What is Prolotherapy and How Does it Work?

Orthopaedic & Spine Center
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Jenny L. F. Andrus, MD

There are many causes of chronic pain and a leading one is joint pain due to joint instability. Strains and sprains to ligaments (they connect bone to bone) and tendons (they connect muscle to bone) over time can result in their loosening. Many experts believe that this loosening or instability around the joint leads to damage, such as cartilage wear. Some also believe that the ligaments’ instability in the spine may lead to premature disc degeneration.

When a tissue is injured the body, it usually starts an inflammation response which results in healing.  However, ligaments and tendons have a poor blood supply which limits the body’s ability to repair them. Prolotherapy works by causing a localized inflammation response in the damaged tissues.  It was first developed in the 1930s for musculoskeletal use and has been used to treat numerous musculoskeletal conditions since that time.

Prolotherapy is a regenerative treatment which involves the injection of an irritant, usually dextrose, into the damaged tissue. This results in the body beginning an inflammatory cascade. As the inflammation reduces, the body produces collagen and over time, that collagen is remodeled, becoming stronger.  This remodeling can happen for months after the injections. As the tissue remodels and becomes stronger, the ligament or tendon begins to function more like it did before injury and pain improves.

As there is a lag time between the onset of the inflammatory response and the body laying down collagen, typically prolotherapy is repeated at intervals of 3 to 6 weeks. This process usually needs to be repeated multiple times for adequate healing.  It’s best to treat all of the tender and dysfunctional ligaments of an unstable joint at each visit. Multiple joints can be treated at each visit.

The injection is usually very well tolerated and includes a local anesthetic which reduces discomfort. After the injection, there’s usually a mild increase in pain which is normal, due to the inflammatory response we seek to achieve.

The data on the benefits of prolotherapy is emerging with research to support its use in multiple musculoskeletal conditions, particularly in back and knee pain. Prolotherapy is a good option for patients wishing to avoid surgery or for whom standard care, such as physical therapy and steroid injections, hasn’t been sufficient. The success rate depends on the condition treated as well the patient’s overall health.


If you’re interested in making an appointment with Dr. Andurs or another OSC provider, get started online by clicking the “Request Appointment” button below or by calling (757) 596-1900.