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Prolotherapy

Prolotherapy is based on the principle of “rehabilitation of an incompetent structure by the generation of new cellular tissue”. It is derived from proli, a Latin word meaning offspring. Prolotherapy involves interventional regenerative modalities for painful musculoskeltal pathologies and is commonly used for treating damaged joints, especially knee, hip and shoulder joints. Because of its poor vascularity, the worn out cartilage in damaged joints is known to heal very slowly or not at all. Thermal capsulography was originally described by Hippocrates who practiced thermocoagulation of the anteroinferior capsule for treatment of recurrent shoulder dislocation “with red hot slender irons”. Many dysfunctional and painful syndromes arise from pathologic conditions of the connective tissue, hence a large variety of functions depend on the proper homeostasis of connective tissue. (Bannister et al., 1995; Dorman 1992)

Mechanism of Action of Prolotherapy
  1. Temporary neurolysis via chemoneuromodulation
  2. Mechanical transections of A-delta & C fibres
  3. Stimulation of inflammatory cascade & release of growth factors
  4. Chemomodulation of collagen
  5. Modulation of local hemodynamics
Principle of prolotherapy is also used in following situations:
  1. IDET – used to achieve nuclear shrinkage, seal annular fissures & thermocoagulate nociceptors in herniated discs
  2. Use in plastic surgery – chemical & laser induced facial peels for regeneration & rejuvenation of skin collagen
  3. Sclerotherapy – for hydroceles, hernias & varicose veins
  4. Present concepts advocated by AAPM, ASIPP, ISIS & IASP

Aprill et al., 1990; Bogduk et al., 1982.86,88,96,97

History of Prolotherapy
  1. 1935 – Scultz – strengthening of painful subluxation of TM joint by inducing ligament fibrosis
  2. Sylnasol (Sylnasol-sodium psylate an extract of psyllium seed oil) was used biweekly with complete patient satisfaction
  3. 1941 – Shuman – treatment of recurrent shoulder dislocation with sylnasol
  4. 1945 – Bahme – treatment of painful SI joints with sylnasol1954 – Gednney – treatment of spondylisthesis with injections into interspinous & iliolumbar ligts
  5. 1956 – Hackett – introduced the term ‘Prolotherapy’
  6. 1974 – Blumenthal – used it for migraine, cluster headache & for cervicodorsal pain
  7. 1969 – Cyriax – used at interspinous & facet joint capsular ligaments of the Cervical, Thoracic & Lumbar regions
  8. 1993 – Klein et al. – for Lower Back Pain
  9. 1993 – Massie et al. – used intradiscally
  10. 2000 – Reeves – used in knee osteoarthritis
  11. 2003 – Yelland – conversion of IL-1 to IL-2
  12. 2004 – Linetsky – used in Cervical facets