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Prolotherapy, also called regeneration injection therapy or proliferation therapy, is an injection treatment typically used for joint and muscle pain. The goal is to use the body's natural response mechanism to focus healing in a specific area. Studies on prolotherapy have shown it to be a safe and effective alternative to surgery and for those who have failed other conservative treatments. The procedure was made popular by Dr. George Hackett, a surgeon, in the 1950's to treat pain in muscle tendons and ligaments. Black Tie Health is one of the few providers of prolotherapy in the greater Atlanta area.

Prolotherapy and Joint Pain

About Prolotherapy

What is prolotherapy?

Prolotherapy is an injection-based treatment for chronic musculoskeletal conditions. Typically, it involves the use of an injectable substance, the most common being dextrose (a form of sugar). The dextrose causes increased inflammation around the area injected. This inflammation is thought to stimulate healing through this inflammatory mechanism. When the body's immune system responds to the injected area, cells begin to repair the damage using the body's natural healing processes.

What conditions can prolotherapy be used to treat?

Prolotherapy is an alternative medicine treatment that may be used instead of strong or addicting medications or surgery. Prolotherapy has typically been used to treat:

Is prolotherapy safe?

There are risks with any medical procedure. Prior to treatment, the risks, benefits, and alternatives to prolotherapy will be discussed in-depth in our office. The ingredients in prolotherapy are typically substances such as dextrose (a type of sugar) and lidocaine (a numbing agent).


Some providers of prolotherapy include an ingredient known as Sarapin. Sarapin is derived from the pitcher plan (Sarracenia purpurea) and is used as an analgesic. Sarapin is non-toxic and has not been associated with any known side effects. Sarapin has also been used to treat peripheral neuropathy

Side effects when prolotherapy is done properly are rare. Possible side effects of prolotherapy injections include infection and  allergic reaction. If prolotherapy is used for nerve pain, such as in peripheral neuropathy, nerve damage can occur if the procedure is done improperly. That's why patients seeking prolotherapy as a treatment for pain should ensure the injections are being performed by an experienced physician.

How does prolotherapy work?

There is currently no consensus in the medical community about how exactly prolotherapy works in the body. Most scientists and physicians attribute the efficacy of prolotherapy to a combination of inflammation, immune system response, pain control, and scar tissue. The original theory of prolotherapy was that the inflammation caused by the injections would cause the cells in the area to begin regenerating tissue.

What is the success rate for people that get prolotherapy injections?

The rate of success depends on the part of the body being treated as well as the severity of the condition. For many conditions, the success rate is somewhere between 80% and 90%. For example, some studies have shown that the success rate of prolotherapy injections for knee pain is around 82%. 

Studies on prolotherapy injections for back pain have shown that the success rate is between 85% and 95%. In contrast, studies on the effectiveness of back surgery show a 52% improvement.

What is prolotherapy?

Stop living with pain.

If you're happy with how your pain is being treated, we're happy for you. If not, let us take care of you.

Prolotherapy Injection for the Knee

Is there any published research on prolotherapy in peer-reviewed medical journals?

Absolutely. In fact, research on prolotherapy continues to be published despite this treatment being over half a century old. According to a paper published in October 2022 by the journal, Orthopedic Reviews, "Prolotherapy has been shown to be a safe option for improving pain, function, and quality of life as effectively as other treatment options." A study published in the Journal of Alternative and Complementary Medicine in April 2022 concluded that "dextrose prolotherapy may result in safe, significant, sustained improvement of knee pain, function, and stiffness scores".

What are the alternatives to prolotherapy?

Depending on the condition(s) being treated, more traditional medical alternatives to prolotherapy may include:

  •  Non-steroidal anti-inflammatory medications (NSAIDs) such as ibuprofen, meloxicam, naproxen, or aspirin.

  • Steroid injections

  • Surgery

  • Opioid medications such as hydrocodone, oxycodone.

  • Muscle relaxants such as flexiril or tizanidine.

  • Physical therapy

Prolotherapy is just one of many alternative treatments we offer in an effort to relieve your pain without risky medications or surgery. If you're terrified of needles and injections aren't for you, consider osteopathic manipulation (also know as "OMT") to treat your pain or discomfort. OMT is a treatment modality where medications and needles aren't necessary. Learn more about OMT.

