Neural prolotherapy is also known as subcutaneous prolotherapy or the Lyftogt technique. It is named after its founder, Dr. John Lyftogt of New Zealand, who has been using this method to treat musculoskeletal injuries and various pain conditions over the last decade with amazing results. Neural prolotherapy is the injection of dextrose or manitol just below the skin (subcutaneous) to promote healing of injured nerves and restoration of tissue function.
The rational for neural prolotherapy is based on Hilton’s Law. Dr. John Hilton was a British surgeon who mastered the anatomy and noted that the nerve that innervates a joint also innervates the skin over that joint and the muscles that move that joint. Based on this Dr. Lyftogt hypothesized that irritation to a nerve that supplies sensation to the skin over a joint may also cause dysfunction and pain to the muscles and tissue around that joint. Knowing that dextrose promotes tissue healing in connective tissue such as ligaments and tendons (traditional prolotherapy) and nerves contain connective tissue, Dr. Lyftogt postulated that dextrose could do the same for nerves. He injected small amounts of dextrose under the skin and noted decreased local swelling, and improvement of pain and function. Thus, he postulated that restoration of nerve function will lead to healing in deeper structures underlying those nerves and reduction in pain. Although more research is needed to prove this hypothesis, the anecdotal evidence is compellingly. The Lyftogt method is now being taught around the world because of its efficacy with minimal risk and side effects.
How does Neural prolotherapy relate to traditional prolotherapy?
Prolotherapy is deep injections to promote regeneration or repair of connective tissue (ie. ligaments and tendons) whereas neural prolotherapy is superficial injections that target subcutaneous nerves. Both modalities result in pain relief and functional restoration.
What is the solution that is injected?
Neural Prolotherapy solution contains either 5% Dextrose in water (D5W) or 5% Manitol in water (M5W). Manitol is a sugar alcohol derived from the desiduous tree called flowering ash and Dextrose is a natural sugar found in corn. D5W is the same solution used in IV bags in the emergency room and hospitals.
How does Neural prolotherapy work?
Tissue injury causes a release of proinflammatory substances (ie. Bradykinin, prostaglandins) that activate a nonselective cation channel on nerves called Transient receptor potential cation channel V1 (TrpV1), also known as the capsacin receptor. This in turn results in nerve release of substances that cause inflammation, like substance P and calcitonin gene related peptide (CGRP) leading to leaky blood vessels (swelling), hypersensitivity, burning and painful sensations. It is postulated that dextrose and manitol bind to and inhibit the TrpV1 nerve receptors, preventing this cascade and restoring normal nerve function.
Injury to nerves by stretching, constricting, or cutting them, also result in the release of these pro-inflammatory substances which can lead to chronic nerve dysfunction and “neurogenic pain”. Nervi nervorum are small nerves that connect with larger subcutaneous nerves. They are more sensitive to tissue tension changes that can result in nerve constriction, especially at sites where the nerves penetrate muscle or fascia. These potential chronic constriction sites are thought to cause abnormal nerve function and are the primary targets of subcutaneous prolotherapy.
This is a picture of different layers of tissue around the knee. Below the skin is a whitish layer of connective tissue called fascia. The picture on the right hand side shows subcutaneous nerves and nervi (yellow) that penetrate the fascia and are responsible for sensation to that area. Below this layer are muscles and tendons that are innervated by the same nerves (middle picture). Below that are the bones and ligaments (left).
At AcuProlo Institute we use the smallest possible hypodermic needle (30Gauge) to inject the neural prolotherapy solution just under the skin (subcutaneous) about ¾ inch deep. No local anesthetic is required because it is such a well tolerated procedure compared to other types of injections. Multiple injections are done along the subcutaneous nerves. Some insertion points may result in mild discomfort or a sensation of initial burning or stinging followed by resolution of pain.
How will I feel after a neural prolotherapy treatment?
Most patients get immediate significant pain relief after the treatment and some get complete resolution of pain. This analgesic effect may initially last anywhere between hours to weeks. With subsequent treatments less areas need to be injected because the tissue has healed and the pain free duration gets progressively longer.
How often do I need these treatments?
This is different for each individual. Some people may get permanent relief after just 2 or 3 treatments. Many require multiple injections every 1-2 weeks for 6-10 consecutive weeks.
Is neural prolotherapy safe?
It is safe when administered by a properly trained physician. With the proper technique the risk of infection and tissue injury is minimal to none. Possible adverse effects include local swelling, bruising and mild transient pain. The solution injected is very safe because it is the same solution used in IV bags in the hospital, sugar water (D5W).
What conditions will neural prolotherapy treat?
Neural Prolotherapy is very effective in treating nerve pain as well as any musculoskeletal injuries, including shoulder, knee and ankle tendonitis, neck and low back pain, migraines, temporal mandibular joint (TMJ), and many other conditions. Many people present to Acuprolo Institute with chronic pain for which they have “tried everything”, including surgery, and still have persistent pain. These people respond very well to neural prolotherapy.
Can neural prolotherapy be done on a child or an elderly person?
Yes! Since it is minimally invasive and utilizes a very natural solution, it is safe and effective in both the pediatric and geriatric population.
Will my insurance cover for neural prolotherapy?