Prolotherapy - 10 years of ‘Healing by inflammation’

I was introduced to the concept of prolotherapy ten years ago by a particularly good friend and colleague. She knew I had a surgical bias but felt that I might find prolotherapy a useful possibility in cases where surgery is not really an option such as those with severe financial constraints, or older animals with co-morbidities where surgery is very risky or where post-operative confinement would be incredibly challenging.  

The underlying principle of prolotherapy is well accepted in human and veterinary sports and rehabilitation medicine. To use the words of Dr Lowri Davies specialist veterinarian in canine sports medicine and rehabilitation – “We heal by inflammation.”

Simply put when it comes to injured tendons, ligaments, and joints it is the inflammation that drives fibroblast activity, collagen deposition, remodeling, and healing. Consequently if we take an injured ligament, tendon or joint which is already inflamed and trying to heal and infiltrate it with an irritant solution like 25% dextrose we create even more inflammation and thereby accelerate healing significantly.  

The concept of creating irritation or injury to stimulate healing has been recorded as early as Roman times when hot needles were poked into the shoulders of injured gladiators.

Modern prolotherapy was pioneered by a medical doctor and surgeon from Ohio Dr George Hackett in the 1930s. Dr Hackett coined the term prolotherapy because his original work showed that the tissue laid down during the healing process was new healthy tissue and not scar tissue. This distinguishes prolotherapy from a related technique called sclerotherapy. Dr Hackett’s work was continued by Dr G.A. Hemwall M.D. in the 1950’s. 

I was inspired to try prolotherapy after reading articles on the success they were experiencing with it by veterinarians like Dr Carvel Teichert from the USA and Dr Sagiv Ben-Yakir from Israel. What also influenced me was a mindset change I experienced. As a young graduate my mindset was very much that of a surgeon i.e. “A chance to cut is a chance to cure.” After twenty years of doing surgery and enjoying lots of success but also living though a few horrendous failures, where I wished I had never operated, my mindset started to change to one of “First do no harm.” 

The first few cases I treated were small dogs with cruciate injuries. They all responded very well but I remained skeptical as we know that small dogs (in particular) can heal their cruciate injuries conservatively. However, when I started to experience similar success with larger dog cruciate injuries, I realised that there was more than just luck and self-healing happening. I started to see cruciate injuries that may have healed conservatively in 9 to 12 months improved and heal in 3 to 6 months reaffirming to me that prolotherapy really does accelerate healing. 

As I grew in confidence with the technique, I started to apply it to other conditions and experienced similar success. Currently I have enjoyed success in treating the following conditions:

In all cases I recommend regular physiotherapy as well. I have found the combination of prolotherapy and physiotherapy beneficial. Having said that a number of pet parents have not been able to follow through with physiotherapy, yet their animals have still responded well to prolotherapy alone.   

In summary after treating over two thousand injured joints and ligaments with prolotherapy over the past ten years my experience is that it is a very safe, economical, and easy to perform treatment that can restore many injured animals to function without the need of surgery.  

Article written by : Dr Steve Wimberley