by EBSCO CAM Review Board

Related Terms

  • Sclerotherapy

What Is Prolotherapy?

Prolotherapy was created to tighten ligaments and tendons around a joint. It is based on a theory that some chronic joint pain is caused by excess movement of the joint. The extra movement puts stress on the muscles around the joint and causes spasms and pain. Tightening the ligaments and tendons keeps the joint more stable and relieves strain on the muscles.

Prolotherapy injects a solution into the area and around ligaments. The solution is often a simple sugar called dextrose but can also be other substance such as cod lievr oil mix. The solution triggers a response from your immune system to heal the area. This is thought to cause growth and thickening in the ligaments and tendons. This makes them tighten up.

It is not an FDA approved therapy but has been used to treat or manage:

  • Back pain
  • Osteoarthritis
  • Fibromyalgia,
  • Plantar fasciitis
  • Sciatica
  • Sports injuries
  • Temporomandibular joint disorder (TMD)
  • Tendinitis
  • Tension headaches
  • How Is Prolotherapy Performed?

    The doctor will inject the solution around the joint. An ultrasound machine may be used. It will show the doctor where the injection is placed.

    Prolotherapy is repeated every few weeks until change is made. A total of 3 to 6 treatments is typical.

    May Be Effective

    outputclass="SectionHeader">What Is the Evidence for Prolotherapy?

    Prolotherapy may be effective for

  • Lateral epicondylitis, better known as tennis elbow
  • Achilles Tedinopathy that recurs after rest and medicine
  • TMD, if jaw keeps dislocating
  • May or May Not Be Effective

    There is conflicting information on whether prolotherapy is effective for:

  • Low back pain. 5,610,13
  • Osteoarthritis 7,8
  • Safety Issues

    In studies, prolotherapy has not caused any serious, irreversible injury. The injection cause some discomfort in the area for a few minutes to several days. 9 Of more concern, severe headaches have been reported in treatment of low back pain in a minority of patients.

    It is important to know what substance is used to avoid an allergic reaction.

    There is also always a chance of infection when passing through skin.

    Finding a Qualified Prolotherapy Practitioner

    Prolotherapy is practiced by a medical doctor (MD) or doctor of osteopathy (DO). Generally, physicians specializing in orthopedics or physical medicine and rehabilitation are most likely to practice prolotherapy.


    REF1 Hauser RA. Punishing the pain. Treating chronic pain with prolotherapy. Rehab Manag . 1999;12:26-30.

    REF2 Liu YK, Tipton CM, Matthes RD, et al. An in situ study of the influence of a sclerosing solution in rabbit medial collateral ligaments and its junction strength. Connect Tissue Res. 1983;11:95-102.

    REF3 Reeves KD. Prolotherapy: present and future applications in soft tissue pain and disability. Phys Med Rehab Clin North Am . 1995;6:917-926.

    REF4 Klein RG, Dorman TA, Johnson CE. Proliferant injections for low back pain: histologic changes of injected ligaments and objective measures of lumbar spine mobility before and after treatment. J Neurol Orthop Med Surg . 1989;10:141-144.

    REF5 Ongley MJ, Klein RG, Dorman TA, et al. A new approach to the treatment of chronic low back pain. Lancet. 1987;2:143-146.

    REF6 Klein RG, Eek BC, DeLong WB, et al. A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic, low back pain. J Spinal Disord. 1993;6:23-33.

    REF7 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;6:68-70,72-74,77-80.

    REF8 Reeves KD, Hassanein K. Randomized, prospective, placebo-controlled double-blind study of dextrose prolotherapy for osteoarthritic thumb and finger (DIP, PIP, and trapeziometacarpal) joints: evidence of clinical efficacy. J Altern Complement Med. 2000;6:311-320.

    REF9 Klein RG, Eek BC, DeLong WB, et al. A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic, low back pain. J Spinal Disord. 1993;6:23-33.

    REF10 Yelland MJ, Glasziou PP, Bogduk N, et al. Prolotherapy injections, saline injections, and exercises for chronic low-back pain: a randomized trial. Spine . 2004;29:9-16.

    REF11 Dagenais S, Yelland M, Del Mar C, Schoene M. Prolotherapy injections for chronic low back pain. Cochrane Database of Systematic Reviews . 2007;2.

    REF12 Dagenais S, Mayer J, Haldeman S, Borg-Stein J. Evidence-informed management of chronic low back pain with prolotherapy. Spine J 2008 Jan-Feb;8(1):203-12.

    REF13 Dechow E, Davies RK, Carr AJ, et al. A randomized, double-blind, placebo-controlled trial of sclerosing injections in patients with chronic low back pain. Rheumatology (Oxford). 1999;38:1255-1259.

    Revision Information

    • Reviewer: EBSCO CAM Review Board
    • Review Date: 02/2022
    • Update Date: 05/17/2022