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Prolotherapy is a regenerative medicine procedure that stimulates tissue healing and repair.  The injections are a safe, non-surgical treatment for chronic injuries, pain and arthritis.  Prolotherapy treatment will stimulate the body's immune response to repair, rebuild and strengthen through injection of small volumes of dextrose (sugar) solution over painful ligaments, tendons and joints.

Prolotherapy has been used to treat chronic musculoskeletal pain and injuries for over 100 years, however, its modern application can be traced back to the 1950s when the prolotherapy injection protocols were formalized and studied by George Hackett, a general surgeon in the U.S.  In several studies conducted on pain patients, a significant majority received good to excellent results in pain relief and improved function (see references 1, 2).  The use of pain medications are often greatly reduced and sometimes stopped after treatment.

Image by Otto Norin
Arthritis of ankle . X-ray of foot . Lateral view . Invert color style . Gout or Rheumatoi
Common Conditions Treated With Prolotherapy
  • Jaw - temporomandibular (TMJ) dysfunction

  • Cervical Spine - arthritis, instability, whiplash, disk disease

  • Thoracic Spine - arthritis, instability, rib dysfunction

  • Lumbar Spine - arthritis, instability, disc disease, spondylosis, pain after surgery

  • SI Joint - arthritis, instability

  • Pubic Symphysis - osteitis pubis, instability, sports hernia

  • Shoulder - instability, recurrent subluxations, impingement syndrome, rotator cuff tears, arthritis of joint or acromio-clavicular joint, labral tears

  • Elbow - instability, arthritis, tennis elbow (lateral epicondylitis), golfers elbow (medial epicondylitis), tricep tendonosis

  • Wrist and Hand - thumb arthritis and instability, carpal bone instability, carpal tunnel syndrome, TFCC tears, finger arthritis

  • Hip and Pelvis - instability, arthritis, pelvis tendonosis and pain of stabilizing muscles and tendons of the hip, chronic IT band tendonosis, chronic hamstring strains, tears

  • Knee - arthritis, ligament instability and tears, peripheral meniscal tears, runners knee (tendonosis), Osgood-Schlatter's disease, pes anserine tendonosis

  • Ankle and Foot - arthritis, instability, chronic strains, sinus tarsi syndrome, Achilles tendonosis, tears, plantar fasciitis

How Does It Work?

When injuries occur the area may not heal completely due to lack of proper treatment, strengthening or poor blood supply.  If left untreated, damaged ligaments become loose allowing bones in the joint to move excessively causing pain, muscle spasms and eventually arthritis.  Arthritis progresses more rapidly in the joints and spine as a result of instability in the structures supporting them.  Prolotherapy can intervene by stabilizing  these soft tissue structures and decrease the progression of pain, degeneration and aging.  The injections initiate healing through a progressive, 3 stage process.

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The Three Stages Of Healing
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IMPORTANT:  If, during the three stages of the healing process, anti-inflammatory drugs, ice and/or immobilization are used to reduce pain and inflammation, complete and normal healing will be inhibited.  Most people are taught that inflammation is bad and don't realize that without inflammation, no healing will occur.  

Image by Maayan Nemanov
Instructions Prior To Treatment
  • Stop taking all anti-inflammatory medications (except for baby aspirin taken for the heart), including Naprosyn, Ibuprofen, Aleve, Naproxen, Cortisone type drugs, Motrin, Advil, Aspirin, Celebrex.  Please advise us if you are on blood thinners.

  • Eat a light meal one to two hours before treatment.

  • Drink plenty of water the day prior to the treatment and the day of treatment.

  • Acetaminophen is safe to take before or after the treatment.

  • Decrease or quit smoking as it impairs the healing process.

Instructions Following Treatment
  • DO NOT take anti-inflammatory medications after the injections.  Examples of anti-inflammatories include ibuprofen (Advil), full strength aspirin (325 mg), naproxen (Aleve), prednisone, Celbrex, Mobic and Voltaren.  Similarly, some herbal supplements can have an anti-inflammatory effect.

  • You make take Tylenol (acetaminophen) or other approved medications for relief of injection pain following treatment.  For most people a maximum dose of Tylenol per day is 4,000 mg, but if a patient has a history of liver issues or consumes more than three alcoholic drinks a day, a lower maximum dose should be used.

  • You may use heat for soreness (heating pad, warm moist towel, hot shower or bath).  However, refrain from the use of ice during the first week and longer if possible, as it may impair healing as it decreases blood flow.

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Further Reading

1. Rabago, D., Slattenren, A., Zgierska, A.  Prolotherapy in Primary Care Practice.  Prim Care. 2010 March; 37(1): 65-80


2. Hauser, R., Lackner, J., Steilen-Matias, Danielle., Harris, D.  Systematic Review of Dextrose Prolotherapy for Chronic 2 Musculoskeletal Pain. Clin Med Insights Arthritis Musculoskeletal Disorder. 2016; 9: 139-159.

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