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The Biology of Prolotherapy and Its Application in Clinical Cervical Spine Instability and Chronic Neck Pain: A Retrospective Study

Background: In an effort to facilitate the diagnosis and treatment of clinical cervical spine instability (CCSI) and chronic neck pain, we investigated the role of proliferative injection Prolotherapy in the reduction of pain and recovery of constitutional and neurological symptoms associated with increased intervertebral motion, structural deformity and irritation of nerve roots. Methods: For this retrospective case series, 21 study participants were selected from patients seen for the primary complaint of cervicalgia. Following a series of proliferative injections, performed in a private sub-specialty pain clinic, patient-reported assessments were measured using questionnaire data, including range of motion (ROM), crunching, stiffness, pain level, numbness, and exercise ability, between 1 and 39 months post-treatment (mean = 24 months). All patients signed a consent form prior to treatment. Results: 95 percent of patients reported that Prolotherapy met their expectations in regards to pain relief and functionality. Significant reductions in pain at rest, during normal activity, and during exercise were reported. A mean of 86 percent of patients reported overall sustained improvement, while 33 percent reported complete functional recovery. 31 percent of patients reported complete relief of all recorded symptoms. No adverse events were reported. Conclusion: The results of this study demonstrate statistically significant reductions in pain and functionality, indicating the safety and viability of Prolotherapy for cervical spine instability. Such clinical efficacy of this procedure warrants further investigation as a non-invasive treatment option.

Atlanto-Axial Joint, Barré-Liéou Syndrome, Cervicalgia, Cervical Instability, Facet Joint Injury, Manual Therapy, Posterior Cervical Sympathetic Syndrome, Prolotherapy

Ross A. Hauser, Danielle Steilen, Karina Gordin. (2015). The Biology of Prolotherapy and Its Application in Clinical Cervical Spine Instability and Chronic Neck Pain: A Retrospective Study. European Journal of Preventive Medicine, 3(4), 85-102.

Copyright © 2015 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. White A, Panjabi MM: Clinical Biomechanics of the Spine. Philadelphia: J.B. Lippincott Company; 1978.
2. Kim CW, Perry A, Garfin SR: Spinal instability: the orthopedic approach. Semin Musculoskelet Radiol 2005, 9(1):77–87.
3. Dupuis PR, Yong-Hing K, Cassidy JD, Kirkaldy-Willis WH: Radiologic diagnosis of degenerative lumbar spinal instability. Spine 1985, 10(3):262-276.
4. Lowery DW, Wald MM, Browne BJ, Tigges S, Hoffman JR, Mower WR, NEXUS Group. Epidemiology of cervical spine injury victims. Ann Emerg Med 2001, 38(1):12–16.
5. Desjardins G: Injuries to the cervical spine []
6. Hoy DG, Protani M, De R, Buchbinder R: The epidemiology of neck pain. Best Prac Res Clin Rheumatol 2010, 24(6):783-92.
7. Barnsley L, Lord S, Bogduk N: Whiplash injury. Pain 1994, 58(3):283-307.
8. Freeman MD, Croft AC, Rossignol AM, Weaver DS, Reiser M: A review and methodologic critique of the literature refuting whiplash syndrome. Spine 1999, 24(1):86-96.
9. Panjabi MM, Pearson AM, Ito S, Ivancic PC, Gimenez SE, Tominaga Y: Cervical spine ligament injury during simulated frontal impact. Spine 2004, 29(21):2395-2403.
10. Siegmund GP, Myers BS, Davis MB, Bohnet HF, Winkelstein BA: Mechanical evidence of cervical facet capsule injury during whiplash: a cadaveric study using combined shear, compression, and extension loading. Spine 2001, 26(19):2095-101.
11. Tominaga Y, Ndu AB, Coe MP, Valenson AJ, Ivancic PC, Ito S, Rubin W, Panjabi MM: Neck ligament strength is decreased following whiplash trauma. BMC Musculoskelet Disord 2006, 7:103.
12. Foreman SM, Croft AC: Whiplash injuries: the cervical acceleration/deceleration syndrome. Philadelphia: Lippincott Williams & Wilkins; 2002.
