Prolotherapy: Overview

Alternative names: Ligament Reconstructive Therapy, Stimulated Ligament Repair, Sclerotherapy, and Non-surgical Joint Repair.

Prolotherapy is a method of regrowing and strengthening ligaments and tendons by an injection technique which treats very common sources of chronic pain.  Pain from auto accidents, athletic injuries and overuse injuries often arise from injury to the soft tissues in the body.  These soft tissues, which include ligaments, muscles, tendons and joint capsules, are called connective tissues because they connect structures to bone, thereby supporting the skeleton.  Prolotherapy causes these connections to be rebuilt and strengthened.

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Prolotherapy is not a supplement, but a treatment to strengthen the ligaments and tendons by proliferation of new cells.  Similar to a rubber band, a ligament or tendon can become "over stretched".  The resulting laxity can cause pain as bones rub together or muscles are overworked as they tighten in an attempt to stabilize the bones.  According to some experts, this is actually the cause of most osteoarthritis.

Soft tissue injuries can become chronically painful.  The injured tendons and ligaments normally go through a repair and healing process that takes from four to six weeks.  As these tissues do not have a rich blood supply, they sometimes do not fully heal.  Repeated injury only makes full recovery less likely.  Anti-inflammatory drugs are often given to treat these injuries, but they may actually slow or stop this healing process.

Medications and other forms of passive treatment such as ultrasound, ice, heat, massage, acupuncture and manipulation may give minimal lasting benefits because the primary problem is not being addressed, namely the loose and injured ligaments.  Stretching and strengthening exercises usually can provide some relief from chronic pain, but this is often only temporary.  When these exercises have failed to increase the support sufficiently to diminish pain and improve function, a chronic pain cycle ensues.

When rest and pain medications fail, other types of treatment become necessary.

Physical therapists often use muscle strengthening as the means to stabilize joints and reduce pain.  However, it is primarily the ligaments that stabilize a joint.  When they fail, strengthening muscles to do the ligaments' job, though helpful, is not dealing with the cause of the problem.

Why not go to the cause of the problem, and strengthen the ligaments themselves?  Most doctors are not aware that this can be done.  Other types of treatment such as chiropractic care, massage therapy and acupuncture treatments may only give temporary relief.

Why don't more people know about prolotherapy?

  • Chronic pain is not well understood by most health care professionals and, therefore, is frustrating to treat.  Thus the comment, "There is not much you can do about it... you just have to live with it".
  • Prolotherapy is not taught in medical schools, so doctors are unfamiliar with it.
  • The technique of prolotherapy requires an in-depth knowledge of anatomy and the skill to place the injections accurately.  It takes a great deal of study and training for a physician to become adept at the technique.
  • The procedure takes up to one hour of clinic time, and most busy clinics cannot afford to take this amount of time for one patient.
  • Many doctors and patients are looking for a "quick fix", but prolotherapy results do not always occur overnight.  Therefore the prolotherapy patient must be committed to the treatment because multiple sessions are often required.
  • Pharmaceutical companies are not promoting it because there is no money in it for them.  Prolotherapy solutions contain common and inexpensive substances.  Drug companies cannot obtain exclusive manufacturing rights, so there is no investment potential and thus no profit to be made.
  • Because there are very few doctors who perform prolotherapy, patients typically just accept the pain or have surgery.  While surgery has its place, many patients and doctors are not aware that prolotherapy may relieve their pain and delay or prevent the surgery they thought they needed.
  • Since prolotherapy is considered by most insurance companies to be "investigational" and "alternative" it is therefore not usually covered.

Unfortunately, it is performed by only a handful of physicians in the U.S.


Prolotherapy has been in use since the 1930s and treatment results have often been amazing.

Function; Why it is Recommended

A proliferative solution such as concentrated glucose is injected directly into the site of the weakened ligament.  The body's own immune system grows new and healthy tissue which stabilizes the bones and joints, relieving musculoskeletal pain.  Prolotherapy is used to rejuvenate specific parts of our aging body.

