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A natural treatment for pain and injury Prolotherapy is a type of “regenerative injection therapy” that stimulates the body’s natural healing mechanisms to repair chronically damaged ligaments, tendons, or other structures. The treatment involves injecting the injured area with a safe substance that causes a small amount of local tissue irritation or inflammation. This inflammation triggers the body’s natural repair processes to strengthen the existing tissue and to enhance the growth of new tissue/collagen. Regenerative injection therapy such as prolotherapy is the only non-surgical treatment for chronically damaged ligaments and degenerative tendons.

What conditions does it help?

Loose ligaments and degenerative tendons may produce one or more of the following symptoms:

Significant tenderness to palpation. Inability to maintain one position for prolonged periods of time. Pain when the joint is first used that is relieved after repeated movement. A numbness or pins-and-needles sensation in a specific pattern that doesn’t become more sensitive or painful when stroked. A sense of looseness or instability in the affected joint(s). Local and referred pain. Referred pain is felt some distance away from the injured site. Muscle tightness and spasms. Muscles will contract in an attempt to pull the joint back to the correct location or stabilize it to protect it from further damage. If the joint is slightly out of place because of a loose ligament, it may respond to treatment by manipulation, such as osteopathic manipulative treatment (OMT) or chiropractic care. Conditions that respond well to these manipulative treatments but quickly return to a painful condition tend to respond very well to prolotherapy. Trigger points or knotted muscles that keep recurring in the same locations or that don’t respond to other treatments. Recurring trigger points may indicate that there is a problem elsewhere in the body that is affecting the muscle(s). Arthritic / degenerative joints by stabilizing the joint capsule and surrounding ligaments. This includes arthritis of any joint of the body, most commonly treating arthritis of the: knees, hips, spine, hands, ankles, and TMJ (temporomandibular joint).

How do I determine if I am a candidate for prolotherapy?

Regenerative injection therapy such as prolotherapy is the only non-surgical treatment for chronically damaged ligaments and degenerative tendons. During your first office visit, we will determine whether prolotherapy is appropriate for your condition by reviewing your history and doing a physical exam. There may be a need to obtain X-rays or MRI, or have diagnostic musculoskeletal ultrasound performed within the office to determine if there is an injury in need of treatment.

The treatments:

How often are treatments given?

While response to treatment varies, most people will require three sets of injections. Each set of treatments is spaced two to four weeks apart. We never give treatments more frequently than every two weeks. While sometimes one treatment is enough, typically a minimum of three sessions is required to see clinical improvement. If there is no indication that the treatments are helping after three treatments, we usually stop, as it is unlikely they will help. If improvement is noted, then treatments continue. It is not uncommon for patients to have five to six sessions before they receive maximal benefit.

Treatments are stopped if:

You are markedly better (at least 90% improved).
There is no further improvement (you have reached a “plateau”).
You are satisfied with your improvement and simply wish to stop treatment.
There is no improvement after three treatments, as noted before

How many treatments are needed?

There is no limit to the number of treatments you can have. We have had patients who needed only one treatment, and we have had some who needed 15 or more treatments over a two-year period.

What happens after the prolotherapy procedure?

It is important not to use non-steroidal anti-inflammatory medications (NSAIDS) during treatment. At a minimum, NSAIDs should not be used seven days before your injection and for the first ten days after injection.

For the discomfort following each treatment session, most patients only need some acetaminophen (Tylenol). Rarely patients may need a prescription strength pain medication for one or two days after treatment. It is recommended to use heat to the area for 10-20 minutes every 3-4 hours after the treatment for the first three days

You are encouraged to avoid aggressive physical activities, especially ones that stress the injured area, after treatment. You want to allow the new “baby” fibers to grow stronger. Instead, we recommend gentle or light rhythmic activity, such as walking, swimming, using an elliptical trainer, etc. Follow your physician’s advice on activity levels.

What are the side effects?

Injection side effects, such as soreness at the area of injection, are common. Infection is always a risk with any type of injection; however, the risk is less than the risks associated with much more commonly performed corticosteroid injections.

How long does it take to see results?

While some patients will have an excellent response after the first treatment and within the first 2-3 weeks, in most cases, patients will see little to no pain relief after their first treatment. This does not mean that the treatment is not working. Rather, it is an indication that the ligaments and tendons are not yet strong enough to stabilize the joints. The amount of collagen growth required to stabilize the joint is different for each person.

If absolutely no improvement is seen after the third injection series, we will discontinue prolotherapy, as it is unlikely to help. The main reason patients may achieve only partial pain relief with prolotherapy is because they don’t complete the full course of treatment. It is important that you don’t become disappointed or discouraged if you don’t see improvement after one or two sessions, especially if you have been in pain for many years.

What is the evidence?

Over the years evidence supporting prolotherapy and other regenerative injection therapies have been rapidly growing. Several studies of lateral epicondylitis (tennis elbow) and Achilles tendinitis demonstrate significant pain reduction with significant improvement in pain after one year when compared with corticosteroid injections. For a list of prolotherapy-related research studies, please refer to

Will my insurance cover prolotherapy treatment?

Although prolotherapy has been used successfully and safely for decades, most insurance companies still consider it “experimental” and do not pay for it. You are welcome to contact your medical insurance provider to seek approval for prolotherapy injections. You can submit the expense of your initial office visit to your insurance company. Visits between prolotherapy sessions to assess progress can be submitted to insurance


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