Prolotherapy, also known as Proliferative therapy regenerative injection therapy (RIT), is a form of treatment for chronic musculoskeletal pain. It is commonly used to correct arthritis, back pain, neck pain, sports injuries, whiplash, carpal tunnel syndrome, chronic tendonitis, partially torn tendons, degenerated or herniated discs, TMJ, sciatica, and fibromyalgia. Prolotherapy is particularly effective because it corrects the original cause of pain, rather than merely alleviating symptoms.

Patients whose pain has increased despite anti-inflammatory medications, cortisone shots, arthroscopy, and joint replacement surgery typically feel relief after undergoing prolotherapy. Additionally, many athletes use prolotherapy to accelerate the recovery time from injuries like ACL tears. Patients who wish to participate in prolotherapy must have a strong immune system, maintain a healthy diet, have normal hormone levels, and be able to move and exercise.


How it works

First, the physician performs a palpatory exam to locate the area causing the pain. It is important that the injections are inserted into the areas causing the pain, not the areas where the pain is felt.

A proliferant, or mild irritant solution, is injected into the problematic ligament or tendon, where it attaches to the bone, causing a localized inflammation. The inflammation increases the blood supply and the flow of nutrients to the area and stimulates the tissue to repair itself. New collagen, which is the building block of ligament and tendon tissue, is formed and begins to shrink, tightening the area that was injected and strengthening the tissue.

Injections may also be given to injured joints to stimulate cartilage growth and repair injured tissue, as well as to reduce the joint instability that leads to degeneration.

The average number of injections needed is between four and six, though the amount is variable and can be as low as two injections or as high as ten, depending on the body’s ability to heal itself and the technique and skill of the physician.


Prolotherapy techniques

Hackett-Hemwall Dextrose Prolotherapy

With Hackett-Hemwall Dextrose Prolotherapy, the irritant solution contains dextrose (sugar) and an anesthetic (either Procaine or Lidocaine). Multiple injections are given at once, into and around the injured area. Multiple body parts can be treated during the same visit and other proliferants may be added to the base solution.


Platelet Rich Plasma Prolotherapy

Platelet Rich Plasma Prolotherapy requires the patient’s blood to be drawn and processed to extract growth factors. The growth factors are then added to the proliferant and injected into the injured area. Additionally, dextrose is injected into the areas surrounding the injury.

Platelet Rich Plasma Prolotherapy is used for more advanced injuries that require the growth factors’ assistance in stimulating new growth in the injured area.


Stem Cell Prolotherapy

All joints have a limited ability to heal themselves. Stem cell prolotherapy is unique in that it makes joint anabolic (in the process of building).

The stem cells are obtained from bone marrow (from the shin or hip) or fat (from the love handles or stomach) and are mixed into a solution with platelet rich plasma. The stem cells and platelets help generate additional new growth.

Like Platelet Rich Prolotherapy, stem cell prolotherapy is used for more advanced injuries. Treatments are administered every six to eight weeks.



Prolotherapy is typically a permanent solution to chronic pain. It ultimately improves function of the area injected, reduces stiffness, and reduces or eliminates pain. After the first visit, 50-75% of the pain is reduced, and the pain continues to diminish over the remaining treatment period. By reducing pain, prolotherapy also enables patients to improve the strength of the injured area.



  • Bruising in treatment area
  • Increased pain
  • Swelling
  • Stiffness
  • Joint effusion
  • Infection
  • Puncture of lung if treating spine
  • Tendon/ligament injury


Side effects and outcomes are unique to each patient and will be discussed before any treatment options are prescribed.