Background

Prolotherapy is the injection of a solution for the purpose of tightening and strengthening weak tendons, ligaments or joint capsules. Prolotherapy works by stimulating the body to repair these soft tissue structures. It starts and accelerates the inflammatory healing cascade by which fibroblasts proliferate. Fibroblasts are the cells through which collagen is made and by which ligaments and tendons repair. Prolotherapy has been shown in one double-blinded animal study over a six-week period to increase ligament mass by 44 percent, ligament thickness by 27 percent, and the ligament-bone junction strength by 28 percent.^[38] In human studies on prolotherapy, biopsies performed after the completion of treatment showed statistically significant increases in collagen fiber and ligament diameter of 60 percent.^[39,40] Fluoroscopically-guided cervical prolotherapy for instability has shown statistically significant results in regard to pain relief and correlates with improvements in the instability with blinded pre- and post-radiographic readings.^[41] Prolotherapy for chronic spinal pain and the neck has also been shown to improve one’s ability to work.^[42]

George S. Hackett, MD, coined the term prolotherapy.^[43] As he described it, “The treatment consists of the injection of a solution within the relaxed ligament and tendon which will stimulate the production of new fibrous tissue and bone cells that will strengthen the ‘weld’ of fibrous tissue and bone to stabilize the articulation and permanently eliminate the disability.”^[44] Animal studies have shown that prolotherapy induces the production of new collagen by stimulating the normal inflammatory reaction.^[45,46] In addition, animal studies have shown improvements in ligament and tendon diameter and strength.^[47,48] Dr. Hackett himself reported good to excellent results in 90 percent of 82 consecutive patients he treated with neck and/or headache pain using prolotherapy. He surmised the neck pain and referral headaches were from ligament damage from whiplash-type injuries.^[49,50] Dr. Kayfetz and associates confirmed these results in a similar group of patients.^[51,52] Recent research, using flexion/extension x-rays to document cervical spine instability and fluoroscopically-guided cervical prolotherapy, demonstrated statistically significant correlations between a reduction in both cervical flexion and extension translation and improvement in the patients pain level.^[37] While these results are promising, they looked primarily at neck pain control.

The observational study described in this article was undertaken to evaluate the effectiveness of Hemwall-Hackett dextrose prolotherapy not just for neck pain but also quality of life measures.

Neck study reference:
Hauser R, Hauser M. Dextrose Prolotherapy for unresolved neck pain. Practical Pain Management. 2007; 7(8):56-69.