Classic prolotherapy had been developed in 1940 by an American doctor Dr George Hackett. He used injections of Sylnasol, a sclerosing agent commonly used at the time for sclerosis of the veins, hemorrhoids and hernias.

He infiltrated loose and weak ligaments with Sylnasol to make them stronger. Hackett thought that weak ligaments were the cause of most joint and ligament pain and that reinforcing it would solve the pain. It was certainly very successful and published 16 articles and a book.

Hackett claimed an 80% success rate for the treatment of the lumbosacral spine and many other painful situations. After Sylnasol was removed from the market in 1950, many other sclerosing solutions were used which are still in use in the USA and in many other countries. One of the solutions developed was P2G which contains glucose, glycerin and phenic acid.

This solution was also used in New Zealand by the Doctor Milne Ongley but caused too many side effects to the point of deleting Dr. Ongley from the register of doctors in 1974. The person responsible for occasional serious adverse reactions was highlighted in phenol. Other doctors in the USA, Australia and other places continued to use glucose infiltrations and no other side effects were reported except for temporary and mild irritation.

A growing number of studies on prolotherapy over the past 40 years have showed good to excellent results from the treatment with glucose infiltrations for painful conditions affecting the joints, ligaments and tendons. With the advent of evidence-based medicine in the past 20 years the demand of scientific research has become very demanding and financially far beyond the possibilities of many researchers unless supported by the large grants of the pharmaceutical industry.

A result with a good high level of evidence (level 1 & 2 on a scale of 5) in prolotherapy research was almost impossible to achieve, but three researchers, Professor Michael Yelland from Australia, Professors David Rabago and Prof. Dean Reeves from the USA have improved the trend with excellent studies published recently. Dr. John Lyftogt has published four studies in the Australian musculoskeletal medicine journal until 2005 and is coauthor of a randomized level 2 trial published in the British Journal of Sports Medicine in June 2009.

SURFACE PROLOTHERAPY

Dr John Lyftogt has been a general practitioner since 1978 and was a senior partner in the Parkland Medical Center. He had an intensive training after graduation and practice in sports medicine and musculoskeletal field. He began the practice of prolotherapy after completing a prolotherapy course with the Doctor. Margaret Taylor in Adelaide in 2003. He has been a full-time prolotherapist since 2004.

Dr Lyftogt’s initial research has focused on treating Achilles tendon problems of which he has treated more than 300 of them with a success greater than 90%. He has published four articles on Achilles tendons. The technique developed for the treatment of the Achilles tendon differs from classical prolotherapy. In fact, in this technique the infiltrations are performed subcutaneously while great care is taken to avoid contact with the tendinous structures.

This protocol of 'neural prolotherapy' or 'subcutaneous prolotherapy' was successfully extended to the tratment of tennis elbow ', painful knees, shoulders, neck, hips, ankles, muscle and lumbosacral injuries. The results are consistent and in a two-year follow up the studies showed a success rate between 80-100%. Treatment is also less invasive than traditional prolotherapy. Since neural prolotherapy does not target tendons, ligaments or joints, the question that arises is what causes this, sometimes, important decrease in the level of pain even after only a few treatments. A developed working hypothesis hypothesizes that glucose promotes the repair of the connective tissue in the nerve trunks under the skin in the same way as the connective tissue is repaired in the ligaments and tendons with classical prolotherapy.

These skin nerves are known to be responsible for painful conditions identified as 'neuralgia' or 'peripheral neuropathic pain'. The nerve trunks of the skin are made up of 80% of connective tissue and are structurally similar to the tendons and ligaments. There is now also a compelling scientific evidence that very small nerves that innervate the trunk, known as 'nervi nervorum', are responsible for inflammation of the connective tissue of the nervous trunk and surrounding tissues.

 

This interesting and surprising fact has been known for more than 125 years. It is also known that this 'neurogenic inflammation' differs from conventional inflammation in that it does not respond to anti-inflammatories or cortisone infiltrations.

This is one of the reasons why the common drugs used prove ineffective in many painful conditions in combination with the growing awareness that they are not without side effects. It is clear from clinical observations on more than three thousand patients and from the large series of cases that neural prolotherapy actually reverses neurogenic inflammation 'and resolves neurogenic pain.

This result opens the way to the exploration of other substances that may have the potential to reverse neurogenic inflammation 'similar to glucose but without having to infiltrate it. One of these substances has already been identified in vitamin D in the form of tablets and dermal cream. Dr John Lyftogt is studying other promising drugs and trying these 'potential cures' to eradicate pain and injury.