Prolotherapy will work on injuries regardless of their age.  Very old injuries respond as readily to prolotherapy as more recent injuries, unless the problem has become more widespread over time as a result of repeated injury.

Prolotherapy can help or cure the following conditions:

  • Whiplash injury to the neck, upper back, shoulders and low back as a result of a car accident.
  • Headaches and TMJ pain often associated with car accidents.
  • Low back pain from lifting or work-related injuries.
  • Overuse injuries such as tennis elbow or shoulder tendonitis.
  • Muscle pain from fibromyalgia and other similar conditions.
  • Joint pain from arthritis.
  • Degenerative conditions of the spine.
  • Athletic injuries that have never healed.
  • Chronically weak and unstable shoulder, elbow, wrist, knee, and ankle joints from injury to supporting ligaments.

Most other types of treatment provide only temporary relief; prolotherapy can be an alternative to surgery in many cases.  George Hackett M.D., a prolotherapy pioneer, proved that strengthening connective tissue relieves soft tissue pain.  A research study in the respected medical journal, the Lancet, demonstrated the effectiveness of prolotherapy.

Prolotherapy is an effective treatment for a multitude of conditions.  There is no other treatment that replaces prolotherapy for strengthening weakened ligaments and tendons.  Healing occurs slowly but surely, and naturally.  Multiple treatments are usually necessary to achieve maximum joint stability and long-lasting relief from pain.  An Internet search should yield sites or associations which can direct you to doctors using prolotherapy in your area.

Expected Outcome

As many as 85-90% of patients have received good to excellent results when assessing their pain relief and improved function.  Just as importantly, pain medications can be greatly reduced or even eliminated.  Prolotherapy often produces long-lasting relief, naturally.

The healing that prolotherapy encourages seems to occur in stages over a six week period.  Reevaluation of the injured site, after prolotherapy treatment, can confidently be made after 6 weeks.

Stage 1 (Inflammation): Increased blood flow, swelling and pain.  Cells are called in to remove damaged tissue: this occurs during the first week.

Stage 2 (Fibroblastic Cells): The swelling and pain begin to subside with new blood vessels forming.  Fibroblasts increase in number at the sites of injection and over the course of four to six weeks secrete a substance called collagen which is a very strong and relatively inelastic substance.  The new collagen makes the ligaments thicker, denser and stronger, providing more support to the joints.

Stage 3 (Completed Healing): New blood vessels mature and tissue is stronger and pain subsides.  Collagen density and diameter are increased.  The strength of the injected ligaments can increase up to 40% above normal.  Stability is increased as pain and muscle spasm decrease.  The newly formed tissue continues to mature for one and one-half years.

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Prolotherapy can help with the following:


Premature/Signs of Aging

Prolotherapy can help keep joints stabilized.


Vulvodynia / Vestibulitis

The iliolumbar ligament may be weakened and referring pain to the vulvar area.  Prolotherapy can strengthen that ligament.



Prolotherapy is the treatment of choice for any weakened ligament or tendon and its associated pain.  Prolotherapy successfully regrows tendons and ligaments and reduces or eliminates pain from tendonitis.



Prolotherapy is the best and often only treatment when ligaments are weakened and cartilage damaged.  As good as some of the other treatments are for pain, nothing seems to come close to the effectiveness of Prolotherapy.  Prolotherapy is the only treatment that can stimulate the regrowth of the injured tissue.


Prolotherapy, by strengthening the ligaments involved, provides definitive results in the relief of the chronic chest pain of costochondritis.

TMJ Problems

Prolotherapy regrows tendons and ligaments to strengthen and stabilize overly mobile joints such as the TMJ.

Heel Pain

Plantar fasciitis is one of the many ligament problems that respond well to prolotherapy treatments.

Neck / Spine

Low Back Pain

Chronic lower back pain is one of the easiest conditions to treat with prolotherapy.  See Pain, Pain, Go Away, by William J. Faber, DO and Morton Walker, DPM.

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