13. White AA, III, Panjabi MM: Clinical Biomechanics of the Spine. Philadelphia, PA: J.B. Lippincott Company; 1990.
14. Dickerman RD, Mittler MA, Warshaw C, Epstein JA: Spinal cord injury in a 14-year-old male secondary to cervical hyperflexion with exercise. Spinal Cord 2006, 44(3):192–195.
15. Benzel E: The Cervical Spine. 5 ed. Philadelphia PA: Lippincot, Williams and Wilkins; 2012.
16. Volle, E: Functional magnetic resonance imaging- Video diagnosis of soft tissue trauma to the craniocervical joints and ligaments. Int Tinnitus J 2000, 6(2): 134-139.
17. Saldinger P,Dvorak J, Rahn BA, Perren SM: Histology of alar and transverse ligaments. Spine 1990, 15:257-261.
18. Dvorak, Scheider E, Saldinger PF, Rahn B: Biomechanics of the craniocervical region: the alar and transverse ligaments. J Orthop Res 1988, 6:452-461.
19. Schafer RC: Chiropractic Management of Sports and Recreational Injuries. 2 ed. Philadephia: Williams & Wilkins; 1986.
20. Dvorak J, Panjabi MM: Functional anatomy of the alar ligaments. Spine1987, 12(2):183-189.
21. Hulse, M: Die Cervicalen Gleichgewichtsstorungen. Heidelberg: Springer-Verlag; 1983.
22. Dvorak J, Dvorak V, Drobny T: Manual Medicine: Diagnostics. Stuttgart: Thieme Publishers; 1984.
23. Darnell MW: A proposed chronology of events for forward head posture. J craniomandibular pract 1983, 1(4):49-54.
24. Paris SV: Course Notes: The Spine Evaluation and Treatment of Spinal Dysfunction. Course notes: 1978 and 1981.
25. Rocabado M: Physical Therapy and Dentistry I and II. Course notes, 1979 and 1981.
26. Jackson R: The Cervical Syndrome. Springfield: Charles C. Thomas Publisher; 1977.
27. Kirkaldy-Willis WH, Farfan HF: Instability of the lumbar spine. Clin Orthop 1982, (165):110-123.
28. Chen B, Fellenberg J, Wang H, Carstens C, Richter W: Occurrence and regional distribution of apoptosis in scoliotic discs. Spine 2005, 30(5):519-524.
29. Wang YJ, Shi Q, Lu WW, Cheung KC, Darowish M, Li TF, Dong YF, Zhou CJ, Zhou Q, Hu ZJ, Liu M, Bian Q, Li CG, Luk KD, Leong JC: Cervical intervertebral disc degeneration induced by unbalanced dynamic and static forces: a novel In Vivo rat model. Spine 2006, 31(14):1532-1538.
30. Schafer RC: Clinical Biomechanics: Musculoskeletal Actions and Reactions. 2 ed. Philadelphia: Williams & Wilkins;1983.
31. Nicholl EA: Fractures of the dorso-lumbar spine. J Bone Joint Surg Br 1949, 31B(3): 376–394.
32. Pope MH, Panjabi MM: Biomechanical definitions of spinal instability. Spine 1985, 10(3):255-256.
33. Rocabado M: The importance of soft tissue mechanics in stability and instability of the cervical spine: a functional diagnosis for treatment planning. J Craniomandibular Pract 1987, 5(20):130-138.
34. Ebraheim NA, Xu R, Ahmad M, Heck B, Yeasting RA: The effect of anterior translation of the vertebra on the canal size in the lower cervical spine: a computer-assisted anatomic study. J Spinal Disord 1997, 10(2):162-166.
35. Panjabi MM: The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. J Spinal Disord 1992, 5(4):390-397.
36. Kritjansson E, Leivseth G, Brinckmann P, Frobin W: Increased sagittal plane segmental motion in the lower cervical spine in women with chronic whiplash associated disorders, grades I-II: a case control study using a new measurement protocol. Spine 2003,28(19):2215-2221.
