Prolotherapy, also called proliferative therapy, is an injection-based treatment type used in chronic musculoskeletal disorders. Treatment involves the repeated injection of an irritating solution into a part of the joint, for example, the interior of the joint or a supporting tendon or ligament. The injected solution initiates a deliberate inflammatory process in the tissue. Thus, the blood supply of functionally weakened or lost tissue increases. Various cells arrive at the injection site and the repair process is initiated. Prolotherapy is a method that can be effective in pain control. It is considered safe for most people. However, only a few studies have been done on its overall effectiveness.
What is prolotherapy?
Prolotherapy is a complementary medical treatment method used for muscle-joint pain and injuries. With prolotherapy, a liquid mixture is injected into the damaged joints, cartilage, ligaments, and tendons, which will put these issues in the reconstruction and self-repair phase. Prolotherapy is applied by injecting a natural irritant into the soft tissue of an injured joint. The irritant injection initiates the body’s healing response. Supporters believe that prolotherapy can provide significant relief for joint or back pain.
Prolotherapy is a treatment method that was discovered by the American doctor, Dr. George S. Hackett in the 1940s, and later developed and advanced by Dr. Hackett and Dr. Hemwall. It is a treatment method that has been successfully applied and widely used in many developed countries, especially in the United States of America, for about 50-60 years. Its history in our country is 7-8 years.
What preparations are made before prolotherapy?
- Before the appointment, your doctor evaluates the area to be treated with imaging methods such as direct radiography, magnetic resonance imaging, and computed tomography scanning. Then, the injection points are determined.
- Before the procedure, the skin in the relevant areas cleans with alcohol. Next, they apply lidocaine cream to the injection site to reduce pain. If necessary, sedation can be used in patients who experience severe pain.
- Before prolotherapy, it is recommended to eat a meal containing plenty of protein to strengthen immunity. In addition, your doctor may recommend that you stop taking anti-inflammatory drugs at least three days before the appointment so that the body can create a strong immune response and respond well to treatment. Blood-thinning drugs that can cause bleeding tendency can be stopped under the supervision of the doctor for a certain period of time before the procedure.
How is prolotherapy applied?
Prolotherapy is completed in 30 minutes or less, including pre-procedure preparation. After the application of local anesthesia, the affected areas are carefully injected. Immediately after the treatment, the patient rests for 10-15 minutes by applying heat packs to the injection areas. After the heat application, the patient can return home.
How does prolotherapy work?
Prolotherapy involves injections of aqueous solutions to relieve pain in the affected joints. These injections typically contain natural ingredients such as dextrose, saline, in addition to a drug such as lidocaine. This treatment is different from platelet-rich plasma (PRP) and steroid injections, which require stem cells from the person being treated. However, some experts consider PRP injections as a subtype of prolotherapy.
Dextrose solution is generally preferred in prolotherapy. Dextrose is a potentially irritating solution and triggers the body’s healing response. Thus, the repair factors are activated in the body. This activity begins to strengthen and repair damaged ligaments in the joint. Strengthening the ligaments helps stabilize the joint over time. When the joint is better supported, the pain may disappear.
Your doctor gives the injection to one or more specific and targeted areas of the injury site that trigger the healing response in your body. Because this treatment promotes tissue growth, it may not be effective in patients with long-term conditions such as Crohn’s disease or chronic fatigue.
Prolotherapy usually requires several sessions of treatment to be effective in the area of injury or weakened area. 4 to 15 applications can be applied to a person per session. These sessions are completed in a period of 3 to 6 months. It is important to correctly apply the irritant to the area or areas that require repair.
How is the healing process after prolotherapy?
Immediately after the procedure, mild swelling and stiffness are common. But these resolve quickly, and most people can resume normal activities the same day or the next day. Some patients may experience bruising, discomfort, swelling, and stiffness for up to a week.
Prolotherapy should never cause severe pain. Since severe pain accompanied by fever may be a sign of infection, it is essential to seek medical help immediately. Multiple prolotherapy treatments may be recommended to continue to stimulate new tissue growth. Some experts recommend about 3 to 6 treatment sessions administered every four weeks.
Types of Prolotherapy
Prolotherapy is done by injecting various substances into the body to stimulate the growth of normal cells, tissues, or organs. Different prolotherapy solutions are used for injection and these are selected according to the problem being treated. Prolotherapy types include proinflammatory dextrose, provolone, PRP (platelet-rich plasma), and stem cell (bone marrow or fat) solutions.
