Prolotherapy Modality

Prolotherapy, as defined by Webster’s Third New International Dictionary, is “the rehabilitation of an incompetent structure, such as a ligament or tendon, by the induced proliferatin of cells.” “Prolo” comes from the world proliferate. Prolotherapy injections proliferate or stimulate the growth of new, normal ligament and tendon tissue. ^[12] In human studies on prolotherapy, biopsies performed after the completion of treatment showed statistically significant increases in collagen fiber and ligament diameter of up to 60%.^[13]

Prolotherapy is based on the concept that the cause of most chronic musculoskeletal pain is ligament and/or tendon weakness (or laxity). Prolotherapy has been shown in one double-blinded animal study over a six-week period to increase ligament mass by 44%, ligament thickness by 27%, and the ligament-bone junction strength by 28%.^[14] Another animal study confirmed that prolotherapy induced the normal healing reaction that occurs when an injured tissue is healing itself. In this study, the prolotherapy caused the circumference of tendons to increase by approximately 25% after six weeks time.^[15]

Prolotherapists have a long history treating TMD since the time of Louis W. Schultz, MD, DDS in the 1930’s. Dr. Schultz was unique in that he was both a dentist and a medical doctor. He was an Associate Professor in the Department of Surgery at the University of Illinois and Rush College of Medicine. He published several papers on the treatment of subluxation of the temporomandibular joint, including one in 1937 in the Journal of the American Medical Association.^[16] In this paper he described just how common TMJ syndrome was and that the traditional treatments of rest, appliances in the mouth, physical therapy, and surgery were only partially successful. He described a simple method of shortening and strengthening the TMJ capsule by injection (later termed prolotherapy). He tested various solutions in animals until he found one that caused a strengthening of the ligaments that support the TMJ but caused no injury to other structures.^[17] In regard to prolotherapy into the TMJ he found that:

• There was no alteration of the normal joint cavity; the proliferation occurred in the ligaments.
• There were no gross changes in the ligaments other than their thickening.
• Lymphocytes infiltrate the area injected within 30 minutes.
• Proliferation of tissue can be seen in four to six days.

He found that a series of three to five injections were required to often permanently stop the clicking, pain, and hypermobility of the TMJ joint. Dr. Schultz noted that over the course of his twenty years of doing prolotherapy for TMD, not only was it effective, but the treatment lacked significant side effects.

Dr. Schultz taught the technique of TMJ prolotherapy to Gustav S. Hemwall, MD. The primary author has worked with Dr. Hemwall and eventually assumed his practice upon his retirement from medicine in 1996. After acquiring Dr. Hemwall’s practice, Dr. Schultz’s son came to the clinic for a prolotherapy evaluation. He commented that in his father’s many years of practice as a dentist, medical doctor, and surgeon, the procedure that gave him the most amount of satisfaction in treating a TMJ case was prolotherapy.

While practitioners of prolotherapy since the time of Dr. Schultz have commonly used prolotherapy for all sorts of TMD, even in cases not involving subluxation, no other studies have been done since that time. This retrospective observational study was undertaken to evaluate the effectiveness of Hemwall-Hackett dextrose prolotherapy—not just for TMJ pain—but also for quality of life measures.

TMJ Study reference:
Hauser, R, and Hauser, M. Dextrose Prolotherapy and Pain of Chronic TMJ Dysfunction Practical Pain Management Nov/Dec 2007; pp 49-57.