What is Prolotherapy?

Prolotherapy is a unique, time-tested injection method used to treat chronic pain. It is defined by Webster’s Third New International Dictionary as “the rehabilitation of an incompetent structure, such as ligaments or tendons, by the induced proliferation of new cells.”

Persistent pain from previous injury, chronic overuse injury, or even when there is no known cause, often arises from damage to the soft tissues in the body. These soft tissues, which include ligaments, muscles, tendons and joint capsules, are also called “connective tissues” because they connect to bones, thereby supporting the bony skeleton. Prolotherapy causes these connections to be repaired, rebuilt and strengthened. It is for this reason that prolotherapy has also been called ligament reconstructive therapy or stimulated ligament repair.

Soft tissue injuries can often become chronically painful. Normally, injured muscles, tendons, and ligaments go through a repair and healing process which takes about four to six weeks. But, what happens when the low back pain, neck pain, and headaches from a whiplash injury, just will not get better? Or, what about the athletic injury that causes nagging pain and prevents you from staying active, especially keeping you from the sport you enjoy the most? What about the pain where you cannot pinpoint a specific injury, but think it may be due to some repetitive tasks at work or from overdoing it while working around the home?

 

Standard Treatments for Chronic Pain

There are many types of treatment for the injuries and conditions mentioned previously. More often than not, those with chronic pain will try some or all of the following to treat their problem:

• Rest
• Ice, heat, ultrasound
• Anti-Inflammatory drugs, pain killers, muscle relaxors and other drugs
• Physical therapy, including home stretching and strengthening exercises
• Bracing, taping and orthotics
• Manual therapy such as massage, acupressure, myofascial release, craniosacral therapy and rolfing
• Chiropractic adjustments
• Acupuncture
• Electrotherapy such as TENS and muscle stimulation
• Cortisone shots into the joints or spine
• Pain clinics, which use many of these treatments as well as a psychologist to help people cope with their pain and manage it better
• Surgery, including arthroscopic, joint replacement, spinal fusion and other forms of surgery.

While some of these methods can be used to help certain conditions, in a significant number of cases persistent pain and a disrupted daily life will occur. Some treatments may even mask the problem or slow the recovery process. A doctor might tell you at some point that “you just have to live with it…there is nothing you can do about it” or that your only options are a lifetime of drugs or a major operation. That news is frustrating and discouraging!

Well, take heart! There is a reason why many problems don’t respond to treatment: the wrong treatment is being used. There is one treatment which can relieve pain and correct the problem ... permanently.

 

 

Prolotherapy Spells Relief

Although you may not have heard about prolotherapy until now, it has been used since the 1940’s and treatment results have been amazing. In one clinical study, 85-90% of patients received good to excellent results in pain relief and improved function. Just as important, pain medications can be greatly reduced or even eliminated. This is good news, because pain medications have potentially serious side effects and increase the cost of health care. But, the best part of all is that prolotherapy produces long-lasting relief...naturally. Most other types of treatment provide only temporary relief.

Prolotherapy is an alternative to surgery in many cases, thereby avoiding disfiguring scars and lengthy rehabilitation. George Hackett, M.D., a prolotherapy pioneer, proved that strengthening connective tissue relieves soft tissue pain. A research study in the respected medical journal, Lancet, demonstrated the effectiveness of prolotherapy, as did a recent double-blind study on knees.

Connective tissues (ligaments, tendons, muscles) heal very slowly when injured and often don’t fully heal due to a relatively poor blood supply or improper treatment. The attachment sites where ligaments anchor to bone are the weakest links. In addition, connective tissue cells called fibroblasts are deficient, as seen under microscope. This deficiency of fibroblasts leads to loose ligaments and weakened tissues. As a result, the normal supportive function of the ligaments which was present prior to injury is lost. Therefore, joint stability is reduced. Damaged ligaments are like loose hinges on a door, allowing bones in the joint to swing out of alignment causing pain, muscle spasms, and eventually arthritis, if left untreated.

Small pain fibers in these damaged ligaments transmit pain signals to the brain when stretched. Through a subconcious reflex, the surrounding muscles go into a tight and painful spasm in an attempt to stabilize the joint. This may cause burning and tingling sensations to occur, as well as, an achy, numb or fatigued feeling. The individual will often notice painful “knots” in the affected muscles.

