PROLOTHERAPY is an injection therapy designed to stimulate the proliferation and production of new fibrous connective tissue in order to repair and strengthen the skeletal infra-structure (ligaments, tendons, fascia, joint capsules), because weakness or laxity of these elements result in chronic musculoskeletal pain. Weak or lax fibrous connective tissue does not have a proper tensile strength, therefore, it will not be able to absorb the stress / strain energy properly, and this energy will be transmitted to the sensory nerve fibers which will respond by firing pain impulses. The greatest stresses to the fibrous tissue occur at the fibro-osseous junctions, because two different types of tissue meet (fibrous and bone). As the blood supply is very poor at these junctions, the healing that results is usually incomplete. Prolotherapy injections take place at these junctions to act as spot welding, strengthening the weld between the fibrous tissue and bone. Prolotherapy turns on the natural healing cascade of the body (inflammation), by creating a temporary low grade inflammation at the injection site to raise the growth factors level, which will stimulate the fibroblasts to lay down new fibers to form strong connective tissue. Different proliferants (solutions) have been used in prolotherapy: Chemical irritant, some particulate, chemotactic agent, osmotic agent (dextrose), which is the main solution used in prolotherapy and is still used till now, growth factors, platelet rich plasma, and stem cells. Mal-Alignment changes the normal line of pressure of the body, subsequently, changes the normal 6 normal forces which are normally exerted on the body, hence weakening the infra-structures elements of the body, and causing the musculoskeletal pain.

Sector Chief of the American Academy and Association of Orthopedic Medicine in Europe and Africa, American Academy / Association of Orthopedic Medicine “AAOM” American Academy of Regenerative Medicine “AARM” Hackett Hemwall Patterson Foundation “HHPF”, Egypt