Depending on what is being treated, the doctor may recommend various types of prolotherapy treatments. Each treatment is effective in treating pain and supporting soft tissue repair.
- Dextrose solution
Dextrose is a solution that triggers the release of growth factors. For this reason, concentrated dextrose is injected into and around the injury site. Stimulated growth factors stimulate the growth and repair of tendons, ligaments, and other soft tissues.
- Platelet-rich plasma (PRP)
PRP consists of the initials of the words platelet-rich plasma in English and means platelet-rich plasma. It is a form of prolotherapy that involves the injection of platelet-rich plasma taken from the person’s own body into the injury site. Platelets are tissue repair components that secrete various growth factors. For this purpose, blood is taken from the patient first and then centrifuged. This process separates the blood plasma and concentrates the platelet content. When PRP is injected into the face, it gives a younger appearance and repairs the scars.
An ozone solution is used in Prolozone injections. Ozone injection is often used to treat soft tissue injuries, pain in arthritic joints, back pain, and sciatica.
- Stem cells
Stem cells for prolotherapy are obtained from the patient’s own bone marrow or adipose tissue. The cells collected are specialized cells that have the potential to replace other cells in various tissue structures and stimulate healing. Bone marrow stem cells can also be used for bone repair where it is needed.
Which diseases are treated with prolotherapy?
Prolotherapy mostly uses it to treat injured joints and ligaments. It is most commonly applied to the back. In addition, prolotherapy can be used in the body areas listed below;
- Other joints and ligaments
Some of the ailments in which prolotherapy is used;
- Sports injuries
- Back pain
- Neck pain
- Carpal tunnel syndrome
- Partially torn tendons,
- ligaments, and cartilage
However, treatment areas are not limited to these and can also be used for different musculoskeletal pain. In some cases, it may be preferred to relieve pain in patients with chronic conditions such as degenerative disc disease or arthritis.
WE CAN LIST THE PROLOTHERAPY INDICATIONS AS FOLLOWS:
1-Joint laxity and loss of strength (laxity)
2-Tendinitis (Chronic diseases in tendons and ligaments that do not heal)
3-Bursitis (inflammation in the organs that produce fluid that provides lubrication of joints and tendons)
4-Arthrosis (joint calcification, wear, and aging)
5-Avascular necroses (necrosis of bone tissue due to insufficient blood flow)
6-Discomfort in which muscles and tendons cannot function as a result of recurrent swelling and pain
8-Recurrent neck pain
9-Recurrent back pain
10-Recurrent back pain
11-Muscle and ligament pains that do not pass in the spine, chest, and ribs
14-Persistent pain after ankle and wrist sprains
15-Coccidinia (Coccyx pain)
16-Scoliosis (Contrary to what is known in scoliosis, ligament imbalance is a very important reason)
21-Tennis elbow (epicondylitis)
24-Lumbar hernias that do not heal after surgery
25-Post-operative muscle and joint pain
28-Temporomandibular joint hypermobility
29-Carpal Tunnel Syndrome
Are there risks to prolotherapy?
The risks of prolotherapy are significantly less than those seen in surgical treatment. Prolotherapy does not require general anesthesia and hospitalization. Recovery time is much shorter than surgery and the possibility of infection is significantly less.
Prolotherapy is generally considered safe. Although it has positive effects, being a new treatment means that there may be risks that are not yet known. For example, some experts have stated that they are concerned that the dextrose solution injected in prolotherapy may cause tissue-damaging sugar molecules to accumulate in joint tissues in the long term. But to date, there is no data to prove this. Current research has shown extremely positive results.
In rare cases, the infection may occur after treatment. Signs of infection include pain and fever. In this case, antibiotics are given to the patient for treatment. Receiving prolotherapy treatments only from a trained and certified professional will minimize the risks that may arise. The biggest risk in prolotherapy treatment is nerve damage caused by an injection too close to a nerve.
HOW MANY SESSIONS IS PROLOTHERAPY APPLIED?
The number of sessions to be done determines the condition of the patient and his disease and depends on many factors. Additional problems such as the patient’s age, weight and duration of the disease, extent, and degree of damage, diabetes, hypothyroidism, metabolic syndrome, obesity, smoking, and alcohol use prolong the recovery period. 4-6 sessions are sufficient for most patients, some patients show significant improvement in 1-2 sessions, while some patients may require 8-10 sessions to get results.
