What Is Prolotherapy?

Alternative Treatment That Uses Injections to Promote Healing

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Prolotherapy, also called proliferation therapy, is an alternative medicine treatment used for musculoskeletal disorders. Since the 1950s, individuals with chronic pain have sought prolotherapy for the management of osteoarthritis symptoms, low back pain, and joint laxity.

By injecting a solution of dextrose (a natural sugar chemically identical to the body's own glucose) prolotherapy providers aim to provide non-surgical healing for inflamed and damaged joints. Here's what you should know about the efficacy and risks of prolotherapy.


Prolotherapy is an alternative medicine injection of dextrose meant to treat osteoarthritis and other musculoskeletal conditions.

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Patient having knee injection by medical provider

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What Prolotherapy Involves

The theory behind prolotherapy is the belief that injecting an irritant solution (typically dextrose) into a joint or tendon triggers the body's natural healing process.

Prolotherapy solutions contain between 12% to 25% dextrose and sometimes also have additives like zinc, human growth hormone, ozone, manganese, platelet-rich plasma, or bone marrow.

To ensure proper placement of the injection, some healthcare providers use ultrasound technology to guide prolotherapy. Since ultrasounds are low-risk and don't cause pain or discomfort, ultrasound-guided prolotherapy is considered by many to be a preferred industry standard for effective treatment with prolotherapy.

Proponents believe that prolotherapy injections boost growth factors at the injection site and stimulate recovery from wounds or the degeneration of tissue, as in osteoarthritis. Three to four shots are administered every month for a series of several months. Patients may also choose to get shots as needed for flare-ups or acute problems.

Conditions Treated

The purpose of prolotherapy is to promote the regeneration of damaged tissues. It is thought that injecting dextrose kills off cells and localized trauma occurs. Inflammation follows as the body responds to heal the damaged area. Then, matrix and bone remodeling occur, leaving the injection site in better shape than before treatment.

People may look to prolotherapy for help with conditions like:

Unfortunately, claims that prolotherapy can effectively signal regrowth of the tendons and joints are difficult to replicate or prove in a lab setting. Support for prolotherapy is primarily anecdotal, with patients reporting improved symptoms after treatment.

It is possible that the placebo effect is at play for many of the positive reactions to prolotherapy treatment. Placebo effects can be profound, especially with something slightly invasive, like an injection. That is not to diminish the potential benefit of prolotherapy for osteoarthritis patients dealing with chronic pain.

Osteoarthritis can have a significant impact on the quality of life. Prolotherapy is unlikely to interfere with other treatments (like medications or physical therapy) so it could be considered one part of a more comprehensive therapy approach.

Studies on knee osteoarthritis demonstrate patient-reported improvements after prolotherapy treatment, including a greater range of motion and a reduction in pain and stiffness. Although it's been around for over 70 years, researchers continue to hypothesize about the benefits of prolotherapy for various health conditions.

Prolotherapy can be a good option for patients who are unable to have surgery or those who are not responding well to other forms of conservative treatment.

Studies on foot and ankle pain show prolonged benefits from prolotherapy that lasted an average of two and a half years. Up to 81% of the study participants believed prolotherapy to have been effective, suggesting that it's a worthwhile option to consider.

Side Effects

Prolotherapy has minimal associated risks, especially when compared to more clinically-significant injections, like steroid treatments. Rarely, patients may have some pain at the injection site that resolves within 72 hours.

Swelling, stiffness, or allergic reactions are unlikely but possible. Solutions that contain dextrose only are the least likely to cause negative side effects, since dextrose is well-tolerated by the body. When additional components are included in the prolotherapy solution, the potential for negative side effects goes up.

Using your judgment along with the advice of your healthcare provider can help you find a reputable clinic and avoid prolotherapy practitioners who are inexperienced at giving injections or using additives that may be harmful.

Average Cost

The out-of-pocket expense for prolotherapy is high and, as a form of alternative medicine, insurance doesn't cover it. Individual injections can be $150 or more.

Depending on your insurance plan, you may be able to pay for the cost of prolotherapy treatment with funds from a health savings account (HSA) or flexible spending account (FSA). You can also ask your provider about no-interest payment plans to help finance prolotherapy treatments.

Where Is Prolotherapy Provided?

Prolotherapy is generally not accepted by traditional medical professionals due to a lack of definitive scientific evidence supporting its efficacy. You're most likely to find it in orthopedic practices and sports medicine clinics.

If you see a rheumatologist for the management of osteoarthritis, they probably would not recommend prolotherapy.

Prolotherapy is not included in the guidelines set out by the American Academy of Orthopaedic Surgeons and is not considered a standard practice in conventional medicine. However, this may change as more research on prolotherapy is conducted and better quality studies are provided.

Most healthcare providers are more likely to advise other non-surgical options, like physical therapy, occupational therapy, anti-inflammatory medications, or steroid injections. Although many patients would prefer less invasive treatment, sometimes surgery is the best solution for severe cases of musculoskeletal pain.

If you choose to try prolotherapy, do your research to find a reputable provider. While the risks of prolotherapy are usually small, there is always a risk of infection or side effects with injections. You'll want to be sure the clinic is using safe and sterile practices.

Always let your healthcare provider know about any alternative medicine treatments that you're doing.

A Word From Verywell

There is not enough evidence to support the use of prolotherapy to replace other evidence-based treatments for joint conditions, like osteoarthritis. However, prolotherapy has the potential to make patients feel better and is generally a low-risk procedure.

Aside from the financial cost, prolotherapy is an option that stands to benefit a number of patients, especially when used as part of an overall lifestyle plan to manage chronic pain.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Hauser RA, Lackner JB, Steilen-Matias D, Harris DK. A systematic review of dextrose prolotherapy for chronic musculoskeletal pain. Clin Med Insights Arthritis Musculoskelet Disord. 2016;9:139-159. doi:10.4137/CMAMD.S39160

  2. Buchanan BK, DeLuca JP, Lammlein KP. Technical innovation case report: Ultrasound-guided prolotherapy injection for insertional achilles calcific tendinosis. Case Rep Orthop. 2016;2016:1560161. doi:10.1155/2016/1560161

  3. Delzell E. Prolotherapy for osteoarthritis. Arthritis Foundation.

  4. Sanderson LM, Bryant A. Effectiveness and safety of prolotherapy injections for management of lower limb tendinopathy and fasciopathy: a systematic review [published correction appears in J Foot Ankle Res. 2015;8:60]. J Foot Ankle Res. 2015;8:57. doi:10.1186/s13047-015-0114-5

  5. Sit RW, Chung VCh, Reeves KD, et al. Hypertonic dextrose injections (prolotherapy) in the treatment of symptomatic knee osteoarthritis: A systematic review and meta-analysis [published correction appears in Sci Rep. 2017 Apr 07;7:45879]. Sci Rep. 2016;6:25247. doi:10.1038/srep25247

  6. Hajimirsadhegh AN, Rivello GJ. Clinical effects of prolotherapy for chronic foot and ankle pain. Podiatry Institute.

By Anastasia Climan, RDN, CD-N
Anastasia, RDN, CD-N, is a writer and award-winning healthy lifestyle coach who specializes in transforming complex medical concepts into accessible health content.