Concentrated dextrose (sugar water) or saline (salt water) or other natural substances, are used as an irritant to stimulate a mild inflammation which “tricks” the body into thinking the area is injured and to begin healing again. Dextrose Prolotherapy raises growth factor levels or effectiveness to promote tissue repair, reducing or eliminating musculoskeletal pain.

Dextrose Prolotherapy is practiced by physicians in the U.S. and worldwide, has been shown effective in treating many musculoskeletal conditions – such as tendinopathies, ligament sprains, osteoarthritis, back and neck pain, tennis/golfers elbow, ankle pain, joint laxity and instability, plantar fasciitis, shoulder, knee pain and other joint pain. It is commonly referred to as simply “Prolotherapy”. For more information read THE NEW YORK TIMES article, the MAYO CLINIC HEALTH LETTER, and PRACTICAL PAIN MANAGEMENT article on dextrose prolotherapy.

How Prolotherapy Works

Prolotherapy works by causing a temporary, low grade inflammation at the injection site, activating fibroblasts to the area, which, in turn, synthesize precursors to mature collagen and thus reinforce connective tissue. It has been well documented that direct exposure of fibroblasts to growth factors (either naturally occurring or added) causes new cell growth and collagen deposition. Inflammation creates secondary growth factor elevation. The inflammatory stimulus of Prolotherapy raises the level of growth factors to resume or initiate a new connective tissue repair sequence which had prematurely aborted or never started. Animal biopsy studies show ligament thickening, enlargement of the tendinosseous junction, and strengthening of the tendon or ligament after Prolotherapy injections.

Prolotherapy for Musculoskeletal Pain

Prolotherapy is a method of injection treatment designed to stimulate healing.[1] This treatment is used for musculoskeletal pain which has gone on longer than 8 weeks such as low back and neck pain, chronic sprains and/or strains, neck and whiplash injuries, tennis and golfer’s elbow, knee, ankle, shoulder or other joint pain, chronic Tendinitis/tendonosis, and musculoskeletal pain related to osteoarthritis. Prolotherapy works by raising growth factor levels or effectiveness to promote tissue repair or growth.[2] It can be used years after the initial pain or problem began, as long as the patient is healthy. Because prolotherapy works to repair weak and painful joint areas, it is a long term solution rather than a palliative measure such as drugs, and should be considered prior to the use of long term drugs or surgery in appropriate patients.

In the April 2005 issue of the Mayo Clinic Health Letter, the authors wrote: “In the case of chronic ligament or tendon pain that hasn’t responded to more conservative treatments such as prescribed exercise and physical therapy, prolotherapy may be helpful.”[3] Prolotherapy has been used in the U.S. for musculoskeletal pain since the 1930’s, is endorsed by former U.S. Surgeon General, C. Everett Koop,[4] and has even made its way into the professional sports world.[5] In an issue of The Physician and Sportsmedicine, “Are Your Patients Asking About Prolotherapy?” the article starts:

“Prolotherapy, considered an alternative therapy, is quietly establishing itself in mainstream medicine because of its almost irresistible draw for both physicians and patients: nonsurgical treatment for musculoskeletal conditions.”[6]

Patient receiving dextrose prolotheray knee injection
A patient receives a dextrose prolotherapy knee injection treatment.

Why Don’t More Doctors Know About Prolotherapy?

By Donna Alderman, D.O.

In 1998, at the First Annual Prolotherapy Injection Seminar, given in Thebes, Illinois, one of the attending student physicians quite abruptly, and with clear skepticism, asked Dr. Gustav Hemwall, the world’s most experienced Prolotherapist at the time, “If Prolotherapy is so great, why don’t more doctors know about it?” Dr. Hemwall paused a moment and then calmly answered, “Because it’s too simple.”

I was the brash young doctor who asked that question back then, and, ironically, now I am asked the same question—though, I’m glad to say, not as often as when the first edition of my book was published in 2008. Since then, more and more doctors have been finding out about Prolotherapy, especially the more advanced forms such as platelet-rich plasma or stem cell–rich formulas. Nowadays, there is increased public awareness about regenerative approaches to healing, as well as many more training seminars and conferences. In fact, I have given many lectures to physician groups and there is a huge interest in these therapies. In addition, some medical schools now give lectures on Prolotherapy, and some residency programs educate doctors in these techniques. Nevertheless, some physicians still don’t know about Prolotherapy— or they don’t understand how it works—and so may dismiss its validity.

A patient of mine who’d experienced great results from Biocellular Prolotherapy on his knee told me he’d shared his excitement with a family friend, who happened to be a physician. The physician family member then proceeded to “pooh-pooh” the technique, saying that no studies demonstrated its effectiveness and that the only reason it had worked was because of the placebo effect. My patient shared with me how dismayed he felt about the doctor’s dismissiveness. I explained that since Prolotherapy is not generally taught in medical schools, some doctors assume that no medical evidence supports it, which is simply not true, see “Prolotherapy Regenerative Medicine Is Evidence Based”, and the bibliography of medical studies, research articles, and books regarding Prolotherapy Regenerative Medicine throughout this website and many cataloged articles in the Learning Hub. As for the placebo effect, though it does exist in human medicine, Dextrose, PRP, and Biocellular Prolotherapy treatments have all been conducted on animals with excellent results. Although there is some controversy about the placebo effect in animals, most scientists generally agree that animals do not experience this phenomena since animals have no expectation with treatment. (If Tali, a playful Australian shepherd mix could speak, she’d attest to how effectively PRP and Biocellular Prolotherapy treated her knee condition; click to see her video.)

Skepticism is healthy, especially in science and medicine. As noted earlier, I myself was skeptical when I first learned about Prolotherapy. That’s why education and getting the facts and evidence is so important before drawing a conclusion. Understanding the scientific concepts, reviewing the medical literature, and hearing from reputable sources about the outcomes of a particular treatment is, in my opinion, the best way to decide on a treatment’s validity.


[1] Uhl RL, Roberts TT, Papaliodis DN, Mulligan MT, Dubin AH. Management of chronic musculoskeletal pain. Journal of the American Academy of Orthopaedic Surgeons. 2014; 22(2): 101–110.

[2] American Academy of Orthopaedic Surgeons. One in two Americans have a musculoskeletal condition: New report outlines the prevalence, scope, cost and projected growth of musculoskeletal disorders in the U.S. ScienceDaily. 2016 March 1 [cited 2022 March 19]

[3] Kay MC, Register-Mihalik JK, Gray AD, Djoko A, Dompier TP, Kerr ZY. The epidemiology of severe injuries sustained by national collegiate athletic association student-athletes, 2009–2010 through 2014–2015. Journal of Athletic Training. 2017; 52(2): 117–128; Åman M, Forssblad M, Henriksson-Larsén K. Incidence and severity of reported acute sports injuries in 35 sports using insurance registry data. Scandinavian Journal of Medicine & Science in Sports. 2016; 26(4): 451–462.

[4] Center for Disease Control and Prevention, Osteoarthritis Fact Sheet, last update 2017 Feb [cited 2017 May 17]

[5] Wehling P, Moser C, Maixner W. How does surgery compare with advanced intra-articular therapies in knee osteoarthritis: Current thoughts. Therapeutic Advances in Musculoskeletal Disease. 2016; 8(3): 72–85.

[6] Schnirring, L. News Brief: Are your patients asking about Prolotherapy? The Physician and Sprortsmedicine. 28(8):15-17.