These muscles become tight and painful as they try to compensate for the weak and damaged underlying ligaments. The muscle spasms reduce blood flow, causing even more pain. Not only are these symptoms felt in the muscle, but they are often referred (transmitted) through nerve pathways into the legs and feet, arms and hands, and head (headaches). In other words, pain felt in the head and arms may come from the neck, and pain felt in the legs may come from the low back.

For example, weakness or injury to the ligaments in the neck may interfere with the sympathetic (automatic) nervous system, causing a group of symptoms called Barré-Liéou Syndrome. This syndrome consists of one or more of the following: dizziness, visual blurring, loss of balance, ringing in the ears, runny nose, salivation, trouble swallowing, hoarse voice, nausea, vomiting, nervousness and headaches. These symptoms are caused by instability in the neck and can be eliminated by prolotherapy.

Medications and other forms of passive treatment such as ultrasound, ice, heat, massage, acupuncture and manipulation may give only temporary benefit because the primary problem, the loose and damaged ligaments, is not being addressed. Stretching and strengthening exercises can provide some relief from chronic pain, but this is often only temporary as well. When these exercises have failed to increase the support sufficiently to diminish pain and improve function, the chronic pain cycle begins. Prolotherapy should be started as soon as possible, before the problem becomes wide-spread.

How Does Prolotherapy Work?

Prolotherapy works based on a very simple principle: injecting the prolotherapy solution at the sites of pain and weakness stimulates the body’s own healing mechanism to repair and rebuild injured tissue into a stronger, more supportive, less painful tissue than it was before.

The most basic prolotherapy solution contains a naturally-occurring sugar (dextrose, derived from corn) combined with an anesthetic (lidocaine). Other common natural substances can also be used effectively. When the injured tissues are injected with small amounts of the prolotherapy solution, a reaction begins, starting a three-stage healing process.

The prolotherapy solution initiates the first stage (Inflammation). Stages two (Fibroblastic) and three (Maturation) follow automatically as part of the body’s natural healing process.

INFLAMMATION

In stage one, the body sends in special cells which help to clean up the debris, much like a cleanup crew at a construction site. These cells respond as if another injury has occurred resulting in a controlled inflammation and increased blood flow. Most people are taught that inflammation is bad and don’t realize that without inflammation no healing will occur. This process takes about a week.

FIBROBLASTIC

In stage two, the body begins the process of repair and healing. This is accomplished by the addition of tissue repair cells called fibroblasts which are lacking in the injured tissue. Fibroblasts increase in number at the sites of injection, and over the course of four to six weeks secrete a substance called collagen, a very strong, inelastic protein which is found naturally in the body. The new collagen is normal, healthy tissue and makes the ligaments thicker, denser and stronger. This provides more support to your joints, primarily where the ligaments anchor or attach to bone. The strength of the injected ligaments can increase up to 40% above normal. Stability is increased causing pain and muscle spasm to decrease.

MATURATION

In stage three, the newly formed tissue continues to mature for two years. Improvement, therefore, may continue for up to three years after the last treatment. But, if during the three stages of the healing process, anti-inflammatory drugs, ice, compression and/or immobilization are used to reduce pain and inflammation, complete and normal healing will be inhibited.

So, in essence, prolotherapy strengthens ligaments and decreases pain by stimulating the body’s own repair and healing mechanism to go into action. This solution does not contain cortisone, which is known to decrease inflammation, which will slow or stop the healing process. Acute pain may be relieved with cortisone, but repeated use causes a weakening of the tissues and chronic pain develops. With prolotherapy, however, there is no masking of pain, tissues heal naturally and become stronger, without the formation of scar tissue. It is for this reason that prolotherapy gives long-lasting relief for months to years. Several treatments spaced apart by about four weeks are usually required to get the full benefit from prolotherapy.

When a house is built, as each support is added, the structure becomes more solid, giving more strength to the house. The same is true for joints. As each treatment creates new tissue to strengthen the ligaments, more strength and support is added to the joint structure. No treatment other than prolotherapy is able to increase the strength and stability of joints.

What About the Procedure Itself?

Prolotherapy is a very safe procedure when performed by a well-trained and highly-skilled physician who has an in-depth knowledge of anatomy and experience using this injection technique. The use of needles involves risks, but complications from prolotherapy are rare. The solutions commonly used have been shown to be safe and, as stated previously, do not contain cortisone.

