Prolotherapy: Procedure, Benefits, and Risks

Prolotherapy (also called sclerosing injections) is an injection-based treatment for chronic musculoskeletal pain that’s been in use for over 60 years.

Prolotherapy works by prompting your body’s natural repair mechanisms to heal injured or weakened joints, ligaments and tendons. It’s a natural, non-surgical method of stimulating growth when ligaments or tendons have been stretched, damaged or torn. (Ligaments are the tough tissues that connect bones to one another, while tendons are a similar type of tissue connecting muscles to bones.)

This technique can be used in most joints that are unstable including:

  • Sacroiliac joint dysfunction (the joint that connects the sacrum to the hip bone)
  • Peripheral joints such as the knee
  • Chronic lower back pain
    Prolotherapy involves a series of three injections that are usually given six weeks apart to encourage optimal tissue growth.

    You’ll be given a local anaesthetic to ensure minimal discomfort as we inject a dextrose solution (glucose sugar water) into your painful ligament and tendon sites, and/or into adjacent joints.

    The injection makes your cells lose water, causing inflammation in that area of your body. Inflammation stimulates the growth of collagen fibres and connective tissue. That’s thought to thicken, tighten and strengthen the weak tissue, resulting in a stronger tendon or ligament that can hold your body’s structures in place more effectively.

    As the weakened area heals, your pain should reduce significantly. This biological process can often take up to six to eight weeks, meaning you may not feel the benefits immediately. Prolotherapy is often used as an alternative to cortisone injections, which may weaken connective tissue with long term use.
    In contrast, the dextrose solution used in prolotherapy is water-soluble and easily excreted by your body once it’s done its job. Although prolotherapy has been used for many years, few controlled studies have properly evaluated the efficacy of this therapy. Most of these studies have been carried out for low back pain in general and have reached contradictory findings.
    Nevertheless, there is good evidence supporting the specific use of prolotherapy around the sacroiliac joint, with one study reporting a functional improvement in 78% of treated patients.

    Furthermore, irrespective of the solution, the actual motion of injecting into the ligament has been shown, in some patients, to induce inflammation, resulting in significant long-term pain relief and reduced disability.
    Due to the local inflammation caused by prolotherapy, some bruising, pain, stiffness and/or swelling in the injected area may occur for the few days following the procedure. If pain persists you should follow up with your doctor.

    Apart from a small amount of local bleeding and bruising, other possible side effects for the procedure are uncommon. Infection is rare, and minimised by the use of sterile techniques. Allergic reactions to the injected substances rarely occur. You’re likely to be sore for several days following the injections.

    After the procedure
    Use gentle heat, rather than ice, for pain relief. It’s very important that you avoid taking anti-inflammatory medicines such as ibuprofen, aspirin, corticosteroids and curcumin (turmeric) during this treatment. Soreness after prolotherapy is actually a good thing. It means that an inflammatory reaction is occurring. That’s part of your body’s natural healing response and should strengthen the ligament. However, if the pain lasts more than a week, please contact your doctor.
    During treatment and for at least 6 weeks after your final injection, you should avoid:

  • Deep squats or lunges
  • Heavy lifting
  • Yoga
  • Any movements that stretch or strain the treated tissues.
  • To keep fit, focus on upper body exercise, walking, low resistance cycling, and swimming (no breast stroke). You may wish to continue to wear your SIJ support belt initially during exercise.

    Once 6 weeks have passed since your final injection, it’s time for physiotherapy. A physio can teach you to engage your core muscles (pelvic floor, diaphragm and trunk), as well as strengthening your gluteal and leg muscles.