Prolotherapy, which is shorthand for proliferative therapy, refers to a variety of techniques for healing or repairing damaged ligaments and tendons. Earliest reports of this practice date back to Hippocrates, who used a hot poker to repair the rotator cuffs of javelin throwers, and a hot needle lanced in and around the vertebra to cure back pain. Seemingly barbaric, it is thought that this stimulated inflammation, and the body's natural healing response.

"stimulate a natural healing"

Modern prolotherapy does not use hot pokers, today practitioners use a variety of injectable substances to generate local inflammation and stimulate a natural healing. Often dextrose, phenol, glycerin, and others are used to trigger the cascade of events that occur with normal wound healing.

This is particularly useful in the case of ligaments and tendons. These strong connective tissues have a very minimal blood supply, which results in very slow healing. When there is an injury, the healing of ligaments and tendons lags far behind muscles and bones, which enjoy a rich blood supply.

"heal in a stretched out, non-functional condition"

Remember, ligaments connect bone to bone, and stabilize your joints. Tendons connect muscle to bone, and give your joints a smooth action. In many cases, after an injury when patients are anxious to return to activity, these tissues never heal completely. Or, they may heal in a stretched out, non-functional condition. This allows ongoing pain, and if a joint is involved, abnormal motion and early arthritis.

Prolotherapy is not only used after an injury. It is also useful for people with ligamentous laxity. Some people have extremely loose ligaments that fail to hold the bones in proper position.

This can occur naturally, which is more common in women, or it can occur because of lifestyle. Things such as poor posture, or a lifetime of lifting and bending can cause chronically stretched out and lax ligaments. Prolotherapy is reported to shorten and strengthen these damaged structures.

"proliferants, irritants, and particulates"

Injection techniques, solutions, and theories vary among practitioners. In general, the solutions injected can be separated into three categories, proliferants, irritants, and particulates. Proliferants and irritants work by damaging a few cells, which stimulates the inflammation and begins the wound healing cascade. Particulates work by attracting macrophages to the area which begins a series of events resulting in collagen production.

The newest advance in prolotherapy is the injection of growth factors. They are used to directly stimulate the cells leading to a proliferation of fibroblasts and collagen generation.

"Success rates with prolotherapy vary..."

Success rates with prolotherapy vary, depending on who you talk to. Proponents claim a 85-95% success rate, but the reports are mostly anecdotal, and well controlled independent studies are lacking. Acceptance into modern medicine requires the gold standard study, a double blind comparison, using large numbers of people.

Prolotherapy is not widely accepted in the United States medical community, but this does not mean, that it does not work. It only means that adequate studies have not been done, and doctors have not embraced the procedure.

Designing a large scale, double blind, high quality study for prolotherapy is a difficult task. A double blind study requires an adequate control or placebo for comparison to the procedure being studied. This is easy enough when studying oral medications, because you can make two different pills look exactly the same. This becomes much more difficult with procedures, and especially procedures involving an injection. Prior studies of similar procedures have always rendered confusing and inconclusive results.

"reviewed five studies of prolotherapy"

A scientific group, The Cochrane Collaboration, reviewed five studies of prolotherapy for low back pain. They determined that three studies showed prolotherapy was not useful in the treatment of low back pain. Two studies showed that it may help when combined with other treatments, such as spinal manipulation, and exercise.

The risks of prolotherapy are low, with infection being the most serious possibility. This risk is well controlled with adequate precautions. The most common side effect is soreness and stiffness for a few days to a few weeks after the injection.

"The answer is "it depends"

Should you get prolotherapy? The answer is "it depends". If you have chronic pain , ask your doctor or orthopedic surgeon if you have ligamentous laxity. Or if there was an injury, could you have injured a tendon or ligament.

When you consider the low risk, and the potential for great benefits, prolotherapy may be worth considering.

David Stevens PA-C

Author's Bio: 

David Stevens is a physician assistant with 12 years experience working with a spine surgeon and he has recently taken a position with a pain management physician. He brings a special perspective to caring for his patients with pain, because he has been living with back pain ever since a motorcycle accident as a teenager crushed two vertebrae in his spine. His website at provides information and inspiration for people living with back pain. Learn more about the treatments for back pain at