37. Cook C, Brismee JM, Fleming R, Sizer PS: Identifiers suggestive of clinical cervical spine instability: a Delphi study of physical therapists. Phys Ther 2005, 85:895-906.
38. Vandemark RM: Radiology of the cervical spine in trauma patients: practice pitfalls and recommendations for improving efficiency and communication. Am J Roentgenol 1990,155(3):465-72.
39. Gatterman M: Foundations of Chiropractic, 1st ed. St. Louis: Mosby/Elsevier; 1995.
40. Hino H, Abumi K, Kanayama M, Kaneda K: Dynamic motion analysis of normal and unstable cervical spines using cineradiography. An in vivo study. Spine1999, 24(2):163-168.
41. Binkley J, Finch E, Hall J, Black T, Gowland C: Diagnostic classification of patients with low back pain: Report on a survey of physical therapy experts. PhysTher 1993, 73(3):138-155.
42. Baumgarten M, Mouradian W, Boger D, Watkins R: Computed axial tomography in C1-C2 trauma. Spine 1985, 10:187-192.
43. Ono K, Yonenobu K, Fuji T, Okada K: Atlantoaxial rotary fixation: Radiographic study of its mechanism. Spine 1985, 10(7):602-608.
44. Hutting N, Scholten-Peeters GG, Vijverman V, Keesenberg MD, Verhagen AP: Diagnostic accuracy of upper cervical spine instability tests: a systematic review. Phys Ther 2013,93(12): 1686-1695.
45. Jull G: Whiplash, Headache and Neck Pain. N.p.: Elsevier Limited; 2008.
46. Volle E: Diagnostische Methoden bei Verletzungen am kraniozervikalen Übergang. In: Moskopp D, Wassmann H, editors. Neurochirurgie. Handbuch für die Weiterbildung und interdisziplinäres Nachschlagewerk. New York: Schattauer Verlag; 2004.
47. Johansson BH: Whiplash injuries can be visible by functional magnetic resonance imaging. Pain Res Manag 2006, 11(3):197-199.
48. Dvorak J: Musculoskeletal Manual Medicine. Stuttgart, Germany: Georg Thieme Verlag; 2008.
49. Antinnes JA, Dvorák J, Hayek J, Panjabi MM, Grob D: The value of functional computed tomography soft-tissue injury in the upper cervical spine. Eur Spine J 1994,3(2):98-101.
50. Dvorak J, Panjabi MM, Novotny JE, Antinnes JA: In vivo flexion extension of the normal cervical spine. J Orthop Res 1991, 9:828-834.
51. Dvorak J, Penning L, Hayek J, Panjabi MM, Grob D, Zehnder R: Functional diagnostics of the cervical spine using computer tomography. Neuroradiology 1988, 30(2):132-37.
52. Lord SM, Barnsley L, Wallis BJ, Bogduk N: Chronic cervical zygapophysial joint paint after whiplash: a placebo controlled prevalence study. Spine 1996, 21(15):1737-1744.
53. Manchikanti L, Boswell MV, Singh V, Pampati V, Damron KS, Beyer CD: Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic and lumbar regions. BMC Musculoskelet Disord 2004, 5:15.
54. Bogduk N: The clinical anatomy of the cervical dorsal rami. Spine 1982, 7:35–45.
55. Dwyer A, Aprill C, Bogduk N. Cervical zygapophyseal joint pain patterns. I: a study in normal volunteers. Spine 1990, 6:453–457
56. Manchikanti L, Singh V, Rivera J, Pampati V: Prevalence of cervical facet joint pain in chronic neck pain. Pain Physician 2002, 5(3):243-249.
57. Schafer RC: Clinical Biomechanics: Musculoskeletal Actions and Reactions. 2 ed. Philadelphia: Williams & Wilkins;1983.
58. Quinn KP, Bauman JA, Crosby ND, Winkelstein BA: Anomalous fiber realignment during tensile loading of the rat facet capsular ligament identifies mechanically induced damage and physiological dysfunction. J. Biomech 2010, 43(10):1870–1875.
