Prolotherapy
Prolotherapy uses dextrose injections and has been studied for selected joint, tendon and ligament concerns. Evidence and expected outcomes vary by condition.
Regenerative Injection Therapy
What is Prolotherapy?
Prolotherapy, short for "proliferative therapy," is an injection treatment that stimulates the body's natural healing response. A solution of concentrated dextrose is injected into damaged or weakened connective tissue, triggering a controlled inflammatory response that initiates tissue repair and regeneration.
This technique has been used since the 1930s, when George Hackett, MD, developed it as a treatment for ligament and joint pain. Over the decades, prolotherapy has been refined and studied extensively, with dozens of clinical trials demonstrating its effectiveness for various musculoskeletal conditions.
Unlike cortisone injections, which suppress inflammation and can weaken tissue over time, prolotherapy works with your body's natural healing mechanisms to strengthen and repair damaged structures. This makes it particularly valuable for chronic conditions where the goal is lasting repair rather than temporary symptom relief.
How Prolotherapy Works
Injection
A solution of concentrated dextrose (typically 12.5-25%) is injected directly into the damaged tissue; whether that's a joint capsule, tendon attachment or ligament.
Healing Response
The hypertonic solution triggers a controlled inflammatory response that activates growth factors including platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-β) and fibroblast growth factor.
Tissue Repair
Over the following weeks, fibroblasts lay down new collagen, strengthening the damaged tissue. Multiple treatments build upon each other, progressively improving tissue integrity.
Conditions We Treat with Prolotherapy
Prolotherapy has been studied in clinical trials for numerous musculoskeletal conditions. Click on each condition to learn more about the research and treatment approach.
Osteoarthritis
16 clinical trials support prolotherapy for osteoarthritis, particularly knee OA. Studies show significant improvements in pain, stiffness and range of motion with effects lasting years.
Learn moreTendon Injuries
Strong evidence supports prolotherapy for tennis elbow, plantar fasciitis and Achilles tendinopathy. Meta-analyses show meaningful improvements in pain and function.
Learn moreBack & Sacroiliac Pain
Prolotherapy shows particularly strong results for sacroiliac joint pain, with one study finding 58.7% maintained relief at 15 months compared to only 10.2% with steroid injection.
Learn moreResearch Evidence
Meta-analyses have confirmed prolotherapy's effectiveness for lateral epicondylitis (tennis elbow) and plantar fasciitis, with improvements exceeding the minimal clinically important difference; the threshold that indicates a real, meaningful improvement for patients.
What to Expect
-
Initial Consultation
We'll review your condition, examine the affected area and discuss whether prolotherapy is appropriate for you. We'll explain the treatment process and answer any questions.
-
Treatment Sessions
There is no standard series suitable for every condition. Whether a procedure is repeated depends on diagnosis, response, risks, alternatives and whether the expected benefit continues to justify treatment.
-
Recovery
Temporary pain, stiffness, bruising or swelling can occur, along with less common injection-related complications. Individual aftercare and warning signs are reviewed at the visit.
-
Results
Response varies and cannot be predicted. Published group results do not guarantee that an individual will improve or establish how long any change will last.
Safety Profile
Prolotherapy is an invasive procedure with risks that depend on the anatomical area, technique, formulation and individual health. Familiar ingredients do not make an injection risk-free.
Common temporary effects:
- Mild to moderate soreness at injection sites (1-3 days)
- Temporary stiffness in the treated area
- Minor bruising
Serious complications are rare. In the published clinical trials involving hundreds of patients, no serious adverse events have been reported with dextrose prolotherapy.
Related Treatments
Neural Prolotherapy
Very dilute dextrose (5%) injected along superficial nerves for neurogenic inflammation and chronic pain conditions including neuropathy.
Learn moreMicrocurrent Therapy
A non-injection option sometimes used alongside or instead of injection treatment for soft-tissue pain.
Learn moreFrequently Asked Questions
Is prolotherapy painful?
The injections cause brief, mild discomfort. We use a local anesthetic (lidocaine) mixed with the dextrose solution to minimize pain during the procedure. Most patients describe it as a tolerable pressure or aching sensation. After treatment, you may experience soreness similar to a workout for 1-3 days.
How is the number of treatments decided?
There is no fixed series appropriate for every condition. A repeat procedure is considered only after reviewing diagnosis, response, risks, alternatives and whether continued treatment remains justified.
Can I take pain medication after treatment?
Do not start, stop or change medication based on this page. Post-procedure pain management is reviewed individually, including existing prescriptions and advice from the prescribing clinician.
Is prolotherapy covered by insurance?
MSI does not cover prolotherapy. Most private health insurance plans do. We offer direct billing for many major insurers.
How does prolotherapy compare to cortisone injections?
Cortisone injections reduce inflammation and provide quick pain relief, but this relief typically fades over weeks to months and repeated injections can weaken tissue. Prolotherapy takes longer to work (it's stimulating a healing process), but the goal is lasting tissue repair. For sacroiliac joint pain, one study found prolotherapy provided sustained relief in 58.7% of patients at 15 months compared to only 10.2% with steroid injection.
How is suitability assessed?
Suitability depends on the diagnosis, anatomical area, health history, medications, alternatives and applicable risks. An assessment may determine that imaging, rehabilitation, medical referral or another treatment is more appropriate.
Key References
- Hauser RA, et al. A systematic review of dextrose prolotherapy for chronic musculoskeletal pain. Clin Med Insights Arthritis Musculoskelet Disord. 2016;9:139-159.
- Rabago D, et al. Dextrose prolotherapy for knee osteoarthritis: a randomized controlled trial. Ann Fam Med. 2013;11(3):229-237.
- Zhu M, et al. Effects of Hypertonic Dextrose Injection (Prolotherapy) in Lateral Elbow Tendinosis: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil. 2022;103(11):2209-2218.
- Lai CC, et al. Efficacy of prolotherapy for plantar fasciitis: A systematic review and meta-analysis. Medicine (Baltimore). 2021;100(51):e28216.
- Kim WM, et al. A randomized controlled trial of intra-articular prolotherapy versus steroid injection for sacroiliac joint pain. J Altern Complement Med. 2010;16(12):1285-1290.
Ready to Start Your Healing Journey?
Schedule a consultation to discuss whether prolotherapy is right for your condition. We'll review your health history, examine your injury and create a personalized treatment plan.
Book Online (opens in a new tab)