.3 (2008): 248.
Rabago, David, et al. "A systematic review of four injection therapies for lateral epicondylosis: prolotherapy, polidocanol, whole blood and platelet-rich plasma." British journal of sports medicine 43.7 (2009): 471-481.
Prolotherapy for the treatment of lateral epicondylitis: A double-blind pilot study. North American Research Conference on Complementary and Integrative Medicine; Edmonton, Canada. 2006. Focus Altern Complement Ther
Lyftogt, John. "Subcutaneous prolotherapy treatment of refractory knee, shoulder, and lateral elbow pain." (2007): 110.
Coombes, Brooke K., Leanne Bisset, and Bill Vicenzino. "Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials." The Lancet 376.9754 (2010): 1751-1767.
Carayannopoulos, Alexios, et al. "Prolotherapy versus corticosteroid injections for the treatment of lateral epicondylosis: a randomized controlled trial." PM&R 3.8 (2011): 706-715.
Johnson, Greg W., et al. “Treatment of Lateral Epicondylitis.” Am Fam Physician. 2007 Sep 15;76(6):843-848.
Smidt N, van der Windt DA, Assendelft WJ, Deville WL, Korthalsde Bos IB, Bouter LM. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet. 2002;359:657–62.
Green S, Buchbinder R, Barnsley L, Hall S, White M, Smidt N, et al. Non-steroidal anti- inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Cochrane Database Syst Rev. 2001;(4):CD003686.
Smidt N, Assendelft WJ, van der Windt DA, Hay EM, Buchbinder R, Bouter LM. Corticosteroid injections for lateral epicondylitis: a systematic review. Pain. 2002;96:23–40.
Bisset L, Paungmali A, Vicenzino B, Beller E. A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Br J Sports Med. 2005;39:411–22.
Chang, Wen-Dien, Ping-Tung Lai, and Yung-An Tsou. "Analgesic Effect of Manual Acupuncture and Laser Acupuncture for Lateral Epicondylalgia: A Systematic Review and Meta-Analysis." The American journal of Chinese medicine 42.06 (2014): 1301-1314.
Khan KM, Cook JL, Kannus P, et al. Time to abandon the ‘tendinitis’ myth. BMJ. 2002; 324:626– 627. [PubMed: 11895810]
Røe, C., et al. "[No effect of supplement of essential fatty acids on lateral epicondylitis]." Tidsskrift for den Norske laegeforening: tidsskrift for praktisk medicin, ny raekke 125.19 (2005): 2615-2618.
Chesterton, Linda S., et al. "Transcutaneous electrical nerve stimulation as adjunct to primary care management for tennis elbow: pragmatic randomised controlled trial (TATE trial)." BMJ 347 (2013): f5160.
Buchbinder, Rachelle, et al. "Systematic review of the efficacy and safety of shock wave therapy for lateral elbow pain." The Journal of rheumatology 33.7 (2006): 1351-1363.
Rabago, David, Andrew Slattengren, and Aleksandra Zgierska. "Prolotherapy in primary care practice." Primary Care: Clinics in Office Practice 37.1 (2010): 65-80.
Maynard JA, Pedrini VA, Pedrini-Mille A, Romanus B, Ohlerking F. Morphological and biochemical effects of sodium morrhuate on tendons. Journal of Orthopaedic Research. 1985;3:236–248.
Jensen, Kristina T., et al. "Response of knee ligaments to prolotherapy in a rat injury model." The American journal of sports medicine 36.7 (2008): 1347-1357.
Rabago, D., J. J. Patterson, and M. Mundt. "Feature Article Prolotherapy: A nontraditional approach to knee osteoarthritis Dextrose injections into the knee can reduce pain and improve a patient’s quality of life. From The Journal of Family Practice. 2014; 63 (4): 206-208." The Journal of Family Practice 63.4 (2014): 206-208.