Prolotherapy and Prolozone Injections
By Dr. Glenn Wilcox, D.O.M., M.Sc.
Prolotherapy involves injection of substances that cause minor inflammation and promote or stimulate the growth of normal cells and tissue, especially ligaments, tendons and cartilage, thereby regenerating and strengthening the lax or weakened tissue and alleviating musculoskeletal pain. “Prolo” is short for proliferation (propagation, generation). Prolotherapy is also referred to as Regenerative Injection Therapy (RIT).
Prolotherapy focuses on repairing and optimizing the structure and function of tendons and ligaments. A tendon attaches a muscle to the bone and is involved in movement of the joint. A ligament connects two bones and is involved in the stability of the joint. A strain is defined as a stretched or injured tendon and a sprain is a stretched or injured ligament. When tendons or ligaments are injured, your body’s systems are stimulated to repair the injured area. Ligaments and tendons generally have a poor blood supply and so incomplete healing is common after an injury. When ligaments and tendons become lax and weak, the joint becomes unstable and chronic pain results.
With regard to trauma and injury, the greatest point of stress to the ligaments and tendons is where they attach to the bone. With regard to pain, the periosteum (covering of the bone) and the ligaments are the most sensitive structures. With regard to the scale of pain sensitivity (which part of the body hurts more when injured), the periosteum ranks first, followed by the ligaments, tendons, fascia (the tissue that surrounds muscle) and finally muscle. Cartilage contains no sensory nerve endings and therefore the cartilage cannot hurt because it contains no pain sensing nerves. If there is cartilage damage, such as with a tear to the meniscus of the knee, the ligaments are typically the structures that hurt.
Conventional Prolotherapy involves injecting a mild irritant solution referred to as a proliferant. The most common proliferant is a solution of dextrose (sugar water) combined with procaine, a commonly used local anesthetic. Sometimes lidocaine is used instead of procaine. Most commonly, the injections are given into a joint capsule (elbow, shoulder, knee, ankle, spine, etc.) or where a lax, weakened or damaged ligament or tendon attaches to bone. Prolotherapy works by exactly the same process that the human body naturally uses to stimulate the body’s healing response. The first stage of this process is inflammation. The Prolotherapy injection causes a local inflammation. The local inflammation triggers a healing cascade that stimulates fibroblasts, the cells from which connective tissue is developed. Activation of the fibroblasts results in the deposition of new collagen, the strong, fibrous, insoluble protein from which ligaments, tendons and cartilage are made. The new collagen regenerates cartilage in the joint and strengthens the ligaments and tendons and their attachments to the bone. New collagen shrinks as it matures. The shrinking collagen tightens the ligament or tendon that was injected. The result is improved stability and function, and resolution of pain.
Prolotherapy History: Injection of irritant solutions for soft tissue repair has a long history. Around the time of Christ, Celsius used saltpeter to treat hydrocele (swelling in the scrotum due to fluid accumulation) and likely hernias as well. Such injections were performed in London in the 1700’s to repair hernias. Two doctors simultaneously discovered joint based prolotherapy in 1937. That year, Louis W. Schultz, D.D.S., M.D. first published about injection of TMJ (jaw joint pain) to build ligament. Earl Gedney, D.O. published his venture into using irritating substances in SI joints and knees, also in 1937. George Hackett, M.D. further developed the technique of prolotherapy in the 1940’s. In his study of almost 10,000 Prolotherapy cases, Dr. Hackett found that over 99 percent of the patients found relief from their chronic pain.
Prolozone is an injection therapy that more recently evolved from Prolotherapy. Prolozone will also regenerate connective tissue issues (tendons, ligaments, cartilage), to improve function, help resolve pain in the joints and other musculoskeletal areas, and more… Like Prolotherapy, Prolozone involves the injection of procaine, a local anesthetic, along with other natural substances. However, immediately following the injection of the therapeutic fluids, a combination of medical grade oxygen gases is injected – O2 that we breathe, combined with very small amounts of O3 (ozone). This results in a number of natural, healthy, therapeutic responses from our bodies, one of which is activation of the healing cascade, similar to Prolotherapy, that the body naturally performs any time there is an injury. The end result is healing of tissues, normalization of function and resolution of pain.
