PROLOTHERAPY
Sclerosant Injections to Ligaments

Ligaments help to provide stability to joints. They prevent the joint from moving more than the ‘normal range’ (though what is ‘normal’ varies from one individual to another). Some people have lax ligaments that allow greater than ‘normal’ movement in the spine and elsewhere.

In the spine there is a complex arrangement of ligaments, both between each vertebral segment and between the spine and pelvis, which allows flexibility in some directions and produces restraint in others.

Sometimes ligaments can be overstretched, or even torn (as in a sprained ankle). The ligament may then not control the joint adequately – thus leading to ‘instability’ which may put abnormal stresses on the joints and discs in the spine.

In women the pelvic joints need to be supple for child bearing, and so the ligaments soften and stretch more readily. Sometimes they do not tighten up after childbirth and therefore allow too much movement – hence ‘sacroiliac instability’.
Prolotherapy works by stimulating the body to make new fibres which are laid down within the substance of the ligaments, thickening and strengthening them. The solution is a 25% mixture of dextrose in local anaesthetic, and a small amount is injected into each end of the ligament, close to its attachment to the bone. We occasionally use a solution of phenol dextrose + glycerol if required.
This initially provokes inflammation, attracting the cells that make collagen fibres to the area. Over the ensuing weeks, the fibres are incorporated into the existing ligament.

Each ligament has to be injected 3 times, at intervals of a week, in order to produce sound fibrous development. Hence three injections are given as a course of treatment. The interval can be up to 3 weeks

As prolotherapy for ligaments is not widely practised, it has not as yet been licensed for this particular type of treatment.
our 50% glucose ampoules are provided by a licensed manufacturer as are the ampoules of P2G which is occasionally used in difficult cases. Because the organic compounds in the solution are rapidly disposed of by the body, it is safe to have a repeat course of treatment – should it be necessary.

There have been several widely published clinical trials on its usefulness in low back pain with positive results. (see below)

Prolotherapy does not create scar tissue but thicker healthy collagen fibres in the lax ligaments.

Injections are commonly given in the lumbar region, sacroiliac region, thoracic and cervical spine. They are also useful in the ankle and shoulder region.


POINTS TO NOTE

These injections can cause some aching and stiffness for 1-2 days. Rest is not necessary; normal activities should be continued. Paracetamol, rather than Asprin or Nurofen, can be taken for pain relief.

Complications are very rare since the injection is not placed into the spinal canal or near spinal nerves. Infection can occur in about 1 in 17,000 cases, which is the same risk as for most injection procedures. Sterile single use equipment is always used with a no-touch technique.

The benefit is not immediate but gradual. It becomes noticeable after 6-8 weeks, increasing up to twelve weeks.

You will be advised to walk for 20-30 minutes each day after the final injection, for 2 weeks.

If there are any further questions or uncertainties please ask the doctor.

Klein RG, Bjorn CE, DeLong B, et al., A randomised double-blind trial of dextrose-glycerine-phenol injections for chronic low back pain.
J Spinal Disord,1993; 6:23-33
E. Dechow , R.K.Davies et al., A randomised, double-blind placebo-controlled trial of sclerosing injections in patients with chronic low back pain. Rheumatology, 1999; 38 : 1255-9
Prolotherapy injections, saline injections and exercises for chronic low back pain: A randomized trial. Yelland, Glasziou ,Bogduk et al Spine 2004
For ISIS 2003 P104-108 Regeneration Injection Therapy (Prolotherapy) A literature review with Meta-analysis
Ref : Marina Kurgansk ISIS 2003