Another major medical journal, the British Journal of Physical Medicine, wrote, "I hope the book, Ligament and Tendon Relaxation Treated by Prolotherapy, will be widely read by orthopedic surgeons, especially those who are inclined to resort to surgery too rapidly. Here is a method which is not harmful and may well save a lot of laminectomies and save many patients from being trussed up in corsets.(Hackett, G. Ligament and Tendon Relaxation Treated by Prolotherapy. Third Edition. Springfield, IL: Charles C. Thomas, Publisher, 1958.)

Even state medical society journals were excited. For instance the Ohio State Medical Journal wrote, "The book has been written so as to enable the reader to successfully carry out the diagnosis and treatment.(Hackett, G. Ligament and Tendon Relaxation Treated by Prolotherapy. Third Edition. Springfield, IL: Charles C. Thomas, Publisher, 1958.)

The American Medical Association was so excited about Prolotherapy that they let Dr. Hackett make presentations at their scientific exhibits several times in the 1950s. All of the above occurred in the late 1950s.The above confirms that Prolotherapy is a safe treatment that is easily learned, which not only treats, but also confirms the diagnosis and eliminates a lot of unnecessary surgeries. Why aren't all physicians, especially orthopedic surgeons and sports medicine physicians, doing it? The answer is apparent when you get a glimpse into what was occurring in medicine at that time. 

Rate of Healing
Unfortunately for most, one treatment of Prolotherapy is not sufficient to cause enough growth of ligament and tendon tissue to permanently eliminate the chronic pain or sports injury. The typical young athlete requires about two or three treatments. We adults who are not lean, mean, fighting machines typically require anywhere from four to eight treatments. The inflammatory response (of Prolotherapy)  typically occurs over a four to six week period, therefore most Prolotherapy physicians see patients for re-evaluation every four to six weeks. Athletes often do not have six weeks to wait for their next treatment. The athlete will tell the doctor something along these lines, "Doctor, the PGA tour starts in six weeks. I need to be healed by that time." In such an instance, the athlete may be treated weekly or every other week.

There is usually a step-wise progression of healing after Prolotherapy for the person who receives Prolotherapy every four to six weeks. The anesthetic in the solution used during Prolotherapy sessions often provides immediate pain relief. The pain relief may continue, after the effect of the anesthetic subsides, due to the stabilizing of the treated joints because of the inflammation caused by the Prolotherapy injections. This pain relief normally continues for a few weeks after each treatment.

Between the second and fourth weeks, the initial stabilization induced by the Prolotherapy subsides, and because the initial growth of ligament tissue is not complete, some of the original pain may return during this "window period" of healing. The patient is typically seen for follow-up four to six weeks after the treatment so progress can be accurately assessed, avoiding evaluation during the "window period." Prolotherapy is performed every four to six weeks because most ligaments and tendons heal over this time frame.

As the healing progresses, the number of injections required per treatment usually decreases. The pain generally continues to diminish with each treatment until it is completely eliminated, often after four to eight sessions.

In some cases, athletes or other chronic pain patients will not experience pain relief after their first or second Prolotherapy treatment. This does not necessarily mean that the therapy is not working, but rather it is an indication that the ligaments and tendons are not yet strong enough to stabilize the joints. The amount of collagen growth required for stabilization of the joint is different for each person. A patient who experiences pain relief at rest, but not during activity requires further treatment to strengthen the area. If Prolotherapy treatments are continued, there is an excellent chance of achieving total pain relief with the resumption of all previous activities, including athletics.

For the rare person who feels no relief with the third treatment, we do a nutritional assessment to see if there is something impairing the healing process. Some people want to do all of this on the first visit, which is often ideal because all aspects of healing can be initially addressed. Remember that Prolotherapy starts the healing process, the body grows the stronger tissue. The healthier the person, the more the tissue will be stimulated to grow with each treatment. If a person has a depressed immune system because of hormonal problems, nutritional deficiencies, or other medical problems (e.g., diabetes, etc.), these will decrease the body's ability to heal. Smoking and excessive drinking of alcohol have the same effect. This is where techniques like Metabolic Typing, nutritional counseling, and overall natural medicine care are encouraged

Another option available to the Prolotherapist is to increase the strength of the Prolotherapy solution. This will cause an increase in the proliferant ability of the solution-hopefully causing the growth of more tissue with each treatment. A consequence of increasing the strength of the solution is that the athlete will have more pain immediately after the anesthetic wears off. Not all people have the resiliency to tolerate this increased pain. With the normal gentle Prolotherapy solutions, generally only a small amount of soreness is felt after the treatments. It feels similar to the achy sensation after raking leaves. Your back is stiff and sore, but it is a good kind of soreness.

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