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About Prolotherapy

Prolotherapy, also known as regenerative injection therapy, is a non-surgical treatment method that aims to stimulate the body’s natural healing response to repair damaged or weakened connective tissues.

It involves the injection of a solution directly into the affected area, typically a joint, tendon, or ligament, to promote tissue growth and improve overall function. Two common substances used in prolotherapy injections are dextrose and platelet-rich plasma (PRP), each with unique properties and applications.

How prolotherapy works

Prolotherapy injections work by stimulating the body’s natural healing mechanisms. A solution injected into the affected area creates controlled inflammation, which triggers a series of events that promote tissue repair. The inflammatory response leads to an increased blood supply, recruitment of repair cells, and deposition of new collagen, strengthening the weakened or damaged tissues.

Common solutions used in prolotherapy

During prolotherapy, different solutions can be injected into the affected area, depending on the practitioner’s approach and the patient’s specific condition.

Commonly used solutions in prolotherapy include:

  1. Dextrose solution: Dextrose, a type of sugar, is a frequently used solution in prolotherapy. It acts as an irritant when injected into the affected area, triggering a localized inflammatory response. This inflammation stimulates the release of growth factors, which promote tissue repair and strengthen the weakened or damaged connective tissues.
  2. Platelet-rich plasma (PRP): PRP is derived from the patient’s own blood. The patient’s blood is drawn and processed to separate the plasma, which contains a high concentration of platelets. Platelets contain various growth factors and bioactive substances that can accelerate healing and tissue regeneration. When injected into the damaged area, PRP stimulates the body’s natural healing response, promoting the repair of injured ligaments, tendons, and other structures.
  3. Saline: Saline is a sterile solution of sodium chloride in water, which can be mixed with other substances like dextrose or PRP to create the injectate used in prolotherapy. Saline is often used as a diluent or as a component to adjust the concentration or volume of the solution being injected. It helps ensure proper distribution of the active ingredients and facilitates the delivery of the solution into the targeted tissues.
  4. Sodium morrhuate: Sodium morrhuate is a fatty acid derived from cod liver oil. It can be used as an irritant solution in prolotherapy to induce inflammation and trigger the healing process.
  5. Polidocanol: Polidocanol is a sclerosing agent that is occasionally used in prolotherapy treatments. It is commonly employed in vein treatments to induce scarring and closure of varicose veins. In prolotherapy, polidocanol can be used to create a controlled inflammatory response, promoting tissue repair.

Dextrose prolotherapy vs. PRP prolotherapy

Both, PRP and dextrose prolotherapy have demonstrated their ability to stimulate natural healing processes (Clark, 2009). The treatments can be effective and should be considered when planning for connective tissue repair.

However, PRP prolotherapy may be more suitable in cases involving tissue or joint degeneration, the presence of osteoarthritis, or chronic and longstanding issues while dextrose is usually used for milder cases. When platelet-rich plasma is used in prolotherapy, it not only provides the necessary irritation but also delivers growth factors that jumpstart the healing process.

It is important to note that PRP is a more potent formula than dextrose, which can make it more discomforting for the patient post-treatment. Additionally, the cost of PRP prolotherapy is higher due to the additional materials required.

Another distinction is that PRP prolotherapy can result in multiple healing episodes, sometimes leading to fluctuations in pain levels during the weeks following treatment.

Conversely, with dextrose prolotherapy, initial discomfort is typically limited, although individual variations exist. Generally, fewer treatments are needed with PRP compared to dextrose.

Ultimately, the decision regarding which type of prolotherapy to use is based on careful evaluation and discussion between the doctor and patient, taking into consideration various factors, including patient preference (Alderman,2018).

Conditions that can be treated with prolotherapy

Prolotherapy is a versatile treatment approach that can be used to address various musculoskeletal conditions and injuries.

While its effectiveness may vary depending on individual factors, the following conditions are commonly treated with prolotherapy:

  1. Ligament injuries: Prolotherapy can be beneficial for ligament sprains, strains, and partial tears. It helps stimulate the healing and strengthening of damaged ligaments, improving joint stability.
  2. Tendon injuries: Tendinitis, tendonosis, and other tendon injuries can be targeted with prolotherapy. It promotes the repair and regeneration of damaged tendons, reducing pain and improving functionality.
  3. Osteoarthritis: Prolotherapy can provide relief for individuals with osteoarthritis, a degenerative joint condition characterized by cartilage breakdown. It aims to alleviate pain, reduce inflammation, and improve joint function.
  4. Joint instability: Prolotherapy is often used to address joint instability caused by weakened or stretched ligaments. By promoting tissue repair and strengthening the supporting structures, prolotherapy can enhance joint stability.
  5. Chronic low back pain: Prolotherapy may be effective in treating chronic low back pain, particularly when it is related to ligament laxity or weakness. It targets the affected ligaments, reducing pain and improving function.
  6. Sports injuries: Prolotherapy is commonly employed for sports-related injuries, such as sprains, strains, and overuse injuries. It aids in the healing of damaged tissues, accelerates recovery, and supports a return to physical activity.
  7. Neck pain: Prolotherapy can be utilized to alleviate chronic neck pain caused by ligament or tendon injuries, muscle imbalances, or degenerative changes.
  8. Joint pain: Prolotherapy may help reduce joint pain in various joints, including the knees, shoulders, hips, ankles, and wrists. It targets the underlying cause of the pain, such as ligament laxity or degeneration.
  9. Pelvic pain: Prolotherapy can be beneficial for certain types of pelvic pain, such as sacroiliac joint dysfunction or instability.
  10. Musculoskeletal injuries: Prolotherapy can be applied to different musculoskeletal injuries, including sprains, strains, and chronic musculoskeletal pain, promoting tissue repair and pain reduction.