59. Jaumard NV, Welch WC, Winkelstein BA: Spinal facet joint biomechanics and mechanotransduction in normal, injury and degenerative conditions. J Biomech Eng 2011, 133(7):071010.
60. Fujiwara A, Lim TH, An HS, Tanaka N, Jeon CH, Andersson GB, Haughton VM: The effect of disc degeneration and facet joint osteoarthritis on the segmental flexibility of the lumbar spine. Spine 2000, 25(23):3036–3044.
61. Provenzano PP, Alejandro-Osorio AL, Valhmu WB, Jensen KT, Vanderby R Jr: Intrinsic fibroblast-mediated remodeling of damaged collagenous matrices in vivo. Matrix Biol 2005, 23(8):543–555.
62. Ramage L, Nuki G, Salter DM: Signaling cascades in mechanotransduction: cell-matrix interactions and mechanical loading. Scand J Med Sci Sports 2009, 19(4):457–469.
63. Giles LG, Harvey AR: Immunohistochemical demonstration of nociceptors in the capsule and synovial folds of human zygapophyseal joints. Br J of Rheumatol 1987,26(5):362-364.
64. Cramer G, Darby SA: Clinical Anatomy of the Spine, Spinal Cord and ANS. 3d ed. St. Louis, MO: Mosby/Elsevier; 1995.
65. Bogduk N, Lord SM: Cervical zygapophysial joint pain. Neurosurg Quart 1998, 8:107-117.
66. Pearson AM, Invancic PC, Panjabi MM: Facet joint kinematics and injury mechanisms during simulated whiplash. Spine 2004, 29(4):390-397.
67. Winkelstein BA, McLendon RE, Barbir A, Myers BS: An anatomical investigation of the human cervical facet capsule, quantifying muscle insertion area. J Anat 2001,198(pt 4):455-461.
68. Winkelstein BA, Nightingale RW, Richardson WJ, Myers BS: Cervical facet joint mechanics: its application to whiplash injury. Proceedings of the 43 Stapp Car Crash Conference. pp243-252.
69. Stemper BD, Yoganandan N, Pinter FA: Effects of abnormal posture on capsular ligament elongations in a computational model subjected to whiplash loading. J Biomech 2005, 38(6):1313-1323.
70. Lu Y, Chen C, Kallakuri S, Patwardhan A, Cavanaugh JM: Neural response of cervical facet joint capsule to stretch: a study of whiplash pain mechanism. Stapp Car Crash J 2005,49:49-65.
71. Winkelstein BA, Nightingale RW, Richardson WJ, Myers BS: The cervical facet capsule and its role in whiplash injury: a biomechanical investigation. Spine 2000, 25(10): 1238-1246.
72. Iatridis JC, MaClean JJ, Ryan DA: Mechanical damage to the intervertebral disc annulus fibrosus subjected to tensile loading. J Biomech 2005, 38(3): 557-565.
73. Foster CA, Jabbour P: Barré-Lieou syndrome and the problem of the obsolete eponym. J Laryngol Otol 2007, 121(7):680-683.
74. McIntosh J: Chedoke-McMaster Hospital’s Musculoskeletal physiotherapy program: Internal Report. Hamilton, Ontario, Canada: Physiotherapy Departmental Report; 1992.
75. Borghouts JA, Koes BW, Vondeling H, Bouter LM: Cost of illness in neck pain in the Netherlands in 1996. Pain 1999,80(3):629-636.
76. Spitzer WO: Scientific approach to the assessment and management of activity-related spinal disorders: a monograph for clinicians: Report of the Quebec Task Force. Spine 1987, 12:S1-59.
77. Borghouts JA, Koes BW, Bouter LM: The clinical course and prognostic factors of nonspecific neck pain: a systematic review. Pain 1998, 77(1):1-13.
78. Rubinstein SM, Terwee CB, Assendelft WJ, de Boer MR, van Tulder MW: Spinal manipulative therapy for acute low-back pain. Cochrane Database Syst Rev. 2012 Sep 12;9:CD008880.
