Prolotherapy

Prolotherapy (Sclerosant Therapy)

Prolotherapy

The use of an agent to proliferate tissue. Also known as sclerotherapy – formation of scar tissue with a view to strengthening the tissue.

Prolotherapy is used to repair damaged, lax, or weakened ligaments. It has been used for over fifty years to help strengthen damaged ligaments in the back. It has also been used in patients with varicose veins, as an alternative to surgery, to turn a tube of blood into a tube of scar tissue, to remove the varicosity. This clinic does not treat varicose veins.

Prolotherapy has been successfully combined with manipulative techniques to improve the results of both therapies in treating chronic back injuries of a soft tissue type. It is not useful for bony injuries, nerve injuries, infections, cancer, inflammatory diseases or spinal stenosis. It is usually avoided in pregnant patients (due to limitation of benefit), but safe in breast-feeding patients.

Many agents are used for prolotherapy. The common ones include glucose, phenol, alcohol, and a patient’s own blood, however these are weak sclerosants and not very effective at strengthening ligamentous tissue. Ethanolamine Oleate is a simple soap that acts as an excellent sclerosant, and is eliminated from the body in 24-48 hours. Its effect is to stimulate the growth of new scar tissue, while having minimal side-effects. Tetradecyl Sulphate is another newer sclerosant that has been used for varicose veins and for tightening the uvula (at the back of the throat) to prevent snoring. At this clinic we use Ethanolamine Oleate and Tetradecyl Sulphate for strengthening damaged ligaments.

This treatment has virtually no side-effects. In very rare cases, a patient may experience a mild reaction to an agent (skin rash).

After treatment:

Prolotherapy works by creating an artificial local inflammation of sufficient degree to trigger the body’s healing mechanism to lay down new white fibrous tissue (scar tissue). This strengthens the damaged ligament that the doctor is endeavouring to repair. The injected material has a local effect only - it has no other effects in the body and has completely gone in about 5 days. The treatment site may be tender for up to a week after the injection. When the initial tenderness subsides, it is important to remember the repair is very weak in the first six weeks, and gains strength slowly, so that by 3 months it has 3/4 of its strength and it has full strength by 6 months. Correct lifting technique during this time is essential to avoid breakdown of the repair.

It is important not to take any anti-inflammatory drugs for the first 5 days after a sclerosant injection. (It doesn’t matter for corticosteroid injections, as corticosteroids are your body’s own natural anti-inflammatory. Sclerosant has exactly the opposite action to steroids.) This applies to all anti-inflammatories such as diclofenac (Voltaren), naproxen (Naprosyn, Synflex), ibuprofen (Nurofen, Brufen), and aspirin (Cartia, Aspec). Simple pain relief such as paracetamol (Panadol), and paracetamol plus codeine (Panadeine, Codalgin) are useful to diminish the discomfort. The degree of discomfort varies from person to person and according to how inflamed the injury was at the time of injection. Non-pharmaceutical pain relief can be provided with a hot water bottle or heat pack applied directly to the sore area.

Persistence of pain after a week needs to be reported and re-assessed. This persistence of pain is most commonly due to either a recurrent dysfunction at the repair site, from doing a wrong movement (such as an inadvertent forward bend), or from an adjacent dysfunction, which may have been present, but masked by the more severe (treated) tenderness.