Prolotherapy is an injection-based regenerative treatment whose aim is to repair soft tissue and restore its function. Soft-tissue comes in many forms including muscle, tendon, ligaments, fascia, nerves, and synovium. Soft tissue injuries are major sources of musculoskeletal pain both acute and chronic.
Prolotherapy types are different because of the solution being injected into the site of injury. Prolotherapy injection types include hypertonic dextrose, PRP (platelet-rich plasma) and stem cells. Of these, stem cell prolotherapy helps with more intense cases- where dextrose and PRP injections are typically not effective.
Why Stem Cells?
Stem cells have the ability to replace dead and injured cells of a particular tissue. Certain tissues, like skin, have a stem cell layer that works to replace cells that have died naturally or from injury. Certain tissues, however, lack an abundance of stem cells and thus have a harder time healing- such is the case for soft tissues.
To induce the healing of tissue that lacks an abundance of stem cells, transplantation from a site of greater concentration is possible. This is essentially how stem cell prolotherapy works. Stem cells are taken from a site of greater concentration (bone marrow or adipose (fat) tissue) and are injected to a site of lower concentration (the soft tissue injury). The result is a boost in the healing capacity of recipient tissue, making its repair possible.
How do Stem Cells Heal?
Stem cells can become a variety of cells in the body. This is why they are amazing tools for healing. The healing potential of a stem cell can be determined by its potency, that is, how many different cell types it can produce and become. Prolotherapy relies on the use of pluripotent stem cells, which can become virtually any cell in the human body when provided with the right chemical signals.
When stem cells are injected to a new site for healing, the new environment (tendon, bone, etc) provides the chemical signals to induce its transformation. The previously undetermined cell can now become part of the recipient tissue and restore its function. Similarly, in the case of soft tissue injuries, the introduction of stem cells will elicit repair, growth, stability, and restoration of function. Pain relating to previously unhealed injuries and tissue degradation also resolves.
Stem Cells Used
Stem cells used for prolotherapy injections come from the patient’s own body, they are autologous. There are two main sites from which stems cell are harvested for prolotherapy; bone marrow and adipose tissue.
Bone Marrow Stem Cells (BMSCs)-
Stem cells from bone marrow have proven effective in the regeneration of the structure of the skeletal system including bone, and cartilage. These benefit orthopedic purposes such as bone repair, union fractures, and spinal fusion. Also, BMSC can differentiate osteogenically (pertaining to bone formation).
Adipose (fat) Derived Stem/Stromal Cells (ADSCs)-
Like BMSCs, ADMCs have the ability to repair bone and other soft tissue. Unlike BMSCs, there is an abundance of ADMCs (500 to 1,000 time more ADMCs than BMSCs) (1).
Depending on the type and severity of the musculoskeletal injury, a physician may or may not use stem cell prolotherapy. It is good to know, however, that an option exists for more severe cases.
Hauser, Ross A, et al. “Journal of Prolotherapy International Medical Editorial Board Consensus Statement on the Use of Prolotherapy for Musculoskeletal Pain.” Journal of Prolotherapy, 14 Aug. 2017, journalofprolotherapy.com/journal-of-prolotherapy-international-medical-editorial-board-consensus-statement-on-the-use-of-prolotherapy-for-musculoskeletal-pain/.