79. Di Fabio RP: Efficacy of manual therapy. Phys Ther 1992, 72:853–864.
80. Aker PD, Gross AR, Goldsmith CH, Peloso P: Conservative management of mechanical neck pain: systematic overview and meta-analysis. BMJ 1996, 313(7068):1291-6.
81. Bronfort G: Efficacy of spinal manipulation and mobilization for low back and neck pain: a systematic review and best evidence synthesis. PhD thesis. Amsterdam, Netherlands: Thesis Publishers; 1997.
82. Hurwitz EL, Aker PD, Adams AH, Meeker WC, Shekelle PG: Manipulation and mobilization of the cervical spine: A systematic review of literature. Spine 1996, 21(15):1746-1760.
83. Nilsson N, Christensen HW, Hartvigsen J: Lasting changes in passive range of motion after spinal manipulation: a randomized, blind, controlled trial. JMPT 1996, 19(3): 165- 168.
84. Gross AR, Kay T, Hondras M, Goldsmith C, Haines T, Peloso P: Manual therapy for mechanical neck disorders: a systematic review. Man Ther 2002, 7(3):131-49.
85. Peeters GG, Verhagen AP, de Bie RA, Oostendorp RA: The efficacy of conservative treatments in patients with whiplash injury: a systematic review of clinical trials. Spine 2001, 26(4):E64-E73.
86. Norris JW, Beletsky V, Nadareishvili ZG: Sudden neck movement and cervical artery dissection. The Canadian Stroke Consortium. CMAJ 2000, 163(1):38-40.
87. Ernst E: Manipulation of the cervical spine: a systematic review of case reports of serious adverse events, 1995-2001. Med J 2002,176:376-80.
88. Parenti G, Orlandi G, Bianchi M, Renna M, Martini A, Murri L: Vertebral and carotid artery dissection following chiropractic cervical manipulation. Neurosurg Rev 1999, 22(2-3):127-129.
89. Mehalic T, Farhat SM: Vertebral artery injury from chiropractic manipulation of the neck. Surg Neurol 1974, 2(2):125-129.
90. Nall SK: The role of specific manipulation towards alleviating abnormalities in body mechanics and restoration of spinal motion. J Manip Physiol Ther 1982, 5(1):11-15.
91. Mannen E: The use of cervical radiographic overlays to assess response to manipulation. J Can Chiropr Assoc 1980, 24(3): 108–110.
92. Tippets RH, Apfelbaum RI: Anterior fusion with the caspar instrumentation system. Neurosurgery 1988,22(6 pt 1):1008-1013.
93. Deyo RA, Gray DT, Kreuter W, Mirza S, Martin BI: United States trends in lumbar fusion surgery for degenerative conditions. Spine 2005,30(12):1441–1445.
94. Abelson R, Petersen M: An Operation to Ease Back Pain Bolsters the Bottom Line, too. The New York Times, December 31, 2003.
95. Munro D: The factors that govern the stability of the spine. Paraplegia 1965, 3:219-228.
96. Brav EA, Miller JA, Bouzard WC: Traumatic dislocation of the cervical spine: army experience and results. J Trauma 1963,3:569-582.
97. Binder A: Neck pain. Clin Evid (Online). 2008;2008:1103.
98. Shamji MF, Cook C, Pietrobon R, Tackett S, Brown C, Isaacs RE: Impact of surgical approach on complications and resource utilization of cervical spine fusion: a nationwide perspective to the surgical treatment of diffuse cervical spondylosis. Spine J 2009, 9(1):31-38.
99. De Graaff R: Congential block vertebrae C2-C3 in patients with cervical myelopathy. Acta Neurochir 1982,61(1-3):111-126.
100. Bydon M, Xu R, Macki M, De la Garza-Ramos R, Sciubba DM, Wolinsky JP, Witham TF, Gokaslan ZL, Bydon A: Adjacent segment disease after anterior cervical discectomy and fusion in a large series. Neurosurgery 2014, 74(2):139-146.
