_ Prolotherapy is a procedure that involves injecting a solution that stimulates healing to repair and strengthen tissues.  The most common solution is a mixture of lidocaine and dextrose.  Lidocaine acts as a numbing agent, providing pain relief during the procedure, but also breaks the cycle of chronic pain signaling.  The dextrose stimulates the healing in the treated area.  The injections are done in areas of ligament and tendon attachment to bone, and into the joint space.  Treatments occur every 4-6 weeks with a total of 2-10 treatments based on the healing response and desired results.  The treatments are quick, lasting from a few minutes for a small treatment area like a knee joint, to up to 30-45 minutes for larger or multiple areas of treatment like the back and neck treated together.  The procedure is extremely safe if performed by a trained and skilled physician.  The use of needles always carries risk, but complications are rare.  Side effects are minimal but the most common is discomfort from the injections, and temporary increase in stiffness, soreness, and occasional bruising.  These symptoms are typically mild and subside in a few days. 

_ The injected solution triggers a three-stage healing process, the inflammatory, fibroblastic, and maturation stages.  The injection starts the inflammatory phase of healing, the first stage.  During this stage, there is increased blood flow, discomfort, and swelling.  Immune cells converge on the site and remove damaged and unhealthy tissue from the area.  The inflammatory stage occurs during the first week.  The second stage is the fibroblastic stage where the swelling and pain begin to abate.  Blood flow and nutrient supply improves as new blood vessels form.  Additionally, fibroblast cells, the cells responsible for creating new tissue, arrive at the site of injury to form new collagen that repairs injured and unstable tissue at the bony attachments.  This phase begins around day 3 of healing and continues for 6 weeks.  After 6 weeks and continuing for up to 3 years, the maturation stage takes over.  During this period the repaired tissue becomes more organized with healthy fibers, creating stronger structures with higher collagen density.  As the structures become stronger the treated joint becomes less painful as the surrounding muscles begin to relax as they are allowed to perform the job they were designed to do, which is to move joints rather than stabilizing them.  Tissue studies have found that injected ligaments can increase strength up to 40% above normal.  Since the maturation stage of healing can take up to 3 years, improvement can be seen well after the last treatment. 

 
We have been taught that inflammation is bad, but it is an important step in proper healing, and without it, no healing will occur.  Careful consideration needs to be taken when using medications or therapies that may inhibit inflammation.