The most common side effects, aside from some discomfort during the injections, are temporary soreness, stiffness, and occasional bruising after the injections. Although injection discomfort cannot be eliminated, it is well-tolerated in most cases. If necessary, it can be reduced by the use of prescription oral medications for pain control and sedation taken prior to the treatment. Most patients prefer not to be sedated because it makes them feel groggy for a few hours and because a driver is required to and from the appointment. Topical anesthetic cream to numb the skin can also be applied to reduce needle discomfort. The actual treatment may last from a minute, if there is only one site of tenderness such as the elbow, to ten minutes, if larger regions such as the back and neck are being treated together.

Depending on the area treated and the number of injections, which is usually just a few for small areas or many for larger areas, one may return to usual activities the next day or two. The soreness following the injections is normal and gradually lessens over several days, as will any bruising that may occur.

Approved, prescribed drugs or plain Tylenol may be taken for this discomfort. However, no anti-inflammatory drugs may be taken during the treatment period because these will interfere with the healing process that prolotherapy initiates. A goal of prolotherapy is to get the patient off all pain medications. Natural supplements may be recommended to speed recovery and encourage healing.

Can Prolotherapy Cure Everything?

Prolotherapy does not produce healing overnight. It cannot “cure” every condition, nor always eliminate 100% of one’s pain. There are some areas that the Prolotherapist cannot safely reach with a needle. However, most patients completing prolotherapy treatment (usually four to ten sessions) will receive at least 50% relief of their pain. Some even report complete resolution. These results are excellent, considering that chronic pain is exceedingly difficult to treat.

When complementary treatments such as muscle therapy, physical therapy, electrotherapy, oral supplements, and exercise, are combined with prolotherapy, results are often enhanced. It is also important to know that prolotherapy only strengthens tissues. No structures are weakened or damaged and no scar tissue is formed.

A good history and a thorough examination are necessary to select the best candidates for prolotherapy. The motivation to want to get better and complete the necessary treatments is vital. Patience and time are important to reap the full benefit from prolotherapy. Chronic pain problems do not occur overnight and they do not heal that way either. If the pain affects one’s life on a daily basis, then prolotherapy may be indicated.

Individuals who have unhealthy lifestyles, such as smoking or excessive drinking, who are unfit or obese, or who have underlying diseases or stress, may not heal as well, decreasing the effectiveness of treatment. It also should be noted that people who regularly take narcotic painkillers receive less benefit from prolotherapy because these drugs suppress the body’s immune system. Tolerance, physical dependence and addiction are consequences of habitual narcotic use. Weaning off narcotics greatly improves the results of prolotherapy.

In Summary
Prolotherapy is an effective treatment for a multitude of conditions. There is no other treatment that replaces prolotherapy for strengthening weakened ligaments. It works by stimulating the body’s own healing process at the sites of injection. Healing occurs slowly but surely... and naturally. Multiple treatments are usually necessary to achieve maximum joint stability and long-lasting relief from pain. The goals of prolotherapy are to decrease pain and to improve a person’s overall ability to function at work, at home, and during usual activities.

 

 

 

Instructions Prior to Treatment

Stop taking all anti-inflammatory medications, including:

• Ibuprofen
• Advil
• Motrin
• Aleve
• Naprosyn
• Celebrex
• Oral forms of cortisone (Prednisone)
• Aspirin products (except baby aspirin for heart conditions)
  
  
• IMPORTANT: Please tell us in advance if you are taking blood thinners (eg. Coumadin) or if you have allergies to fish, corn, sugar, anesthetics, or pain-killers.
  
  
• Eat a light meal one to two hours prior to your appointment, and drink water up to the time of your treatment.
  
  
• If you are to be sedated with oral medications, they need to be taken about two hours before your appointment and you will need have someone drive you to and from your appointment.
  
  
• Some of the following substances may be injected: dextrose (corn extract), morrhuate sodium (refined cod liver oil), zinc, calcium, along with lidocaine and/or sarapin (anesthetics), and sterile water. No cortisone will be used.

Instructions Following Treatments

• DO NOT take anti-inflammatory medications after the injections. These drugs will interfere with the healing process that the injected solution stimulates.
  
  
• You may take Tylenol or other approved medications for relief of injection pain following treatment.
  
  
• You should start taking the recommended daily supplements beginning the day of your treatment.
  
  
• You may use heat for soreness (heating pad, warm moist towel, hot shower or bath). Refrain from the use of ice during the first week as this may slow healing.
  
  
• Bruises or “lumps” under the skin that occur are normal and will gradually disappear. However, call us at any time if pain worsens after a few days or if you have questions about a possible side effect.
  