Prolozone involves injecting similar solutions as in Prolotherapy, but with less or no inflammatory dextrose added. Then, without removing the needle, a new syringe containing the combination of O2 and O3 gas is attached and that is also injected into the site. The addition of ozone has a mild irritant effect and thus the dextrose is often unnecessary. This is a real advantage for sensitive people who might be more prone to inflammation and pain. The ozone will stimulate tissue regeneration but causes less inflammation, swelling and pain than the dextrose used in Prolotherapy. The addition of ozone in Prolozone further improves outcomes due to the added advantage that it eliminates local bacterial pathogens that can contribute to joint instability, dysfunction and pain. The use of ozone also makes Prolotherapy possible for those with hardware (screws, rods, joint replacements, etc.) near the injection site, since the presence of such hardware is a contraindication for conventional Prolotherapy because of the use of dextrose.
Prolozone History: I started performing Prolozone Therapy in 2007. At that time, I was Medical Director of a large clinic in Albuquerque and worked closely with Dr. Maged Maged, the clinic’s Research Director. During the early 2000s, Dr. Maged worked with Dr. Frank Shallenberger in Reno, Nevada where he learned and helped evolve Prolozone. Dr. Shallenberger is my mentor in advanced Prolozone techniques and one of my mentors in IV ozone therapy. He is also the founder of the American Academy of Ozonotherapy.
Ozone: O3 (ozone) has been effectively used in medicine around the world for five decades and is finally gaining some recognition in America. Ozone is a magic molecule! It is an essential substance used in oxidative medicine, an exceptionally effective, recently developed field of medicine. Ozone, or O3, is simply three atoms of oxygen bound together. We breathe O2 which is very stable. Ozone is not stable and breaks down into O2 and a single atom of oxygen. That single molecule of oxygen is what works the magic. O3 is created when a current of electricity passes through O2. Ozone does not naturally occur in humans, but it does occur in nature when lightning passes through the atmosphere. In the clinic it can also be created by an ozone generating device when electricity is passed through pure medical grade O2.
Why Don’t Conventional Orthopedics Doctors use Prolozone and Prolotherapy:
Conventional orthopedics doctors are not up to speed on these therapies. I found out why in 2019. I attended a daylong continuing education class on joint injection therapy organized by the young orthopods from The University of New Mexico School of Medicine in Albuquerque. They demonstrated excellent injection therapy techniques using Lidocaine combined with steroids… but that was all they used. Injected steroids can sometimes reduce inflammation and therefore pain, but steroids do not promote healing. I asked these very competent doctors if they were aware of other more effective injection therapies such as Prolotherapy, Prolozone and PRP, and why didn’t they use them? Their response was simple. They were not aware of Prolozone; they had heard of Prolotherapy and PRP. But they didn’t perform these because insurance would not reimburse for such therapies, but only steroids. Interesting…!
Response to Treatment: The response to treatment varies depending on whether Prolozone or Prolotherapy is performed, and from person to person due to variations in the traumatic damage done and individual healing ability. Some people experience localized swelling, inflammation and pain around the injection site that resolves over the following few days. Others experience no discomfort. Some people may only need two or three treatments while others may need 10 or more. A typical course of therapy is six to ten treatments, usually involving multiple injections during each treatment. Treatment is usually repeated every four to six weeks for Prolotherapy and can be repeated weekly for Prolozone.
Conclusion: I was first Board Certified in Injection Therapy in 1998 and have been directly involved in the evolution of these effective therapies in New Mexico. Over the years, my patients have experienced dramatic improvement in function, and resolution of pain as a result of these valuable therapeutic tools.
Injection Therapies Compared: