pain in knee

What is Prolotherapy and How Does it Work?

By: James Thompson, DO
Published: March 3, 2020

A non-invasive regenerative medicine therapy practiced for nearly a century by doctors, prolotherapy has the potential to aid in the healing of numerous ailments including common sports injuries and arthritic joints.   

What is Prolotherapy?

Prolotherapy, short for proliferation therapy, is a non-invasive treatment that involves the injection of a solution into a weak or damaged area of the body in order to regenerate and repair tissue. More specifically, a small amount of solution, often dextrose (sugar), lidocaine (a commonly used local anesthetic), and sterile water mixture, is injected near painful or damaged ligaments, tendons, or joints to induce an inflammatory response. Once injected into these areas, these seemingly benign substances promote healing, which is initiated by the body.

pain in the knee joint

How does prolotherapy work?

Initiating the inflammatory process is thought to cause the production of fibroblasts (the body’s repair cells), which deposits new tissue fibers to repair an injury, ultimately stabilizing the area, restoring function, and diminishing pain. The resulting reduction in pain and improvement of function has the potential to be permanent. Each prolotherapy session is done in-office and takes around 30 minutes from prep to finish.

What Can I Expect at a Prolotherapy Treatment Visit?

Before the procedure can begin, an initial discussion of the risks and benefits of prolotherapy will take place between the patient and provider. Once the patient has a thorough understanding of the procedure and associated risks, consent for the procedure will need to be obtained before proceeding with the treatment.

For the actual procedure, the patient is positioned on an exam table, and the treatment area is prepped and sterilized.  Depending on the origin of the complaint or injury and site location, multiple injection sites may be needed.  In most instances, the area will be anesthetized with lidocaine by a very fine needle, followed by the prolotherapy injection(s). The solution is then injected into the treatment area and covered to protect against infection.

How frequently are injections needed?

Depending on the injury or condition, a series of two to three injections are performed over every four weeks. Fewer treatments may be needed depending on the resolution of symptoms. The healing time is different for everyone, but most people can expect to see results as soon as three to four days after their visit.  However, this is a regenerative healing process which may take a few weeks to see full results.

What can I expect after I receive an injection?

The injection site will likely feel sore and achy for the next few days, often resolving 24 to 72 hours post-injection.  It is highly recommended that the injection site be iced.  Refrain from using any steroids or Non-Steroidal Anti-inflammatories (NSAIDS) such as ibuprofen (Motrin) or naproxen (Aleve) for seven days after your procedure; doing so will only block the intended regenerative response.

To prevent infections, avoid swimming or soaking the injection site in a bath or hot tub for 24 hours post-procedure. 

How does prolotherapy differ from steroid injections?

Steroid injections are a commonly used treatment to block inflammation and pain for acute and chronic musculoskeletal conditions but are usually only a temporary solution.

“With corticosteroids, you’re blocking inflammation and you’re blocking the pain, but you have a lot of side effects. High blood pressure, high blood sugar, weight gain, even cosmetic side effects,” said James A. Thompson, DO of TPMG Newport News Internal Medicine.

Steroid injections prevent the body’s normal healing process while masking the pain and, in the long-term, may weaken the joints and ligaments. It might actually be deteriorating the joint.

What are the side-effects of prolotherapy treatment? Is it painful?

Other than mild discomfort during and after the injection, prolotherapy solutions have minimal side effects like any other injection such as swelling. In comparison, steroid injections have been associated with hyperglycemia (high blood sugar), weight gain, skin discoloration, and hypertension (high blood pressure). Prolotherapy injections are mildly painful, much like a flu shot, and can be numbed with a topical cream as needed. Speak with your doctor about what medications you are able to take for any soreness that may occur afterward.

Prolotherapy is commonly used for:

  • Unresolved pain despite the use of Osteopathic Manipulation Therapy (OMT)
  • Joint instability of the shoulder, elbow, wrist, ankle, and knee
  • A non-surgical option for joint and back pain
  • Osteoarthritis of the knee, shoulder and other joints

Commonly used for the treatment of:

  • Degenerative joint disease
  • Tendonitis
  • Sports injuries
  • Sprains & ligament injuries
  • Hip Pain – arthritis, bursitis, labrum lesions
  • Knee pain – meniscal, ACL, MCL, LCL tears
  • Chondromalacia patella
  • Foot & ankle pain – plantar fasciitis, sprains, Morton’s neuroma
  • Neck pain – whiplash, headache, migraines
  • Shoulder pain – rotator cuff, glenoid labrum tears
  • Elbow pain – golfer’s & tennis elbow
  • Wrist pain – carpal tunnel, weak or sore wrists
  • Hand – thumb & finger pain such as Basal Joint Arthritis
  • TMJ (Temporomandibular Joint) dysfunction
  • Over-Manipulation Syndrome
  • Low back pain & sciatica
  • Unresolved back pain despite Osteopathic Manipulation Therapy (OMT)

About Dr. Thompson

James A. Thompson, DOJames Thompson, DO, is a highly skilled primary care physician. He is trained in and provides prolotherapy to treat and repair the underlying causes of pain. Dr. Thompson has been trained for prolotherapy under the Hacket Hemwall Patterson Foundation (HHPF), the gold standard for prolotherapy instruction since 1969. He warmly welcomes new patients to schedule an appointment with him.