Prolotherapy for Joint Pain: Does It Work?

Key Takeaways

• Prolotherapy involves injecting irritant solutions to stimulate healing
• Most commonly used for chronic ligament and tendon pain
• Evidence is mixed—some studies show benefit, others don’t
• Generally safe but can be painful during treatment
• Not typically covered by insurance
• Best considered when standard treatments haven’t helped

Prolotherapy—short for “proliferative therapy”—has been used for decades to treat chronic musculoskeletal pain. While it has devoted practitioners and satisfied patients, the scientific evidence remains debated.

This guide helps you understand what prolotherapy is, what the evidence shows, and whether it might be worth considering.

What Is Prolotherapy?

The Basic Concept

Prolotherapy involves injecting an irritant solution into painful areas—typically where ligaments or tendons attach to bone. The theory is that this controlled irritation:

1. Creates a mild inflammatory response
2. Stimulates the body’s healing cascade
3. Strengthens weakened tissues
4. Reduces chronic pain

Historical Background

• Developed in the 1930s-1950s
• Based on observations that sclerosing agents could strengthen tissues
• Popularized by Dr. George Hackett
• Has remained somewhat outside mainstream medicine

What’s Injected

Most common solutions:

Dextrose (sugar water):

• 12.5-25% concentration
• Most common and studied
• Considered safest

Other agents (less common):

• Sodium morrhuate
• Phenol-glycerin-glucose (P2G)
• Platelet-rich plasma (overlaps with PRP therapy)

How Is It Different from Other Injections?

Versus Cortisone

Prolotherapy	Cortisone
Causes controlled inflammation	Suppresses inflammation
Multiple sessions needed	Often single injection
Aims to strengthen tissue	May weaken tissue over time
Treats underlying problem (in theory)	Treats symptoms

Versus PRP

• PRP uses concentrated growth factors from your blood
• Prolotherapy uses simple irritant solutions
• Some practitioners consider PRP a form of “advanced” prolotherapy
• PRP has more mainstream research support

Versus Hyaluronic Acid

• HA provides lubrication
• Prolotherapy aims to trigger healing
• Different mechanisms, different applications
• HA is FDA-approved for knee OA; prolotherapy is not

What Conditions Does It Treat?

Most Commonly Used For

Low back pain:

• Sacroiliac joint dysfunction
• Ligament laxity
• Facet joint pain

Knee pain:

• Ligament injuries
• Osteoarthritis (controversial)
• Patellar tendinopathy

Other areas:

• Shoulder instability
• Tennis/golfer’s elbow
• Ankle sprains (chronic)
• Temporomandibular joint (TMJ)
• Neck pain

The Underlying Theory

Prolotherapy practitioners believe many chronic pain conditions result from:

• Ligament laxity or weakness
• Incomplete healing from old injuries
• Joint instability
• Tendon degeneration

The treatment aims to address these root causes rather than just symptoms.

What Does the Evidence Show?

The Honest Picture

The challenge:

• Studies are often small
• Placebo control is difficult (injection itself causes response)
• Technique varies between practitioners
• Patient selection varies

For Low Back Pain

Research summary:

• Some studies show benefit for chronic low back pain
• Not clearly superior to control injections in all studies
• May help selected patients with ligament laxity
• Cochrane review (2007) found insufficient evidence

For Knee Osteoarthritis

Research summary:

• Several studies show pain improvement
• A 2016 study showed dextrose prolotherapy superior to saline
• Benefits comparable to PRP in some comparisons
• Not enough evidence for strong recommendations

For Lateral Epicondylitis (Tennis Elbow)

Research summary:

• Some positive studies exist
• May be effective for chronic cases
• Comparative effectiveness to other treatments unclear

Overall Assessment

Where evidence is most supportive:

• Chronic low back pain (selected cases)
• Knee osteoarthritis
• Tendinopathies

Where evidence is weakest:

• Acute injuries
• Severe arthritis
• Widespread pain conditions

The Procedure

Before Treatment

Evaluation:

• Detailed history and examination
• Review of imaging studies
• Discussion of expectations
• May need to stop anti-inflammatory medications

During Treatment

What happens:

1. Treatment area cleaned
2. Local anesthetic may be used
3. Multiple small injections given
4. Typical session: 10-30+ injections
5. Duration: 15-45 minutes

What it feels like:

• Injections can be painful
• Brief, intense discomfort at each site
• Some practitioners use sedation for comfort
• Soreness afterward is common

After Treatment

Immediately:

