What Is Prolotherapy?
Injection of an irritant solution—commonly hypertonic dextrose with local anesthetic—around selected joints, tendons, or ligaments. Evidence varies by diagnosis, and it should not be marketed as proven tissue regeneration.
Overview
Prolotherapy most commonly refers to injection of hypertonic dextrose, often with local anesthetic, into or around a selected painful joint, tendon, ligament, or enthesis. Other substances have historically been called proliferants, so the exact solution and concentration must be named.
Mechanism is not proof of regeneration
Dextrose may alter local osmotic and inflammatory signaling and pain pathways, but claims that it reliably rebuilds ligaments or regenerates cartilage exceed current evidence. Symptom improvement does not prove structural regrowth.
Evidence is diagnosis-specific
Trials examine knee osteoarthritis, selected tendinopathies, and other pain conditions, with variable protocols and controls. Evidence for one target cannot justify broad injections for back pain, instability, neuropathy, or systemic disease.
Technique and anatomy matter
Injection near lung, spine, nerves, vessels, abdominal or pelvic structures has different risk from a superficial tendon target. Imaging may improve target confirmation but does not eliminate complications.
Not PRP or stem cells
Prolotherapy does not concentrate platelets or deliver cells. Combining it with PRP, peptides, or other products creates a different intervention.
Benefits
Uses a relatively simple noncellular injectate when hypertonic dextrose is selected
Has been studied for selected musculoskeletal pain conditions
Can be targeted with imaging when appropriate
Avoids marrow or fat harvest
Can be paired with rehabilitation and outcome tracking
The Procedure
1
Confirm pain generator
2
Define injectate and route
3
Inject with safeguards
4
Rehabilitate and reassess
Preparation
Bring diagnosis, imaging, prior injections, medications and anticoagulants, diabetes status, allergies, infection history, pregnancy status, and rehabilitation plan. Do not stop medication without clinician guidance.
Recovery & Aftercare
A pain flare, stiffness, bruising, or swelling can last several days. Fever, drainage, severe progressive pain, weakness, numbness, chest pain, shortness of breath, or bowel/bladder change requires urgent assessment.
Risks & Considerations
Pain flare, bleeding, bruising, infection, allergic or anesthetic reaction, nerve or vessel injury, tendon or tissue damage, joint infection, pneumothorax near the chest, spinal or neurologic injury near high-risk anatomy, and treatment failure.
Frequently Asked Questions
References
[1]
PubMed: Dextrose Prolotherapy Systematic Reviews.
https://pubmed.ncbi.nlm.nih.gov/?term=dextrose+prolotherapy+systematic+review+musculoskeletal[2]
PubMed: Prolotherapy for Knee Osteoarthritis Trials.
https://pubmed.ncbi.nlm.nih.gov/?term=prolotherapy+knee+osteoarthritis+randomized+trial[3]
CDC. Injection Safety.
https://www.cdc.gov/injection-safety/
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