• After the injected anesthetic has worn off (usually in a few hours), you may have a temporary increase in stiffness and pain. Not only is this expected, but it is also necessary to signal the start of the healing process. This should last only one to three
  days, though some patients experience extended periods of pain after a treatment. This is normal and should not alarm you.
  
  
• Drinking water following treatment may decrease post-treatment pain and will improve cell function.
  
  
• Pain relief is usually first noticed at about two to six weeks following the injections. Four to ten treatment sessions are usually required to adequately treat the problem. More treatments are necessary for difficult problems. Sessions are performed about four weeks apart. Each treatment builds on the previous one and too much time between treatments may slow improvement.
  
  
• Depending on your job and the area treated, you may be advised to reduce your activities after treatment, but as a rule, you are encouraged to return to your usual activities as soon as you feel able.
  
  
• When pain relief occurs, do not rapidly advance to activities you haven’t performed in a long time and avoid excessive stress on the areas treated. You are encouraged to exercise for general fitness and to strengthen areas of weakness. The more active and fit you are, the quicker your recovery will be. If appropriate and necessary, physical therapy with an exercise program may be prescribed.
  

• Prolotherapy injections are intended to provide you with long-lasting, even permanent, relief of your pain. In many cases your pain will be greatly diminished and not return unless you re-injure yourself.
  
  
• Joint strength and stability will increase with each treatment and continue for about two years after the last treatment. The process of healing, increased joint strength, and pain relief is gradual. Patience is required to realize the benefits of prolotherapy. Complete relief of pain cannot be guaranteed.
  

• If you have any problems following the treatment, an increase in your pain or wish to ask questions about prolotherapy, please let us know so we can serve you better.
  

• You will be asked to periodically provide a brief written summary to update your progress and current status.

Why Haven’t You Heard of Prolotherapy?

If prolotherapy is so effective, why doesn’t everyone with chronic pain, or your doctor, at least, know about prolotherapy? It does seem puzzling since so many people have benefitted from prolotherapy. Several logical explanations come to mind:

• Chronic pain, especially as it relates to ligament injury, is not well understood by most health care professionals and, therefore, is frustrating to treat. Thus, the comment, “There is not much you can do about it... you just have to live with it”.
  
  
• Prolotherapy is not taught in medical schools, so doctors are unfamiliar with it.
  
  
• The technique of prolotherapy requires an in-depth knowledge of anatomy and the skill to place the injections accurately. It takes many hours of study and training for a physician to become adept at the technique.
  
  
• The evaluation and procedure may take up to one hour of clinic time, and most busy clinics cannot afford to take this amount of time for one patient.
  
  
• Many doctors and patients are looking for a “quick fix”, but prolotherapy results do not occur overnight. The prolotherapy patient must be committed to the treatment because multiple sessions are usually required.
  
  
• Pharmaceutical companies are not involved because there is no money in it for them.
  Prolotherapy solutions contain common and inexpensive substances. Drug companies cannot obtain patents for exclusive manufacturing rights, so there is no investment incentive, and, thus, no profit to be made.
  
  
• Because there are very few doctors who perform prolotherapy, patients typically just accept the pain or have surgery. While surgery has its place, many patients and doctors are not aware that prolotherapy may relieve their pain and postpone or prevent the surgery they thought they needed.
  
  
• Since prolotherapy is considered by most insurance companies to be “investigational” and it is not usually covered.
  

Frequently Asked Questions

1) What is Prolotherapy and what does it treat?

Prolotherapy is an injection method which treats chronically painful conditions by stimulating your body’s own healing process to repair injured soft tissues, such as ligaments, thereby stabilizing the joints. It involves the injection of a solution containing dextrose (corn extract) or other common substances, and lidocaine (anesthetic), into areas of injury.

2) How many injections are required?

This depends on your condition and the size of the area that needs to be treated. If there is only a small area of injury and tenderness, a few injections, taking 1-2 minutes, may be all that will be required. Large regions such as the lower back, upper back or neck regions usually require more injections. The volume of each injection is small, between 0.5 -1cc (ml). The procedure is performed in the clinic.

3) Do the injections hurt?

Some discomfort is expected with the injections. This varies from patient to patient, but is generally well-tolerated because the most common needle is short and slender, similar to an acupuncture needle. The most important thing a patient can do is to stay very relaxed by not tensing the muscles and to focus on slow, deep, continuous breathing. Patients who undergo prolotherapy may be given the option of receiving a prescription for oral pain medication to help minimize discomfort and/or a sedative medication to reduce anxiety. If sedation is used for the procedure, a friend or relative is required to drive you to and from your appointment. Prescription anesthetic cream to reduce skin sensation is another option. Each option can be discussed with Dr. Wheaton prior to scheduling the first treatment.