How much does prolotherapy cost?

The average cost of prolotherapy in the U.S. is around $250 - $1000 for each treatment. We offer prolotherapy injections for only $149 per treatment. Why do we charge so little? Because our goal is to provide you with the best care possible at a reasonable price. 

The number of treatments will vary depending on the area to be treated and the severity. 

Can prolotherapy be done at the same time with PRP/PRF injections?

Yes! One of the awesome benefits of prolotherapy is its versatility. Platelet rich plasma and platelet rich fibrin can provide additional benefit when getting prolotherapy injections.

How many injections are needed for a complete treatment?

On average, prolotherapy injections are done once a month for 4 to 6 months. The number of prolotherapy injections depends on the area being treated as well as the severity of your condition. Some patients require few treatments while others may require more. Each individual responds differently, however 4-6 injections total is the average.

Prolotherapy Injections for Knee Pain

A randomized controlled trial on prolotherapy for knee pain was published in the Annals of Family Medicine in 2013.  The researchers studied the effectiveness of dextrose prolotherapy injections in the treatment of knee pain from osteoarthritis. The study compared prolotherapy injections with normal saline injections (the control group). Prolotherapy injections were found to improve knee pain, knee stiffness, and function compared to the control group. The study used the WOMAC score as its criteria, which is considered the standard by which clinically meaningful results for knee pain are measured.

A retrospective study published in Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders in 2014 studied the use of prolotherapy injections to treat knee pain from chondromalacia patella (arthritis of the knee cap). The researchers concluded that prolotherapy injections should be considered the "first-line conservative therapy" for chondromalacia pattela. The patients receiving prolotherapy injections reported  improvement in stiffness, range of motion, knee pain, and activities of daily living. In this study, only 3 out of the 16 patients later had knee surgery. The remaining 13 of the 16 patients were able to avoid having knee surgery - that's more than 80%!

A systematic review published in the British Medical Bulletin in 2017 determined that there was evidence that prolotherapy is safe and can significantly improve knee pain and other symptoms of knee osteoarthritis. They found that patient satisfaction for prolotherapy was around 82%!

One of the benefits of prolotherapy is the mild ingredients that are used - dextrose, saline, and lidocaine. These ingredients have fewer side effects, if any, when compared to steroid injections like cortisone. 

Prolotherapy Injections for Carpal Tunnel Syndrome

Pain Management, in 2022, published the results of a randomized, controlled clinical trial comparing the effectiveness of prolotherapy injections with corticosteroid injections in the treatment of carpal tunnel syndrome. The study showed similar efficacy between the two treatments in regards to improvement of pain and other parameters. Essentially, the study determined that prolotherapy is just as effective as steroid injections for the treatment of carpal tunnel syndrome.

A different randomized double-blinded clinical trial published in the Annals of Neurology in 2018 also compared corticosteroid injections with prolotherapy injections for the treatment of carpal tunnel syndrome. This study concluded that prolotherapy injections are actually superior to corticosteroid injections when used to treat carpal tunnel syndrome.

There are several other studies on using prolotherapy injections to treat carpal tunnel syndrome. As with prolotherapy injections for knee pain, prolotherapy avoids the negative side effects that are caused by the injection of corticosteroids. 

Prolotherapy Injections for Shoulder Pain

A study published by the Orthopedic Journal of Sports Medicine in 2022 compared the use of prolotherapy injections to corticosteroid injections for shoulder pain caused by supraspinatus injury. The study found that steroids actually did more to improve the pain at 6 and 12 weeks, but actually produced more damage to the muscle as seen on ultrasound. It would have been interesting to see what the results would have been if the researchers administered more than one prolotherapy injection for these patients.

A study published in Journal of Sport Rehabilitation in 2022 compared the use of prolotherapy with corticosteroid injections for shoulder pain caused by supraspinatus tear. This study revealed that the benefits of corticosteroid injections for the shoulder were better in the sort term, but the benefits went away with time. In contrast, the patients treated with prolotherapy injections had a longer lasting benefit. 

Overall, the studies on prolotherapy injections for shoulder pain appear to focus primarily on rotator cuff injuries. However, the results indicate that steroids provide a short-lasting, temporary benefit while prolotherapy actually provides a gradual lasting improvement over time.



