What to Know About Prolotherapy

Medically Reviewed by David Zelman, MD on September 13, 2023
4 min read

Prolotherapy is an alternative treatment for joint and muscle pain. It usually costs around $150 per injection and isn’t typically covered by insurance.

Prolotherapy is a therapy used to treat joint and muscle pain. It is sometimes called regenerative injection therapy or proliferation therapy.

Prolotherapy involves injecting a sugar or saline substance into your sore joint or muscle, where it acts as an irritant. It’s thought that your body recognizes the irritant and sends immune cells and other chemicals to the area, which starts your body’s natural healing process. This process is meant to help repair any damaged soft tissue in your joint or muscle area, like nerves, blood vessels, and muscle tissue.

Prolotherapy is an old practice that’s been around since the 1950s when a surgeon named George Halkett used it with his patients. The evidence for this treatment is limited and unclear, though.

Some organizations like the American College of Rheumatology don’t recommend prolotherapy. Other organizations like the American Academy for Orthopedic Medicine recommend it only for certain cases of ongoing low back pain.

Experts aren’t clear how or if prolotherapy works, but there are several theories about the way it acts in the body. Possible actions could be that:

  • The injection changes the fluid pressure and causes local cells in the area to burst, which triggers the healing process.
  • The injection attracts immune cells and inflammation chemicals to the area.
  • The injection causes scarring where the collagen is broken down.
  • The injection causes irritation to cells in a confined area by drying them out.

This process is said to cause inflammation and stimulate your body to heal, and people say it eases pain.

There is some research on prolotherapy and some studies that conclude that it might help with conditions like tendon injuries, finger and knee osteoarthritis, and ligament problems that cause low back pain.

Children with Osgood-Schlatter disease, which is an inflamed knee tendon that causes swelling and pain, received prolotherapy injections in the knee. A year after treatment, 84% of those who had the injection were pain free versus 46% who were treated with pain relievers. The group that had prolotherapy injections also had less pain during sports.

In another study, people with osteoarthritis in the knee had prolotherapy and had greater pain reduction, swelling, and movement than those who didn’t.

Some patients with low back pain were also given prolotherapy and had significantly less pain and disability.

But many of the studies on prolotherapy are small and don’t show long-term pain relief or change to the joint or muscle condition. Better quality studies, with more patients being treated or examined over a longer period of time, are necessary.

Procedures that involve needles are known to cause placebo responses, so the placebo effect may be responsible for the pain relief of prolotherapy.

Prolotherapy seems to be a safe treatment based on the limited research. None of the clinical trials for prolotherapy and low back pain show any serious side effects. Mild effects may include:

  • Minor pain at the injection
  • Bleeding
  • Occasional numbness
  • Full feeling in the joint

While there are no reports, it may be possible to have a side effect like:

  • Allergic reaction
  • Infection at the injection site
  • Nerve damage
  • Lightheadedness

Most doctors aren’t in favor of and don’t have formal training from medical school in this treatment. It’s also not a regulated practice that requires a special certification, but the practitioner does need to be highly trained to properly do prolotherapy.

It’s important to make sure you get prolotherapy from someone who is properly trained to give injections.

Because it appears to be safe, the Arthritis Foundation states that you can try prolotherapy if you want. You might find prolotherapy treatment if you visit an orthopedic doctor, sports medicine doctor, or rehabilitation doctor.

Prolotherapy might be helpful for people who:

  • Have chronic low back pain
  • Have a tendon injury
  • Have osteoarthritis
  • Have a sports injury

Talk to your doctor first, because there might be other, more effective treatments that have better research — like simple exercise, stretching, and rehab therapies. Your doctor might only consider prolotherapy if nothing else works.

There are some people with certain health problems who shouldn’t have prolotherapy. These include people who have:

There’s still a lot we don’t know about prolotherapy. There isn’t enough evidence to clearly show how it works or if it’s safe and effective over the long term. Before trying prolotherapy, talk to your doctor.