4) Are there any risks?

Since a needle is used to penetrate the skin into deeper tissues, there is a chance that inadvertent puncture of arteries, nerves, spinal fluid or lung tissue may occur. Complications from needle penetration are extremely rare and are greatly minimized by the skill of the trained Prolotherapist. The naturally-occuring substances used in prolotherapy are pharmaceutical-grade and have been used safely for many years. The amounts are within manufacturer’s guidelines. However, since prolotherapy is a procedure with some risk to the patient, all prolotherapy patients are asked to read and sign a consent and waiver form prior to the procedure.

5) Should I eat before I come?

A light, easily-digested meal and plenty of water are recommended about 1-2 hours prior to the procedure. Water improves cell hydration and lessens the discomfort of the injections, while food diminishes dizziness. Patients report less discomfort when they drink water right up to the time of, and immediately after, the injections.

6) How many treatments are needed?

Most patients receive four to ten treatments for a given area. A few patients respond quickly to just a treatment or two, but most patients will not. Some patients who respond slowly may need ten or more treatments and stronger solutions may be used to improve the response. The longer the problem has existed, and the more severe and widespread it is, the more treatments will be needed to stabilize the joints. After the first session, successive treatments follow at monthly intervals. Reassessment of structural healing and review of your symptoms usually occurs at the fourth session to determine if more treatments are necessary. Staying on a consistent schedule of treatments will decrease the chance that early benefits will be lost.

7) When will benefit from Prolotherapy become noticeable?

Prolotherapy does not result in immediate relief of pain. Some patients report improvement in as little as two weeks following injections, but it is not expected that any significant relief will be obtained until four to six weeks. Some patients report significant improvement in their symptoms following their first two treatments. Others may not receive much benefit at all until they have had further treatment. As ligament strength and joint stability improve, results become more noticeable. Improvement may continue for up to two years after the last prolotherapy treatment.

8) What can I take for the pain during recovery?

Typically, post-injection stiffness and soreness can be expected and is necessary for healing to begin. This lasts only a few days. Heat usually soothes the soreness, but ice should be avoided since it slows healing. No anti-inflammatory (NSAIDs) medications may be used once treatment begins because they interfere with the healing process that the prolotherapy injections created. An exception to this is for those who take a baby aspirin each day for their heart. Regular use of narcotic drugs should be avoided because they inhibit the immune system and also mask pain leading to further injury. Tylenol may be used for a short period of time. If you are not sure whether a medication you are taking interferes with your prolotherapy treatment, bring it to our attention. Specific supplements to assist the healing process are recommended and available at the clinic.

9) Should I exercise following Prolotherapy? What should I avoid doing?

Movement and exercise of the treated area promotes tissue healing and results in faster recovery from the treatment. For this reason, patients are encouraged to begin non-strenuous exercise as soon as possible following prolotherapy. The type and amount will depend on your level of fitness and on how many areas were treated. Actvities tolerated before prolotherapy can be resumed in just a few days following the treatment. Frequent high-velocity chiropractic adjustments should be avoided because they do not allow the joints treated with prolotherapy to stabilize. Massage and other similar therapies are compatible with prolotherapy.

10) When should I return to work?

In some cases, depending on your job, you may return to work the same day as your treatment. If, however, your job places a great deal of stress on the area treated, if you were sedated for the procedure, or if you have significant post-injection discomfort, you should not return to work the same day. We offer later clinic hours and weekend clinics to accommodate work schedules.

11) What are the chances I will get better?

Get worse? How long will it last?Statistics indicate that 85-90% of all patients treated with prolotherapy receive at least a 50% benefit when treated between two and ten times. There has been no evidence of a condition becoming permanently worse from receiving prolotherapy treatments. Also, because actual healing occurs with prolotherapy, it is anticipated that long-lasting or even permanent relief of your pain can take place. If an area is re-injured, or over-used, prolotherapy treatments may be necessary in the future.

12) Will my insurance cover Prolotherapy?

In most cases it will not be covered, as it still is considered by insurance companies to be an “investigational” type of treatment. If Dr. Wheaton is a provider for your insurance plan, the consultation can be sent through to your insurance company. We will discuss your particular situation regarding insurance coverage of prolotherapy and the fees involved before you proceed with treatment.