AT WHAT INTERVALS IS PROLOTHERAPY PERFORMED AND HOW LONG IS THE SESSION?
Injections are made every 3-4 weeks. However, your doctor may shorten this period to 2 weeks or extend it to 6-8 weeks depending on the course of the treatment. Session duration increases in direct proportion to the size of the area to be injected. The application time of each sensation can take 30-40 minutes. Injections are made in a part of this period, the remaining time is used for marking the injection sites with a surgical pen, and a manual general procedure is applied to increase the effectiveness of prolotherapy after injection.
ARE INJECTIONS PAINFUL IN PROLOTHERAPY?
The pain felt by the patients during the injections is completely related to the pain threshold of the patient. It is very rare for a patient who discontinues treatment due to the pain of the injections. It is not right to continue the treatment in such patients who are already afraid of injections. Almost all of our patients tolerate the treatment well, comply with the treatment protocols, and complete their treatment.
WILL I HAVE PAIN AFTER PROLOTHERAPY? SHOULD I REST AFTER THE INJECTIONS?
After the prolotherapy, if possible, rest for the first 3 days. If you do not have such an opportunity, you can continue your daily work without forcing yourself. After the injections, applying hot to the treated area with hot water bags for 15-20 minutes every 3-4 hours for the first 3 days will increase the benefit you will see from the treatment. The temperature should be high, but you should be careful not to burn your skin. (You can do this by wrapping the thermophore from pharmacies in a towel).
I HAVE HAD ONE OR MORE OPERATIONS ON MY PROBLEMATIC JOINT BEFORE. CAN I BE PROLOTHERAPY?
Surgery or surgeries that you have undergone before on your troubled joint (waist, neck, knee, hip, shoulder, etc.) do not usually prevent prolotherapy. Most of these patients also benefit from treatment. Previous surgical interventions may increase the number of sessions.
WHAT ARE THE DRUGS OR SOLUTIONS USED IN PROLOTHERAPY INJECTIONS?
There is no such guarantee in any treatment. Because there are many factors that affect healing. For example; Even after hip, knee replacement, or lumbar hernia surgery, there is no guarantee that you will recover 100% and your pain will completely disappear. Prolotherapy is not a direct treatment of pain, but a treatment method that treats the problem that causes pain and provides natural, permanent, and effective relief or reduction of pain.
CAN PROLOTHERAPY BE APPLIED FOR PAIN ASSOCIATED WITH INFLAMMATORY RHEUMATISM?
Prolotherapy is not a method that treats inflammatory rheumatic diseases. In inflammatory rheumatic diseases (eg: Ankylosing Spondylitis, Rheumatoid Arthritis), it can be applied to treat weakness caused by rheumatism in joints, tendons, and ligaments during remission periods, to strengthen the joint and to reduce mechanical origin pain.
CAN PROLOTHERAPY BE COMBINED WITH OTHER TREATMENTS?
Prolotherapy can be combined with some other treatment methods. Any method that increases blood circulation increases the effectiveness of prolotherapy. In our clinic, we use prolotherapy in combination with Dry Needle Therapy and Neuroprolotherapy, and manual therapy in patients we deem necessary.
WHAT ARE THE SIDE EFFECTS OF PROLOTHERAPY?
Common side effects in prolotherapy include increased pain at the injection site (actually what we expect and want), bruising, swelling, stiffness, flu-like symptoms, and headache. These side effects do not harm the patient and pass by themselves over time.
DOES PROLOTHERAPY HAVE A PROTECTIVE EFFECT IN TRAUMAS AND LIGAMENT STRAINS?
Since prolotherapy is a painful and partially invasive method, it is not preferred in preventive medicine applications, but performing similar applications from time to time in patients who have been treated with this method before may prevent repetitive injuries.
HOW IS THE HEALING PROCESS IN PROLOTHERAPY?
The healing process in prolotherapy depends on the condition of the patient and the disease. Factors affecting the healing process; The age, weight of the patient, the presence of additional disease (Diabetes, hypothyroidism, etc.), alcohol-cigarette use, the chronicity-duration of the disease, the severity of the disease, the healing capacity of the patient’s body, the size of the treated joint, whether the treated joint carries a load or not. Clinical improvement begins to be seen after an average of 3 weeks after the first session. Some patients may experience improvement after a few sessions due to the reasons mentioned above. In prolotherapy, some patients may experience periods of increase and decrease in pain during the first sessions, there is nothing to worry about.
