<h4>Introduction</h4>
Prolotherapy is a natural nonsurgical method of assisting the body to heal injured tendons and ligaments. <a href="https://www.drfields.com/prolotherapy-treatment-overview/">Prolotherapy</a> helps your body make new cells through the introduction of an irritant in the painful area. The mild local inflammatory reaction increases the supply of nutrient-rich blood cells to the affected area. This serves to strengthen lax or torn tendons and ligaments (ligaments are the tough tissues that connect bones to bones, and tendons are the same kind of tissue that connect muscles to bones). The notion of irritating an injured area to stimulate the body to heal itself goes back to ancient Greece. Prolotherapy was founded by Dr. George Hackett and passed on to Dr. Gustav Hemwall to form the modern model of prolotherapy in the 1950s and 1960s. The leading education and teaching organization for this, the Hackett-Hemwall Foundation, is named in their honor.

<h4>When Is It Time for Prolotherapy?</h4>
A patient may present with chronic pain in an injured area or the area remains weak, even after a healing period of weeks, months, or years. The problem lies in the fact that both ligaments and tendons have very poor circulation and it is this lack of blood supply which deprives them of the nutrients that they need to heal properly. These weakened areas may have little or no blood flow, but they have lots of nerves. That is why the patient may continue to feel a significant amount of pain. When ligaments become relaxed and weak, this may lead to increased cartilage degeneration and finally bone-on-bone friction, which may result in arthritis-type pain. Additionally, nerves around the soft tissues become stretched and irritated, producing pain. It is at this point that a patient may have been told that surgery is recommended to “fix” the problem. Prolotherapy is next logical step. Surgery requires weeks of recovery, physical therapy, and more pain.

The prolotherapy technique involves a series of 6 to 8 treatments with injections of a proliferant that causes an inflammatory response, which stimulates the healing process. A local anesthetic is used so that there is minimal discomfort with the injections. The weakened area heals, and the patient’s pain is reduced or eliminated. Prolotherapy is an excellent alternative to cortisone injections, which long-term studies have shown can actually weaken tissue. In addition to chronic (and in some cases acute) back and neck, shoulder, knee, and other joint pain; tendonitis; and bursitis, prolotherapy has been shown to be effective at eliminating the pain of such conditions as sports injuries, tendonitis, arthritis, sciatica, some headaches, degenerated joints, fibromyalgia, and more.

<h4>Prolotherapy Techniques</h4>
<a href="https://www.drfields.com/prolotherapy-treatment-overview/">Dextrose prolotherapy</a> is a natural nonsurgical method of assisting the body to heal injured or weakened ligaments, tendons, or joints. The weakened areas are injected to stimulate the patient’s own immune system to send growth factors. This results in healthy, strong, and vibrant new tissues. With this the pain is alleviated and joints function normally. Most ligament and tendon injuries benefit from dextrose prolotherapy as well.

<strong>Platelet rich plasma (PRP) prolotherapy</strong> uses the patient’s own blood to concentrate platelets by a factor of 7 to 10× (platelets = growth factors). This high concentration of platelets – from 3 to 10 times that of normal blood – can be injected into the damaged areas and catalyze the growth of new soft tissue. PRP accelerates the regeneration of injured tissues and enhances tissue healing. <a href="https://www.drfields.com/prp-treatment/">PRP</a> prolotherapy is good for structures such as the labrum in the shoulder, torn meniscus in the knee, and severe hip arthritis.

<strong>Bone marrow/cellular regeneration</strong> is derived from patient cells in a relatively new process. One type of <a href="https://www.drfields.com/stem-cell-treatment/">cell</a> found in the bone marrow is the mesenchymalstem cell. These immature cells can become tissues such as cartilage, bone, and ligaments. Typically the tissue stimulated with bone marrow cells is articular cartilage, but it can also proliferate soft-tissue structures such as ligament and tendons. Indications for using bone marrow prolotherapy include severe osteoarthritis, certaintypes of tears, and cartilage regeneration typically inseverely degenerated joints such as the knees and hips. All three techniques of prolotherapy acceleratethe fibroblastic proliferation through cell growth, proteosynthesis, reparation, the remodeling of tissues, and chondrocyte proliferation. This amplifies the body’s own repair process and accelerates healing and repairs damaged tissue.

<h4>Summary</h4>
Prolotherapy is a successful nonsurgical technique that helps the body heal itself. It works well on all medical conditions that result in painful joints, is minimally invasive with very little recovery time, and is tolerated well by patients of all ages. Prolotherapy first … surgery last.

<strong>Peter A. Fields, MD, DC, “The Athletic Doc<sup>®</sup>,”</strong> is an expert in the field of orthopedic/sports medicine. He is both a board-certified medical physician and chiropractor, one of only a handful of physicians in the US with both these degrees. Dr. Fields is the director of the Pacific Prolotherapy and Medical Wellness Center in Santa Monica, California. Orthopedic/sports medicine is the main focus of his practice. He also practices holistic medicine, which includes bioidentical hormones, anti-aging medicine, IV nutritional therapy, IV chelation therapy, natural alternatives to prescription medicines, and more. Dr. Fields has appeared as a prolotherapy expert on national television as well as on several television and radio shows. He lectures at medical and chiropractic conferences in the US and around the world on these techniques. He has also written for several publications.

Dr. Fields is a lead clinical instructor with the Hackett-Hemwall Foundation, the nation’s largest teaching and education organization for prolotherapy. He teaches on behalf of the foundation at the University of Wisconsin Medical School. He is also a director of one of three of its clinics in <a href="https://www.drfields.com/honduras-2013/">Honduras</a>, where he volunteers yearly with the foundation, treating patients and teaching physicians from all over the world about prolotherapy. Dr. Fields is a very active and competitive triathlete, having recently completed two Ironman triathlons as well as over 60 other races. He has had his back and shoulder treated by these techniques, which helped him avoid surgery. In other words, this doc “walks his talk.”
