The Healing Response in Prolotherapy
Noel Peterson, ND
Healing of chronic and painful injuries to tendons, ligaments and joints requires an integrative approach. Because these tissues are densely innervated with pain, stretch, and position (proprioceptive) nerve endings, they produce a disproportionate pain response when injured. Referred pain patterns are common. For example, in some cases of tennis elbow, injury to the annular and radial collateral ligaments causes referred pain throughout the forearm, into the hand, pain into the upper arm, neck and shoulder. This referred pain can induce muscle guarding, weakness, tingling, and numbness of the entire arm.
Because ligaments, tendons, and joint tissues have poor blood supply they are slow to repair. Tendon and ligament injury initiates an inflammatory reaction which attracts the migration of pluripotential cells called fibroblasts and macrophages to the site of injury. These cells begin the repair process by removing damaged tissue, and then laying down newer connective tissue, including fibro-elastic fibrils. This process continues as long as there are growth factors present to drive the repair. The local action of growth factors is dependent on age, nutritional reserves, immune competency, and hormonal status. All interact to either promote or quench the healing and repair mechanisms. Often the repair process dies out long before the work of restoring normal function has been completed.
Prolotherapy injections induce the new production and release of growth factors in tissues. Fibroblasts again migrate to the site of injury, and the repair process is renewed. Injections are continued until the joint, tendon, and ligaments are free of pain, and function is restored.
Dextrose is a natural sugar which when injected in a strong enough concentration into the fibro-osseous junction, induces a hyper-osmotic effect which mimics the chemical changes of trauma and inflammation and initiates the migration of fibroblasts to the site of injection, where they get to work repairing and strengthening the tissues.
Dextrose can create growth without inflammation. Research on a variety of human cells exposed to as little as 0.3% to 0.6% dextrose (the normal cell has 0.1% dextrose in and around itself) indicates that within minutes to several hours the cells begin to produce growth factors such as platelet-derived growth factor (PDGF), transforming growth factor-beta (TGFB), epidermal growth factor (EGF), basic fibroblast growth factor (BFGF), and connective tissue growth factor (CTGF). Note that both fibroblasts and cartilage cells respond to a variety of growth factors, which are often named for the first cell in which they are discovered but usually act on a variety of cells.