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What is Prolotherapy?

Prolotherapy, also called proliferative therapy, is a medical procedure performed to treat connective tissue injuries and can be used to relieve musculoskeletal pain.

The procedure involves injecting an irritant into the connective tissue such as injured ligaments or tendons, or the joint spaces. The purpose is to promote healing of the connective tissue that has been weakened, torn or pulled, resulting in tissue looseness and joint instability.

Prolotherapy is an excellent non-surgical option for progressive and chronic ligament injuries caused by sport, falls, daily activities, accidents, and certain medical conditions.

An irritant is a natural substance that causes slight but precise inflammation of the targeted tissue.

Prolotherapy typically uses a local anesthetic and any of the following irritants: 

  • Sugar water (dextrose)  
  • Saline (a mixture of sodium chloride and water) 

Concept of Prolotherapy

Prolotherapy works by encouraging the body’s natural healing mechanism to produce new tissue at the injured or weakened site.

Under normal conditions, the connective tissue firmly holds the bones and joints together. When this tissue is injured or weakened, the bones or joints they are holding become destabilized, leading to pain.

Once injected, the irritant triggers the body’s healing response by creating a local, but controlled inflammation. This leads to increased blood flow to the area and production and growth of new connective tissue.


Repeated prolotherapy over time allows a gradual buildup of new tissue resulting in strengthening of the connective tissue and stabilization of the joints. Once the joints are better supported and stabilized, the pain resolves on its own.

Therefore, prolotherapy is also referred to as a regenerative injection technique, as it stimulates cells to regenerate and heal connective tissue.

Preparing for Prolotherapy

Prior to prolotherapy, you will be evaluated thoroughly with your medical history followed by a physical examination. An imaging test such as an X-ray or MRI may be performed of the injured area.

Additionally, you will be instructed to:

  • Stop taking any anti-inflammatory medications 2 to 3 days before the procedure
  • A protein-rich meal is recommended just prior to the procedure

The Procedure

During the procedure:

  • The skin over the affected area is cleansed with alcohol or another sterilizing solution. 
  • A numbing cream or solution is applied to the skin to reduce discomfort from the injection.  
  • Using a thin needle, the irritant solution is injected into the target area or areas as necessary.
  • More than one injection may be performed at the session
  • Following the injection, a heat pack may be placed over the injection sites for about 10-15 minutes

Frequency of Prolotherapy

Prolotherapy usually requires multiple sessions for the best results. The number and frequency of the shots vary depending on the:

  • Condition being treated
  • Type of irritant being used
  • Severity of the injury or pain

Your physician will discuss the number of shots per session and the total number of sessions you require.

After-Care and Recovery

You can resume your regular activities as tolerated as this encourages healing. Physical therapy may be recommended. It may take about 6 weeks for significant connective tissue healing. 

Benefits of Prolotherapy

Key benefits of the procedure include:

  • Long-lasting pain relief

Side Effects

Immediately after the procedure, the treated area may feel worse before beginning to feel better. Other side-effects experienced occasionally include:

  • Severe pain
  • Bleeding at the injection site
  • Infection at the injection site