WHAT ARE THE RULES THAT THE PROLOTHERAPY PATIENT SHOULD STRICTLY OBEY?
- Never take painkillers (such as parallax, majestic, Voltaren, Athol, melox, etc.) that we call NSAI group. These painkillers with anti-inflammatory effects eliminate the effect of PROLOTHERAPY. If you have a lot of pain, you can take paracetamol group painkillers (parol, mindset, etc.) or tramadol (contramal, Zaldivar) that we will prescribe you without anti-inflammatory effect.
- After the application of PROLOTHERAPY, apply a warm application to the treated area for 20 minutes every 3 hours for the first 3 days. This application increases the benefit you will see from PROLOTHERAPY (you can do this with hot water bags from pharmacies. Diabetics or elderly patients with reduced sensation may not feel them during the hot application, so their skin may be burnt, pay attention to this).
IF THE PROLOTHERAPY PATIENT COMPLIES, WHAT ARE THE SITUATIONS IN WHICH THE BENEFIT FROM THE TREATMENT WILL INCREASE?
- Do the exercises we will give regularly (especially stretching exercises). When exercising, do it up to the limit where it causes pain and fatigue. Do not overstrain. Do not exercise when you have severe pain. Mild and temporary pain that may occur while exercising is not important. If you do not have a lot of pain, do not stay still.
- Taking food supplements that we will prescribe to you during PROLOTHERAPY will make a positive contribution to your treatment. ; Glucosamine complex is Type 2 Collagen, Vitamin C, Omega 3 (buy these products from pharmacies and trusted brands).
- If you are taking blood thinners, you can consult your cardiologist and take PROLOTHERAPY 5 days after stopping the blood thinner medication. 100-150mg of Aspirin taken daily does not prevent PROLOTHERAPY.
Drink 2.5-3 liters of water a day.
- Eliminate simple carbohydrates as much as possible. (Sugar, flour, and products made of flour, such as bread, pastry, bagel, cake, pastry, desserts, etc.)
- Eat a diet rich in minerals, vitamins, and proteins. Eat plenty of vegetables, try to consume vegetables especially raw (tomato, pepper, parsley, dill, mint, cress, radish, onion, garlic, etc.). Consume plenty of homemade yogurts every day.
- Your pain may increase in the first 3 days after PROLOTHERAPY. This indicates that your body is responding to treatment, a good sign. These pains may decrease and last up to 10 days. Do not forget that PROLOTHERAPY is not a direct pain relief method, it is a treatment method that treats the damage in the painful area and provides natural and permanent reduction or disappearance of pain.
- In PROLOTHERAPY, patient-physician compliance and patient’s patience (because it is not a short-term treatment, and from time to time increases in pain at the beginning of the treatment, this is the natural course of PROLOTHERAPY and therefore patience is required) If it is at a high level, the success rate is 70-80%. are in the.
The page content is for informational purposes only. Items containing information about therapeutic health services are not included in the content of the page. Consult your physician for diagnosis and treatment.
You May Also Like>>
- What is a cramp? Causes, Symptoms, and Treatment
- What is electrotherapy? Electrotherapy to Reduce Pain
- What is osteoporosis? Symptoms and Treatment Methods
- What causes foot pain? How does foot pain go?
- Delzell E. (n.d.). Prolotherapy for osteoarthritis.
- Ekwueme EC, et al. (2017). Prolotherapy induces an inflammatory response in human tenocytes in vitro. DOI:
- Eslamian F, et al. (2015). Therapeutic effects of prolotherapy with intra-articular dextrose injection in patients with moderate knee osteoarthritis: A single-arm study with 6 months follow up.
- Hauser RA, et al. (2016). A systematic review of dextrose prolotherapy for chronic musculoskeletal pain.
- Hauser RA, et al. (2011). Journal of Prolotherapy International Medical Editorial Board Consensus Statement on the use of prolotherapy for musculoskeletal pain.
- Kolasinski SL, et al. (2020). 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. DOI:
- Rabago D, et al. (2010). Prolotherapy in primary care practice. DOI:
- Rabago D, et al. (2013). Dextrose prolotherapy for knee osteoarthritis: A randomized controlled trial.