• Soreness and stiffness at injection sites
• May last 1-3 days
• Ice can help (though some practitioners discourage)

Activity:

• Avoid strenuous activity for 2-3 days
• Gentle movement encouraged
• Gradually return to normal activities

Treatment Course

Typical protocol:

• 3-6 sessions
• Spaced 2-4 weeks apart
• Some patients need more
• Response evaluated after each session

Risks and Side Effects

Common

• Pain during and after injection
• Temporary stiffness
• Bruising
• Swelling at injection sites

Uncommon

• Allergic reaction to solution
• Nerve irritation (usually temporary)
• Infection (rare with proper technique)
• Spinal headache (if near spine)

Serious (Rare)

• Pneumothorax (lung puncture) with chest injections
• Nerve damage
• Systemic reaction

Safety Overall

When performed by trained practitioners with proper technique, prolotherapy is considered relatively safe. The dextrose solutions used most commonly have an excellent safety profile.

Finding a Practitioner

Who Provides Prolotherapy?

• Physiatrists (PM&R physicians)
• Sports medicine doctors
• Osteopathic physicians
• Some orthopedists
• Naturopathic doctors (varies by state)

Questions to Ask

1. How many prolotherapy procedures have you performed?
2. What training do you have in this technique?
3. What conditions do you most commonly treat?
4. What outcomes do your patients typically experience?
5. How many sessions will I likely need?

What to Look For

Good signs:

• Realistic about expected outcomes
• Thorough initial evaluation
• Clear treatment plan
• Willing to discuss alternatives
• Tracks patient outcomes

Warning signs:

• Promises guaranteed results
• Recommends extensive treatment upfront
• Won’t discuss limitations
• Discourages other medical evaluation

Cost and Insurance

Typical Costs

• Per session: $150-$500
• Complete course: $500-$2,000+
• Varies by: Location, practitioner, number of injections

Insurance Coverage

• Generally NOT covered by insurance
• Considered experimental by most payers
• Some exceptions exist
• HSA/FSA may be usable

Cost Considerations

Before committing, consider:

• Total cost for full treatment course
• Whether cheaper alternatives exist
• If lack of insurance coverage affects your decision
• Financial impact if treatment doesn’t work

Who Might Consider Prolotherapy?

Potentially Appropriate For

• Chronic pain that hasn’t responded to standard treatment
• Suspected ligament or tendon weakness
• Patients wanting to avoid surgery
• Those who can’t take or haven’t responded to medications
• People willing to invest time and money in unproven treatment

Probably Not Appropriate For

• Acute injuries (need time to heal normally first)
• Severe structural damage requiring surgery
• Those expecting guaranteed results
• Patients who can’t afford the cost
• Those unwilling to commit to multiple sessions

Realistic Expectations

What Prolotherapy Might Provide

• Reduction in chronic pain
• Improved function
• Potential to avoid surgery
• A treatment option when others have failed

What Prolotherapy Won’t Provide

• Instant results
• Cure for underlying disease
• New ligaments or cartilage
• Guaranteed success
• Insurance coverage

Frequently Asked Questions

Is prolotherapy the same as PRP?

No, though they’re related concepts. Traditional prolotherapy uses simple irritant solutions (like dextrose), while PRP uses concentrated platelets from your own blood. Some practitioners view PRP as an advanced form of prolotherapy. PRP has more mainstream research support.

How painful is the treatment?

The injections can be quite uncomfortable—many patients describe it as moderate to significant pain during the procedure. However, it’s brief, and most tolerate it well. Some practitioners offer sedation or more local anesthesia for sensitive patients.

How long until I see results?

Improvement typically develops gradually over the treatment course. Some patients notice benefit after 2-3 sessions (4-8 weeks), while others need a full course (3-6 months). Immediate relief isn’t expected.

Why isn’t prolotherapy more mainstream?

Several reasons: inconsistent research results, lack of standardization, limited insurance coverage, and competition from other treatments. It’s maintained a following but hasn’t achieved broad acceptance in conventional medicine.

Can I combine prolotherapy with other treatments?

Yes, many practitioners encourage physical therapy alongside prolotherapy. However, you may need to avoid anti-inflammatory medications (NSAIDs, corticosteroids) during treatment, as these could counteract the intended inflammatory response.

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Exploring injection options? Learn about PRP therapy or read about steroid injections.

Last medically reviewed: February 2025

Medical Disclaimer: This article is for informational purposes only. Prolotherapy is considered experimental by many medical organizations. Discuss any treatment with your healthcare provider, who can help you weigh the potential benefits against costs and alternatives.