101. Todd AG: Cervical spine: degenerative conditions. Curr Rev Musculoskelet Med 2011, 4(4): 168–174.
102. Gruss P, Tannenbaum H: Stress exertion on adjacent levels after ventral ventrical fusion. Arch Orthop Trauma Surg 1983,101:283-286.
103. Xu R, Bydon M, Macki M, De la Garza-Ramos R, Sciubba DM, Wolinsky JP, Witham TF, Gokaslan ZL, Bydon A: Adjacent segment disease after anterior cervical discectomy and fusion: clinical outcomes after first repeat surgery versus second repeat surgery. Spine 2014,39(2):120-126.
104. James Yue: The Comprehensive Treatment of the Aging Spine: Minimally Invasive and Advanced Techniques. Philadelphia PA: Saunders/Elsevier;2011.
105. Greene J: Cost-conscious prescribing of nonsteroidal anti-inflammatory drugs for adults with arthritis. Arch Internal Med 1992,152:1995-2002.
106. Almekinders LC, Baynes AJ, Bracey LW: An in vivo investigation into the effects of repetitive motion and nonsteroidal anti-inflammatory medical on human tendon fibroblasts. Am J Sports Med 1995,23:119-123.
107. Kulick MI, Smith S, Hadler K: Oral ibuprofen: evaluation of its effect on peritendinous adhersions and the breaking strength of a tenorrhaphy. J Hand Surg Am 1986,11A:110-119.
108. Snider R: Essentials of Musculoskeletal Care. Rosemont, IL: American Academy of Orthopaedic Surgeons; 1997.
109. Truhan AP, Ahmed AR: Corticosteroids: a review with emphasis on complications of prolonged systemic therapy. Ann Allergy 1989,62(5):375-290.
110. Gogia PP, Brown M, al-Obaidi S: Hydrocortisone and exercise effects on articular cartilage in rats. Arch Phys Med Rehabil 1993, 74(5):463-467.
111. Ferland M: Necrose localisee due a une injection intratendineuse de glucocorticoide: etude experimentale comparative. Union Med Can. 1972;101:1768-1771.
112. Carayannopoulos A, Borg-Stein J, Sokolof J, Meleger A, Rosenberg D: Prolotherapy vs corticosteroid injections for the treatment of lateral epicondylosis: a randomized, controlled trial. PM R 2011,3(8):706-715.
113. Jobe FW, Ciccotti MG: Lateral and medial epicondylitis of the elbow. J Am Acad Orthop Surg 1994,2(1):1-8.
114. Speed CA: Corticosteroid injections in tendon lesions. Br Med J 2001,323(7309):382-386.
115. Labelle H, Guibert R, Joncas J, Newman N, Fallaha M, Rivard CH: Lack of scientific evidence for the treatment of LE of the elbow. An attempted meta-analysis. J Bone Joint Surg Br 1992,74(5):646-651.
116. Hirpara KM, Butler JS, Dolan RT, O’Byrne JM, Poynton AR: Nonoperative modalities to treat symptomatic ervical spondylosis. Adv Orthop 2012, 2012: 294857.
117. Gross AR, Goldsmith C, Hoving JL, Haines T, Peloso P, Aker P: Conservative management of mechanical neck disorders: a systematic review. J Rheumatol 2007,34(5):1083-102.
118. Persson LC, Carlsson CA, Carlsson JY: Long-lasting cervical radicular pain managed with surgery, hysiotherapy, or a cervical collar. A prospective, randomized study. Spine 1997,22(7):751-8.
119. Persson LC, Moritz U, Brandt L, Carlsson CA: Cervical radiculopathy: pain, muscle weakness and sensory loss in patients with cervical radiculopathy treated with surgery, physiotherapy or cervical collar. A prospective, controlled study. Eur Spine J 1997,6(4):256-66.
120. Matz PG: Does nonoperative management play a role in the treatment of cervical spondylotic myelopathy? Spine J 2006, 6(6 Suppl):175S-181S.
121. Olson KA, Joder D: Diagnosis and treatment of cervical spine clinical instability. J Orthop Sports Phys Ther 001, 31(4):194-206.
