Prolotherapy is a stabilising injection treatment which may be helpful for women with the chronic pain and instability associated with PGP. It seems to work well for women whose pelvis can be realigned and made pain-free during a manual therapy session, but as soon as they return to the normal activities of life, the pain and instability returns. This can be due to a true instability at the pelvic joints where the ligaments have been overstretched. Ligaments are different from muscles, and once significantly overstretched, sometimes cannot return to their normal length.
Prolotherapy may help where women have had on-going problems with PGP despite having courses of manual therapy from experienced and skilful practitioners, and the joints do not seem to stay in alignment for long after treatment.
Prolotherapy involves the injection of an ‘irritant’ sucrose solution along with a local anaesthetic into a ligament around a joint, including the symphysis pubis, sacroiliac joints or lumbar spine. This causes a local inflammatory reaction, which in turn makes the ligaments tighten up. These changes also result in the deposition of new collagen which is the material from which tendon and ligaments are made. As the collagen matures it shrinks and this, in turn, tightens the ligaments so they appear to be stronger than before.
The best results seem to be in women who have had their pelvic alignment checked just before and after the injections, so the pelvis is in the best possible position for the ligaments to hold it in. If this has not been done, women have reported disappointing results, as the treatment is aimed at changing stability rather than pain.
The effectiveness of prolotherapy treatment may vary because of the different needs of individual women. Some women have reported relief in pain and increased stability after just one session. However, the average person requires around three sessions of treatment. The treatment usually entails three sets of injections with a week to a months break between each set, and these are usually given with local anaesthetic or sedation to reduce the pain of the injections. There might be bruising around the site of the injection after treatment which disappears after a few days. Often the improvement is noticeable quite soon after treatment. You should not take anti-inflammatory medication after the injections as this reduces the inflammatory effect which the treatment is trying to produce.
The procedure is supported by many hospitals in this country and abroad. A Cochrane review of the medical literature which was conducted in 2007 found there was conflicting scientific evidence about the effectiveness of prolotherapy. There are research reviews published on the internet which can help you to understand the pros and cons of this procedure. Many are shown on websites originating in the USA but there are also websites about prolotherapy published within the UK.
Content reviewed and updated in 2017.