Before platelet-rich plasma became a household term, there was prolotherapy — and it is still a useful tool in the right situation.
What is prolotherapy
Prolotherapy involves injecting a mild irritant solution — most commonly dextrose (a sugar solution) — into ligaments, tendons, or joint tissues where they attach to bone. The idea is not to numb the area but to trigger a controlled, local healing response. The body interprets the injection as a signal that this tissue needs attention, and it responds with increased blood flow, growth factor release, and collagen production. Over a series of treatments, the tissue can become stronger and less painful.
It is, in a sense, the original orthobiologic: instead of concentrating your own platelets or cells, it recruits your body's existing repair machinery to a specific spot.
Where it fits in my practice
I consider prolotherapy most often for chronic ligament laxity and tendon insertional pain — the kind of nagging, low-grade problem that has lingered for months and hasn't responded to rest or standard therapy. It is generally well tolerated, inexpensive relative to cell-based options, and requires no blood draw or tissue harvest.
What to expect
A typical course is a series of injections spaced several weeks apart, not a one-time shot. Soreness for a few days after each session is common and is actually part of the intended response. Results build gradually over weeks to months, which is why I pair it with a structured strengthening program — the injection creates the biological opportunity, and the rehab work converts it into durable tissue.
The honest evidence picture
The evidence base for prolotherapy is smaller than for PRP, but there are controlled studies with consistent findings for conditions like chronic low back pain, lateral epicondylitis, and knee osteoarthritis. It is not a miracle treatment, and I will tell you if your problem is beyond what an injection series can reasonably address.
If you have a chronic tendon or ligament problem that hasn't responded to the usual care, it may be worth a conversation. You can book a consultation through the link on this site.