More Research Publications on Prolotherapy

Below is a small collection of studies published in the past 10 years that outline the benefit of prolotherapy for certain conditions.  

Prolotherapy for Knee Pain

  • Medin Ceylan C, Sahbaz T, Cigdem Karacay B. Demonstrating the effectiveness of Platelet Rich Plasma and Prolotherapy treatments in knee osteoarthritis. Ir J Med Sci. 2022 Sep 27. doi: 10.1007/s11845-022-03168-7. Epub ahead of print. PMID: 36166187.

  • Poliwoda S, Noor N, Mousa B, Sarwary Z, Noss B, Urits I, Viswanath O, Behara R, Ulicny K, Howe A, Mychaskiw G, Kaye AD. A comprehensive review of intraarticular knee injection therapy, geniculate injections, and peripheral nerve stimulation for knee pain in clinical practice. Orthop Rev (Pavia). 2022 Oct 13;14(4):38676. doi: 10.52965/001c.38676. PMID: 36267543; PMCID: PMC9568422.

  • Zhao AT, Caballero CJ, Nguyen LT, Vienne HC, Lee C, Kaye AD. A Comprehensive Update of Prolotherapy in the Management of Osteoarthritis of the Knee. Orthop Rev (Pavia). 2022 May 31;14(4):33921. doi: 10.52965/001c.33921. PMID: 35769650; PMCID: PMC9235417.

  • Martínez-Pizarro S. Prolotherapy with dextrose to reduce pain in osteoarthritis of the knee. Reumatol Clin (Engl Ed). 2022 Apr;18(4):251-252. doi: 10.1016/j.reumae.2020.08.002. Epub 2021 Apr 5. PMID: 35489813.

  • Arias-Vázquez PI, Tovilla-Zárate CA, Castillo-Avila RG, Legorreta-Ramírez BG, López-Narváez ML, Arcila-Novelo R, González-Castro TB. Hypertonic Dextrose Prolotherapy, an Alternative to Intra-Articular Injections With Hyaluronic Acid in the Treatment of Knee Osteoarthritis: Systematic Review and Meta-analysis. Am J Phys Med Rehabil. 2022 Sep 1;101(9):816-825. doi: 10.1097/PHM.0000000000001918. Epub 2021 Nov 18. PMID: 34740224.

  • Hauser RA, Sprague IS. Outcomes of prolotherapy in chondromalacia patella patients: improvements in pain level and function. Clin Med Insights Arthritis Musculoskelet Disord. 2014 Feb 17;7:13-20. doi: 10.4137/CMAMD.S13098. PMID: 24596471; PMCID: PMC3937178.

  • Rabago D, Patterson JJ, Mundt M, Kijowski R, Grettie J, Segal NA, Zgierska A. Dextrose prolotherapy for knee osteoarthritis: a randomized controlled trial. Ann Fam Med. 2013 May-Jun;11(3):229-37. doi: 10.1370/afm.1504. Erratum in: Ann Fam Med. 2013 Sep-Oct;11(5):480. PMID: 23690322; PMCID: PMC3659139.


Prolotherapy for Shoulder Pain

  • Eroglu A, Yargic MP. Effectiveness of Ultrasound-Guided Corticosteroid Injections, Prolotherapy, and Exercise Therapy on Partial-Thickness Supraspinatus Tears. J Sport Rehabil. 2022 Apr 21;31(7):869-875. doi: 10.1123/jsr.2021-0254. PMID: 35453118.

  • Lin CL, Chen YW, Wu CW, Liou TH, Huang SW. Effect of Hypertonic Dextrose Injection on Pain and Shoulder Disability in Patients with Chronic Supraspinatus Tendinosis: A Randomized Double-Blind Controlled Study. Arch Phys Med Rehabil. 2022 Feb;103(2):237-244. doi: 10.1016/j.apmr.2021.07.812. Epub 2021 Oct 2. PMID: 34610286.

  • Nasiri A, Mohamadi Jahromi LS, Vafaei MA, Parvin R, Fakheri MS, Sadeghi S. Comparison of the Effectiveness of Ultrasound-Guided Prolotherapy in Supraspinatus Tendon with Ultrasound-Guided Corticosteroid Injection of Subacromial Subdeltoid Bursa in Rotator Cuff-Related Shoulder Pain: A Clinical Trial Study. Adv Biomed Res. 2021 Mar 30;10:12. doi: 10.4103/abr.abr_181_20. PMID: 34195156; PMCID: PMC8204815.

