all information


Related Terms
  • Sclerotherapy
Principal Proposed Uses
  • Back Pain, Osteoarthritis

What Is Prolotherapy?

Invented in the 1950s by George Hackett, prolotherapy is based on the theory that chronic pain is often caused by laxness of the ligaments that are responsible for keeping a joint stable. When ligaments and associated tendons are loose, the body is said to compensate by using muscles to stabilize the joint. The net result, according to prolotherapy theory, is muscle spasms and pain.

Prolotherapy treatment involves injections of chemical irritant solutions into the area around such ligaments. These solutions cause tissue to proliferate (grow), increasing the strength and thickness of ligaments. In turn, this tightens up the joint and presumably relieves the burden on associated muscles, stopping muscle spasms. In the case of arthritic joints, increased ligament strength may allow the joint to function more efficiently, thus reducing pain.

Prolotherapy has not yet been widely accepted in conventional medicine. However, highly respected institutions have studied it and standard textbooks of orthopedics and rehabilitation medicine mention it. The technique is used by prolotherapy practitioners to treat many conditions, including back pain, osteoarthritis, fibromyalgia, plantar fasciitis, sciatica, sports injuries, temporomandibular joint disorder (TMJ), tendinitis, and tension headaches. The best evidence at present is for its use in back pain and osteoarthritis.

How Is Prolotherapy Performed?

Prolotherapy is generally administered at intervals of 4 to 6 weeks, although studies have used a more frequent schedule. The treatment involves injection of a mixture containing an irritant and a local anesthetic. A total of four to six treatments is typical.

When treating back pain, prolotherapy practitioners frequently use a form of manipulation somewhat similar to chiropractic . However, it is applied after local anesthetic has been injected, and is somewhat intense.

There are several irritant solutions used in prolotherapy. Concentrated dextrose or glucose has become increasingly popular because it is completely non-toxic. Phenol (a potentially toxic substance) and glycerin are also sometimes used. Other non-irritant substances may be added to the solution, such as vitamin B 12 , corn extracts, cod liver oil extracts, zinc, and manganese; however, there is no evidence that these substances add any benefit.

What Is the Scientific Evidence for Prolotherapy?

Animal and human studies have found that prolotherapy injections increase strength and thickness of ligaments. 1-4

Six double-blind human trials of prolotherapy have been reported: four involving back pain (with mixed results), and the other two involving osteoarthritis (with positive results).

Back Pain

In a double-blind study, 81 people with low back pain of many years' duration were given either prolotherapy or placebo injections six times a week. 5 The prolotherapy group received a mixture of dextrose, glycerin, and phenol, thought to irritate tissues and stimulate ligament growth. The placebo group received saline (salt-water) injections. Both groups also received spinal manipulation with local anesthetic on the first visit, although in the treatment group this was more extensive.

The results were positive for prolotherapy. Treated participants showed significantly less pain and disability within a month as compared to those in the placebo group, and the relative benefit continued for the full 6 months of the study. One possible complicating factor in this study is that the more extensive manipulation applied to the treatment group might have contributed to the benefit.

A subsequent double-blind study of nearly identical size and design, performed by many of the same researchers, found similar benefits. 6

However, another study conducted by independent researchers failed to find prolotherapy with 20% glucose more effective than saline injections for low back pain. 10 This study involved treatment for 6 months, and a subsequent follow-up of 2 years.

A fourth study also failed to find benefit. 11 At present, therefore, it is unclear whether prolotherapy provides any real benefit for back pain beyond that of the placebo effect.


A double-blind, placebo-controlled study evaluated the effects of 3 prolotherapy injections (using a 10% dextrose solution) at 2-month intervals in 68 people with osteoarthritis of the knee. 7 At 6-month follow-up, participants who had received prolotherapy showed significant improvements in pain at rest and while walking, reduction in swelling, episodes of "buckling," and range of flexion, as compared to those who had received placebo treatment.

The same research group performed a similar double-blind trial of 27 people with osteoarthritis in the hands. 8 The results at 6-month follow-up showed that range of motion and pain with movement improved significantly in the treated group as compared to the placebo group.

Safety Issues

In studies, prolotherapy has not caused any serious injury. There is usually discomfort after each injection that lasts for a few minutes to several days, but this discomfort is seldom severe. 9 Severe headaches have been reported in treatment of low back pain. Because phenol is a potentially toxic substance, treatment with a dextrose solution alone may be preferable.

Finding a Qualified Prolotherapy Practitioner

Prolotherapy is practiced by an M.D. or D.O. Generally, physicians specializing in orthopedics or physical medicine and rehabilitation are most likely to practice prolotherapy. To find a qualified practitioner, contact the following groups:

College of Osteopathic Pain Management and Sclerotherapy
107 Maple Avenue, Silverside Heights
Wilmington, DE 19809

American Association of Orthopedic Medicine
90 S. Cascade Avenue, Suite 1190
Colorado Springs, CO 80909


1.   Hauser RA. Punishing the pain. Treating chronic pain with prolotherapy. Rehab Manag . 1999;12:26–30.

2.   Liu YK, Tipton CM, Matthes RD, et al. An in situ study of the influence of a sclerosing solution in rabbit medial collateral ligaments and its junction strength. Connect Tissue Res. 1983;11:95–102.

3.   Reeves KD. Prolotherapy: present and future applications in soft tissue pain and disability. Phys Med Rehab Clin North Am . 1995;6:917–926.

4.   Klein RG, Dorman TA, Johnson CE. Proliferant injections for low back pain: histologic changes of injected ligaments and objective measures of lumbar spine mobility before and after treatment. J Neurol Orthop Med Surg . 1989;10:141–144.

5.   Ongley MJ, Klein RG, Dorman TA, et al. A new approach to the treatment of chronic low back pain. Lancet. 1987;2:143–146.

6.   Klein RG, Eek BC, DeLong WB, et al. A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic, low back pain. J Spinal Disord. 1993;6:23–33.

7.   Reeves KD, Hassanein K. Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Altern Ther Health Med. 2000;6:68–70, 72–74, 77–80.

8.   Reeves KD, Hassanein K. Randomized, prospective, placebo-controlled double-blind study of dextrose prolotherapy for osteoarthritic thumb and finger (DIP, PIP, and trapeziometacarpal) joints: evidence of clinical efficacy. J Altern Complement Med. 2000;6:311–320.

9.   Klein RG, Eek BC, DeLong WB, et al. A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic, low back pain. J Spinal Disord. 1993;6:23–33.

10.   Yelland MJ, Glasziou PP, Bogduk N, et al. Prolotherapy injections, saline injections, and exercises for chronic low-back pain: a randomized trial. Spine . 2004;29:9-16.

11.   Yelland MJ, Del Mar C, Pirozzo S, Schoene ML. Prolotherapy injections for chronic low back pain: a systematic review. Spine . 2004;29:2126-33.

Last reviewed October 2007 by EBSCO CAM Review Board

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Your Health and Happiness