Former United States Surgeon General, Dr. C. Everett Koop, Endorses Prolotherapy.

The following is a reprinted excerpt from Prolo Your Pain Away by Dr. Ross Hauser. Used with permission from Dr. Koop.

"Prolotherapy is the name some people use for a type of medical intervention in musculo-skeletal pain that causes a proliferation of collagen fibers such as those found in ligaments and tendons, as well as a shortening of those fibers. The "prolo" in Prolotherapy, therefore, comes from proliferative.

Other therapists have referred to this type of treatment as Sclerotherapy. "Sclera" comes from the Greek word "sklera", which means hard. Sclerotherapy, therefore, refers to the same type of medical intervention which produces a hardening of the tissues treated – just as described above in the proliferation of collagen fibers.

Not many physicians are aware of Prolotherapy, and even fewer are adept at this form of treatment. One wonders why that is so. In my opinion, it is because medical folks are skeptical and Prolotherapy, unless you have tried it and proven its worth, seems to be too easy a solution to a series of complicated problems that afflict the human body and have been notoriously difficult to treat by any other method. Another reason is the simplicity of the therapy: Injecting an irritant solution, which may be something as simple as glucose, at the junction of a ligament with a bone to produce the rather dramatic therapeutic benefits that follow.

Another very practical reason is that many insurance companies do not pay for Prolotherapy, largely because their medical advisors do not understand it, have not practiced it, and therefore do not recommend it. Finally, Prolotherapy seems too simple a procedure for a very complicated series of musculoskeletal problems which affect huge numbers of patients. The reason why I consented to write the preface to this book is because I have been a patient who has benefitted from Prolotherapy. Having been so remarkably relieved of my chronic disabling pain, I began to use it on some of my patients – but more on that later.

When I was 40 years old, I was diagnosed in two separate neurological clinics as having intractable (incurable) pain. My comment was that I was too young to have intractable pain. It was by chance that I learned that Gustav A. Hemwall, M.D., a practitioner in the suburbs of Chicago, was an expert in Prolotherapy. When I asked him if he could cure my pain, he asked me to describe it. When I had done the best that I could, he replied., "There is no such pain. Do you mean a pain…" And then he continued to describe my pain much better than I could. When I said, "That’s it exactly," he said, "I can fix you." To make a long story short, my intractable pain was not intractable and I was remarkably improved to the point where my pain ceased to be a problem. Much milder recurrences of that pain over the next 20 years were retreated the same way with equally beneficial results.

I was so impressed with what Dr. Hemwall had done for me that on several occasions, just to satisfy my curiosity, I watched him work in his clinic and witnessed the unbelievable variety of musculoskeletal problems he was able to treat successfully. Many of his patients were people who had been treated for years by all sorts of methods, including major surgery, some of which had left them worse off than they were before. Many of his patients had the lack of confidence in further treatment and the low expectations that folks inflicted with chronic pain frequently exhibit. Yet I saw so many of them cured that I could not help but become a "believer" in Prolotherapy.

I was a pediatric surgeon, and there are not many times when Prolotherapy is needed in children because they just don’t suffer from the same relaxation of musculoskeletal connections that are so amenable to treatment by Prolotherapy. But I noticed frequently that the parents of my patients were having difficulty getting into their coats, or they walked with a limp, or they favored an arm. I would ask what the problem was and then, if it seemed suitable, offer my services in Prolotherapy at no expense, feeling that I was a pediatric surgeon and this was really not my line of work. The results I saw in those many patients were just as remarkable as was the relief I had received in the hands of Dr. Hemwall. I was so impressed with what Prolotherapy could do for musculoskeletal disease that I, at one time, thought that might be the way I would spend my years after formal retirement from the University of Pennsylvania. But the call of President Reagan to be Surgeon General of the United States interrupted any such plans.

The reader may wonder why, in spite of what I have said and what this book contains, there are still so many skeptics about Prolotherapy. I think it has to be admitted that those in the medical profession, once they have departed from their formal training and have established themselves in practice, are not the most open to innovative and new ideas.

Prolotherapy is not a cure-all for all pain. Therefore, the diagnosis must be made accurately and the therapy must be done by someone who knows what he or she is doing. The nice thing about prolotherapy, if properly done, is that it cannot do any harm. How could placing a little sugar-water at the junction of a ligament with a bone be harmful to a patient?

I hope that Dr. Hauser’s book, written for laymen, will push them to inquire more about Prolotherapy and that it might receive the place in modern therapeutics that I think it really deserves."