  • Bertrand H, Reeves KD, Bennett CJ, Bicknell S, Cheng AL. Dextrose Prolotherapy Versus Control Injections in Painful Rotator Cuff Tendinopathy. Arch Phys Med Rehabil. 2016 Jan;97(1):17-25. doi: 10.1016/j.apmr.2015.08.412. Epub 2015 Aug 22. PMID: 26301385.

Prolotherapy for Carpal Tunnel Syndrome

  • Babaei-Ghazani A, Moradnia S, Azar M, Forogh B, Ahadi T, Chaibakhsh S, Khodabandeh M, Eftekharsadat B. Ultrasound-guided 5% dextrose prolotherapy versus corticosteroid injection in carpal tunnel syndrome: a randomized, controlled clinical trial. Pain Manag. 2022 Sep;12(6):687-697. doi: 10.2217/pmt-2022-0018. Epub 2022 Jul 18. PMID: 35848821.

  • Babaei-Ghazani A, Nikbakht N, Forogh B, Raissi GR, Ahadi T, Ebadi S, Roomizadeh P, Fadavi HR, Raeissadat SA, Eftekharsadat B. Comparison Between Effectiveness of Ultrasound-Guided Corticosteroid Injection Above Versus Below the Median Nerve in Mild to Moderate Carpal Tunnel Syndrome: A Randomized Controlled Trial. Am J Phys Med Rehabil. 2018 Jun;97(6):407-413. doi: 10.1097/PHM.0000000000000877. PMID: 29232214.

  • Wu YT, Ho TY, Chou YC, Ke MJ, Li TY, Tsai CK, Chen LC. Six-month Efficacy of Perineural Dextrose for Carpal Tunnel Syndrome: A Prospective, Randomized, Double-Blind, Controlled Trial. Mayo Clin Proc. 2017 Aug;92(8):1179-1189. doi: 10.1016/j.mayocp.2017.05.025. PMID: 28778254.

  • Wu YT, Ke MJ, Ho TY, Li TY, Shen YP, Chen LC. Randomized double-blinded clinical trial of 5% dextrose versus triamcinolone injection for carpal tunnel syndrome patients. Ann Neurol. 2018 Oct;84(4):601-610. doi: 10.1002/ana.25332. Epub 2018 Oct 4. PMID: 30187524.

Prolotherapy for Tennis Elbow

  • Zhu M, Rabago D, Chung VC, Reeves KD, Wong SY, Sit RW. Effects of Hypertonic Dextrose Injection (Prolotherapy) in Lateral Elbow Tendinosis: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil. 2022 Feb 28:S0003-9993(22)00240-4. doi: 10.1016/j.apmr.2022.01.166. Epub ahead of print. PMID: 35240122.

Prolotherapy for Chronic Injuries

  • Goh SL, Jaafar Z, Gan YN, Choong A, Kaur J, Kundakci B, Abdul Karim S, Jaffar MR, A Hamid MS. Efficacy of prolotherapy in comparison to other therapies for chronic soft tissue injuries: A systematic review and network meta-analysis. PLoS One. 2021 May 26;16(5):e0252204. doi: 10.1371/journal.pone.0252204. PMID: 34038486; PMCID: PMC8153441.

Prolotherapy for Back Pain

  • Hauser RA, Matias D, Woznica D, Rawlings B, Woldin BA. Lumbar instability as an etiology of low back pain and its treatment by prolotherapy: A review. J Back Musculoskelet Rehabil. 2022;35(4):701-712. doi: 10.3233/BMR-210097. PMID: 34957989; PMCID: PMC9398090.

  • Giordano L, Murrell WD, Maffulli N. Prolotherapy for chronic low back pain: a review of literature. Br Med Bull. 2021 Jun 10;138(1):96-111. doi: 10.1093/bmb/ldab004. PMID: 33884404.

  • Hoffman MD, Agnish V. Functional outcome from sacroiliac joint prolotherapy in patients with sacroiliac joint instability. Complement Ther Med. 2018 Apr;37:64-68. doi: 10.1016/j.ctim.2018.01.014. Epub 2018 Feb 8. PMID: 29609940.

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