Medical News Today: What is prolotherapy and what is it used to treat?

Prolotherapy is a procedure where a natural irritant is injected into the soft tissue of an injured joint. Supporters believe that it may provide significant relief for joint or back pain.

The disruption to the lives of those who experience joint and back pain can be serious. From missed work to decreased mobility, the impact of back and joint pain can affect nearly every aspect of someone’s life.

In this article, we examine what prolotherapy consists of, what someone should expect from this procedure, and how effective it is in reducing pain.

What is prolotherapy?

Person receiving prolotherapy injections to inflamed knee joint.
Prolotherapy involves injecting irritants into an injured or inflamed joint to stimulate healing.

Prolotherapy is a procedure where a natural irritant is injected into the soft tissue of an injured joint. The irritant kick-starts the body’s healing response.

Prolotherapy is not a surgical treatment. Because of this, it is also known as a regenerative joint injection or non-surgical ligament and tendon reconstruction.

Doctors mainly use prolotherapy to treat injured joints and ligaments. While it is most commonly used for the back, doctors may also use prolotherapy in the following areas of the body:

  • knees
  • hips
  • shoulders
  • other joints and ligaments

In some cases, people with chronic conditions, such as degenerative disc disease or arthritis, may wish to use prolotherapy to help ease their pain.

Although prolotherapy has been in existence since the early 1900s, its overall effectiveness is still questioned. Despite this doubt, many members of the medical community believe it to be a safe alternative or additional treatment for back and joint pain.

How does it work?

Prolotherapy is an injection that contains a potential irritant, such as a sarapin or saline solution. The irritant is thought to trigger the body’s healing response.

Once activated, the body will start to strengthen and repair damaged ligaments in the joint. The strengthening of the ligaments, over time, helps to stabilize the joint. Once the joint is better supported, the pain can disappear.

Prolotherapy requires several shots at the site of the injury or weakened area to be effective. An individual can expect anywhere from 4 to 15 shots per session, and for several sessions to occur over the course of 3 to 6 months.

The injection must be precise so that the irritant is placed at the area or areas requiring ligament repair.

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What to expect

Female doctor and patient discussing treatment and taking medical history.
A patient will need to be assessed for suitability before being recommended for prolotherapy.

Before receiving prolotherapy, a doctor will assess a person with joint or back pain to work out if they are a good candidate for the therapy.

Not all people are suitable for the procedure. People with chronic conditions, for example, may not see any effects from the prolotherapy so a doctor may suggest other alternatives.

During or before an assessment, a doctor will likely examine X-rays or other imaging results. The images will help them decide if the procedure is feasible, given the location and severity of the injury.

If the person is taking anti-inflammatory medication, this should be stopped 2 to 3 days before the procedure. Continuing to take anti-inflammatory medication may prevent the procedure from working.

On the day of the prolotherapy, it is important that a person eats well. Often, doctors recommend that the person undergoing prolotherapy eats a protein-rich meal.

During the procedure, doctors prepare the person’s skin with rubbing alcohol or another sterilizing solution. They may then apply numbing cream to the skin to reduce discomfort from the injection site.

In extreme cases, where the person is in considerable pain or discomfort, additional sedation may be used.

Once prepared, the doctor will use a long, thin needle to deliver the irritant solution to several different points around the target area in the back or joint. The number of injections used depends on the area or joint affected.


Medical professionals who support the use of prolotherapy believe that the strengthened joints will mean the pain is reduced. Also, the improved strength of the joint will help with stability and improve overall movement and function of the back and joints.

Prolotherapy is an all-natural, permanent treatment, as it relies on the body repairing itself to reduce pain.

In contrast, pain relievers and anti-inflammatory medications only provide temporary relief. Similarly, surgical options do not always work to stabilize a joint fully.

Risks and side effects

There have been few reported side effects from prolotherapy. In rare cases, the worst side effect is an infection at the site of an injection. A potential infection will show through fever and pain, and it is usually easy to treat with antibiotics.

Another side effect may be temporary swelling or pain where the injection occurred. Immediately following the procedure, the affected joint may feel worse before beginning to feel better.

Prolotherapy has not been researched extensively. This may mean that there are side effects that have yet to be discovered.

One potential concern involves the use of sugar in prolotherapy. Some doctors have suggested that the buildup of sugar in the joint could cause long-term damage to a person’s joints. However, this has yet to be proven or shown.

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Success rates

Person receiving injection in their back.
Though studies on prolotherapy have shown high rates of success, further research is needed.

According to the available research, people who receive prolotherapy experience high rates of success.

However, the study groups involved are often small in size, and the amount of research that has been done so far is not substantial.

For example, one study conducted and published in the Journal of Alternative and Complementary Medicine used only 13 participants.

Another study tested 38 knees in participants, while a third study used 90 participants. Still, the results of these small studies indicated an overall success with the prolotherapy procedure.

As with any procedure, the skill of the doctor performing it will impact how well it works. Also, how an individual responds to the treatment is likely to vary.

Groups such as Centers for Medicare and Medicaid Services and the Veteran’s Administration do not currently recommend prolotherapy for third-party compensation.


Prolotherapy can be quite costly for an individual. Many insurance companies will not cover prolotherapy, so individuals have to pay for their treatment.

Costs seem to range from around $250 to $600 for the procedure. The exact cost depends on the site of the injections, who does it, and if any additional treatment is required.


Some researchers and doctors remain hopeful that prolotherapy will become more widely accepted. Initial research suggests that, overall, it is a safe, alternative procedure to medication or surgery.

Critics, on the other hand, are skeptical about the efficacy of prolotherapy. They cite a lack of substantial research to back the claims of its supporters. Study sizes are often small, casting doubt on the trustworthiness of the findings. In most cases, critics encourage people to discuss all the options before using prolotherapy.

Prolotherapy is controversial and needs more research to support its use. As a result, people may have difficulty getting insurance to cover the procedure or doctors to perform it.

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