What is Prolotherapy?

Do you suffer from headaches, neck or back pain, sore shoulders elbows wrists or fingers, painful hips or knees, ankles or feet? Prolotherapy is a technique that is used to stabilize sprained or painful joints by strengthening the ligaments that hold the joint together. It can also be used to repair tendon tears, such as in rotator cuff injuries or tennis elbow. It is particularly useful in osteoarthritis as it can help regrow worn cartilage.

Prolotherapy involves injecting certain solutions into injured or diseased tendons, ligaments or joints. These solutions cause inflammation and the release of growth hormone which cause these tissues to proliferate (re-grow and get stronger) and, therefore, to heal.

Prolotherapy Information

What Conditions Respond to Prolotherapy?
Medical studies have found prolotherapy to be a first or second line treatment for a variety of musculoskeletal disorders.
  • Headaches, temporomandibular joint (TMJ) pain
  • Pain in the neck, back, or lower back, particularly the sacroiliac joint
  • Pains in the ligaments and tendons around the joints, ligament or tendon tears
  • Rotator cuff problems of the shoulder, osteoarthritis of the shoulder
  • Tennis elbow, golfer’s elbow
  • Osteoarthritis of the wrist or fingers, carpal tunnel syndrome
  • Chest pains due to rib cage problems
  • Osteoarthritis of the hips, knees, ankles, feet and toes. Morton’s neuroma.
  • Plantar fasciitis, Achilles tendinitis
When Should You Avoid Prolotherapy?
Prolotherapy works by causing inflammation. If you are taking anti-inflammatory medications such as Advil, naproxen, Voltaren, Celebrex, indomethacin, aspirin or ASA (except for the 80 mg dose) or any other nonsteroidal anti-inflammatory medication (NSAID), you will not respond to prolotherapy. Medications which shut down your immune response such as prednisone or Decadron and antirejection medications such as methothrexate, cyclosporin, azathioprine, tacrolimus, or antitumor necrosis alpha antibodies will also prevent prolotherapy from working. If you suffer from an inflammatory condition, such as rheumatoid arthritis, prolotherapy is contraindicated.

If you are very debilitated or malnourished, or if you are a smoker your ability to heal will be interfered with. Before you get prolotherapy, you need to improve your nutrition and your general health. One of the best ways to do that is to quit smoking and eat a healthful diet (check out the caveman diet).

The most likely substances that will be injected when prolotherapy is performed are lidocaine, which is a local anesthetic, and dextrose, which is a kind of sugar. If you are allergic to local anesthetics, or to corn which forms the basis of the dextrose solution, you may be able to receive prolotherapy, but not with the usual solutions. Make sure you warn the doctor before you proceed.
What Are the Risks of Prolotherapy?
Prolotherapy injections can be painful. Following the injections you may have pain in the area for anywhere from one day to two weeks. This is because of the inflammation that is induced by prolotherapy. You will be given painkillers specifically to deal with the problem, and you can use Tylenol (acetaminophen). You must not take any anti-inflammatory medication such as aspirin, ibuprofen, Advil, Motrin, or other NSAIDs. These would prevent the inflammation process which helps heal the ligaments and tendons. Occasionally the needle punctures a blood vessel, which causes bruising, or a nerve, which can send a brief, burning sensation down the limb, or, very rarely, the lung (when the chest area is injected). This may cause chest pain and shortness of breath. Call Dr. Bertrand or your doctor if this happens. Do not use prolotherapy if you are allergic to corn or to local anesthetic. If a joint is injected, there is a 1/10,000 chance of infection. If you experience increased pain in the joint, swelling, redness or heat, see Dr. Bertrand or your doctor as soon as possible. Prolotherapy does not work for everyone. Some people need as many as five treatments prior to experiencing results, and may need as many as 12 prolotherapy sessions.
What Are the Benefits of Prolotherapy?
More than 75% of people given prolotherapy state that their pain has disappeared or is much better, after anywhere from one to six treatments. These treatments are given every two to six weeks. Studies have shown prolotherapy can increase the thickness of the knee cartilage by 65% in cases of arthritis of the knee 2, and it has been shown to cause dramatic pain reduction in pain in the neck 3, arthritis of the wrists and fingers, as well as low back and sacroiliac joint pain 5 6 7.
How Long Does It Last?
Prolotherapy lasts as long as the new collagen which has been built up in your ligaments and tendons will last. Generally the effect of a treatment varies between several months to many years.
How Much Does It Cost?
Each prolotherapy session costs between $50 and $300 depending on the area being treated. Generally people need 1 to 6 treatments to repair tendons and stabilize joints
Prolotherapy FAQ

I have been in pain for many years. Can this treatment work for me?