Risks and side effects

Prolotherapy is generally considered safe, but like any medical procedure, it carries certain risks and potential side effects. It is important to be aware of these before undergoing treatment.

Here are some of the possible risks and side effects associated with prolotherapy:

  • Pain and discomfort: Following the injections, it is common to experience temporary pain, soreness, or discomfort at the injection site. This discomfort usually subsides within a few days to weeks.
  • Swelling and bruising: Injection-related swelling and bruising may occur in the treated area. These side effects are generally mild and temporary.
  • Infection: While rare, there is a risk of infection at the injection site. It is crucial to ensure that the procedure is performed under sterile conditions to minimize this risk.
  • Nerve damage: In rare cases, prolotherapy injections may inadvertently damage nerves in the treated area. This can lead to sensory changes, numbness, or weakness. It is important to have the procedure performed by a skilled and experienced healthcare professional to minimize the risk of nerve damage.
  • Allergic reactions: Some individuals may experience an allergic reaction to the prolotherapy solution, such as dextrose, PRP, or other substances used. Allergic reactions can range from mild skin irritation to more severe systemic reactions. Inform your healthcare provider about any known allergies beforehand.
  • Increased pain or inflammation: Prolotherapy involves deliberately inducing a controlled inflammatory response. As a result, there is a possibility of temporary increased pain or inflammation in the treated area. However, this is part of the healing process and typically subsides within a short period of time.
  • Limited scientific evidence: While prolotherapy has been practiced for many years, the scientific evidence supporting its effectiveness is still evolving. It is important to have realistic expectations and discuss the potential benefits and risks with your healthcare provider.
  • Adverse reactions to anesthesia: If local anesthesia is used during the procedure, there is a slight risk of adverse reactions to the anesthesia itself. This risk is generally minimal but should be considered.

Benefits of prolotherapy

Prolotherapy offers several potential benefits for individuals seeking non-surgical treatment options for certain musculoskeletal conditions.

While the effectiveness may vary depending on the individual and the specific condition, the following are potential benefits of prolotherapy:

  1. Pain relief: Prolotherapy aims to alleviate pain by addressing the underlying cause of the pain, such as ligament or tendon weakness or injury.
  2. Improved joint stability: Prolotherapy can strengthen weakened or stretched ligaments and tendons, thereby enhancing joint stability.
  3. Enhanced healing and tissue regeneration: Prolotherapy stimulates the body’s natural healing response by inducing localized inflammation. This inflammation triggers the release of growth factors and promotes the repair and regeneration of damaged tissues, such as ligaments, tendons, and cartilage.
  4. Non-surgical approach: Prolotherapy offers a non-surgical alternative for individuals who prefer to avoid invasive procedures or who may not be suitable candidates for surgery. It can be used as a conservative treatment option before considering surgical interventions.
  5. Minimal downtime: Prolotherapy is typically performed on an outpatient basis, and the recovery time is usually minimal. Most individuals can resume their regular activities shortly after the procedure, although it is important to follow the healthcare provider’s post-treatment instructions.
  6. Potential for long-term results: Prolotherapy aims to address the underlying cause of the condition rather than simply masking the symptoms. By promoting tissue repair and strengthening the affected area, it may provide long-lasting results and reduce the likelihood of recurrence.
  7. Versatility: Prolotherapy can be applied to various musculoskeletal conditions, including ligament and tendon injuries, joint instability, osteoarthritis, and certain chronic pain conditions. Its versatility makes it a potential treatment option for a wide range of individuals.

It is crucial to consult with a qualified healthcare professional who specializes in prolotherapy to assess your specific condition to determine if prolotherapy is suitable for you. They can provide personalized guidance, explain the benefits and potential side effects, and address any concerns you may have.


Prolotherapy, whether using dextrose or PRP, is a promising treatment option for individuals suffering from chronic musculoskeletal conditions. By harnessing the body’s innate healing capabilities, prolotherapy injections promote tissue repair, reduce pain, and improve overall function.

While it may not be suitable for everyone or every condition, prolotherapy offers a non-surgical approach with potentially significant benefits. If you are considering prolotherapy, consult with a qualified healthcare professional who can assess your condition and guide you through the treatment process safely and effectively.

Written by:

Niharika Mandal

Medically reviewed:

Dr. Igor Wilderman

Niharika Mandal has a PhD in Biotechnology and over four years of experience as a medical writer. Her expertise includes writing and editing clinical documents such as protocols, clinical study reports, patient narratives, and manuscripts, in compliance with regulatory guidelines. She has authored a book and published several articles in international journals in biotechnology. Niharika’s passion for healthcare is evident in her work, as she is dedicated to positively impacting people’s lives through her contributions to the medical field.


Clark G. Platelet rich plasma (PRP) therapy literature reviews. Journal of Prolotherapy. August 2009; 1(3):185–191.

Alderman D. Platelet-Rich Plasma and Stem Cell-Rich Prolotherapy for Musculoskeletal Pain. Pract Pain Manag. 2018;18(4).

Hauser RA, Lackner JB, Steilen-Matias D, Harris DK. A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain. Clin Med Insights Arthritis MusculoskeletDisord. 2016 Jul 7;9:139-59. doi: 10.4137/CMAMD.S39160. PMID: 27429562; PMCID: PMC4938120.

WebMD. (Updated on Jun 12, 2021). What to Know About Prolotherapy. Retrieved from (Accessed Jun 30, 2023).

Healthline. (Updated on May 28, 2020). Prolotherapy. Retrieved from (Accessed Jun 30, 2023).

Medical News Today. (Dec 17, 2017). Prolotherapy: Uses, procedure, and side effects. Retrieved from (Accessed Jun 30, 2023).


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