122. Ho KY, Tan KH: Botulinum toxin A for myofascial trigger point injection: a qualitative systematic review. Eur J Pain 2007,11(5):519-27.
123. Langevin P, Peloso PM, Lowcock J, Nolan M, Weber J, Gross A: Botulinum toxin for subacute/chronic neck ain. Cochrane Database Syst Rev. 2011 Jul 6;(7):CD008626.
124. Landa J, Kim Y: Outcomes of interlaminar and transforminal spinal injections. Bull NYU Hosp Jt Dis 012,70(1):6-10.
125. Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, Sehgal N, Shah RV, Singh V, Benyamin RM, Patel VB, Buenaventura RM, Colson JD, Cordner HJ, Epter RS, Jasper JF, Dunbar EE, Atluri SL, Bowman RC, Deer TR, Swicegood JR, Staats PS, Smith HS, Burton AW, Kloth DS, Giordano J, Manchikanti L: Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Pain Physician 2007,10(1):7-111.
126. Johnson M: Prolotherapy and connective tissue damage syndrome. J Prolotherapy 2009,1(1):45-53.
127. Hooper RA, Frizzell JB, Faris P: Case series on chronic whiplash related neck pain treated with intraarticular zygapophysial joint regeneration injection therapy. Pain Physician 2007,10(2):313-318.
128. Reeves, KD, Hassanein K: Randomized prospective double blind placebo controlled study of dextrose prolotherapy for knee osteoarthritis with or without (ACL) laxity. Altern Ther Health Med 2000,6(2):68-74, 77-80.
129. Ongley MJ, Klein RG, Dorman TA, Eek BC, Hubert LJ: A new approach to the treatment of chronic low back pain. Lancet 1987,2(8551):143-146.
130. Bordeau Y: Five year follow up on sclerotherapy/prolotherapy for low back pain. Manual Medicine 1988,3:155-157.
131. Klein Rg, Eek BC, DeLong WB, Mooney V: A randomized double blind trial of dextrose glycerine phenol injections for chronic low back pain. J Spinal Disord 1993,6(1):23-33.
132. Kayfetz DO: Occipito-cervical (whiplash) injuries treated Prolotherapy. Med Trial Tech Q 1963,9:9-29.
133. Hackett G: Prolotherapy in Whiplash and Low back pain. Postgrad Med 1960,27:214-219.
134. Hooper RA: Case series on chronic whiplash related neck pain treated with intraarticular zygapophysial joint regeneration injection therapy. Pain Physician 2007,10:313-318.
135. Hooper RA, Ding M: Retrospective case series on patients with chronic spinal pain treated with dextrose Prolotherapy. J Altern Complement Med 2004,10(4):670-4.
136. Centeno CJ, Elliott J, Elkins WL, Freeman M: Fluoroscopically guided cervical Prolotherapy for instability with blinded pre and post radiographic reading. Pain Physician 2005,8(1):67-72.
137. Hauser R, Hauser M: Dextrose Prolotherapy for unresolved neck pain. Practical Pain Management 2007:56-69.
138. Kayfetz, DO, Blumenthal LS, Hackett GS, Hemwall GA, Neff FE: Whiplash injury and other ligamentous headache- its management with Prolotherapy. Headache 1963,3:21-28.
139. Hackett GS, Huang TC, Raftery A: Prolotherapy for headache. Pain in the head and neck, and neuritis. Headache 1962,2(1):20-28.
140. Dagenais S, Haldeman S, Wooley JR: Intraligamentous injection of sclerosing solutions (Prolotherapy) for spinal pain: a critical review of the literature. Spine J 2005,5(3):310-328.
141. Dorman T: Whiplash injuries: treatment with prolotherapy and a new hypothesis. J Orthop Med 1999;21(1):13-21.
142. Hooper A, Yelland M: Prospective case series of litigants and non-litigants with chronic spinal pain treated with dextrose Prolotherapy. Int Musculoskeletal Med 2011,33(1):15-20.
143. Rabago D, Best TM, Beamsley M, Patterson J: A systematic review of Prolotherapy for chronic musculoskeletal pain. Clin J Sport Med 2005, 15(5): E376.