Many people, some of whom had been suffering from as long as 40 years, have obtained relief from either of these treatments.

How do I know if this is right for me?

If your pain comes from the parts of your body that move such as your muscles, tendons, ligaments or joints it will be worse when you are moving. If that is the case, then you are likely to be helped by prolotherapy treatments, which can help rebuild these structures.

Are these treatments painful?

Prolotherapy treatments can be painful, but the physician usually freezes the skin before inserting the needle, and this greatly reduces the pain. Following the treatment, there is pain lasting from two days to two weeks.

Once the pain is gone, how long will I be pain free?

Prolotherapy helps rebuild ligaments and tendons, and your pain-free status will last as long as there is no more damage done to those structures.

I have been told I need surgery. Should I consider this treatment as an alternative?

For some people, surgery is the only way to repair damage to the body. It might be worth trying this treatment while you are waiting for surgery, as it is safe, has few side effects, and you can always cancel the surgery if you find your symptoms are relieved.

Does this treatments work all the time?

To my knowledge, no treatment works all the time. You can expect prolotherapy to work about 75% of the time.

Will I have to come back? How often?

On average, people who receive prolotherapy need 1.67 treatments before they are better.

Does this mean I can stop my pain medication?

Many people who undergo prolotherapy have been on narcotics and other pain medicine for a long time. Once you are pain free, you can certainly stop your pain medication, but it is better to do it slowly to avoid withdrawal symptoms. A pharmacist, associated with the clinic, will counsel you on how to proceed.

Should I be taking anti-inflammatory medication to control my pain?

If you take anti-inflammatory medications while you are undergoing prolotherapy, the treatment will not work as it is based on the use of inflammation to start the healing process.

Are there any side effects?

Depending on the area that is injected in a prolotherapy treatment, there is a risk that the injection needle may cause damage to nearby organs. On very rare occasions the following side effects are possible: when the rib cage is injected, the needle can perforate the lung. In the neck, there are many nerves and blood vessels as well as the spinal cord, which can be injured. In the spine, the spinal cord and nerves can be damaged. Serious side effects are less common in the limbs, but some nerves can be injured. Prolotherapy often causes temporary bruising. It is important to remember that these side effects, except for bruising, happen very rarely. Those contemplating surgery should also know that there are risks to surgery as well as to general anesthesia and that recovery time from surgery can be very long.
Original Research

Prolotherapy of the shoulder

Doctor Bertrand is currently completing a research project on the use of prolotherapy to treat the commonest problem with the shoulder, rotator cuff tendinopathy (or tendinitis of the shoulder). 70 people have participated, and received three treatments of either prolotherapy or placebo therapy. Those who received placebo therapy are now being treated with prolotherapy or perineural injection therapy (neural prolotherapy). As soon as all the data has been collected, she will write an article for a medical Journal entitled “prolotherapy in the treatment of rotator cuff tendinopathy.”
References From the Medical Literature
For the best, most up-to-date references, go to


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 Mar;6(2):68-74, 77-80 For a summary, go to

(This is a good basic review of the principles of prolotherapy, and presents good references from the medical literature)

  • -Prolotherapy for musculoskeletal pain. Donna Alderman, DO. Practical Pain Management, January/February 2007. (The article can be downloaded in PDF format minus all the interesting illustrations, if you Google this title.)
  • – Prolo your pain away! Ross A. Hauser, M.D., Marion A. Hauser, M.S., Beulah Land Press 2004 (A book on the subject, easy to read and understand, many religious statements.)