Proliferative therapy · ligament & enthesis
Prolotherapy.
Prolotherapy is an injection of a concentrated sugar solution (dextrose) into a strained ligament or tendon attachment, guided by imaging. It sets off a small, controlled inflammation that can prompt your body's own repair response.
PROLOTHERAPY
What is prolotherapy?
Prolotherapy places a concentrated dextrose (sugar) solution where a ligament or tendon attaches to bone, a spot called the enthesis. These spots carry a lot of load but have a poor blood supply, so they heal slowly. The dextrose sets off a small, controlled inflammation that is thought to bring in repair cells and can prompt the tissue to rebuild collagen.
Prolotherapy works in the opposite direction from a steroid injection. Steroids calm inflammation, which can help in the short term, but repeated steroid injections may weaken ligaments and tendons over time. Prolotherapy provokes inflammation on purpose, to prompt repair in tissue that has stalled.
Regulatory Considerations
Prolotherapy uses dextrose and saline, both of which are FDA-approved substances. However, prolotherapy itself is not FDA-approved as a specific treatment for musculoskeletal conditions. Its clinical use is based on physician judgment, available scientific evidence, and individualized patient evaluation.
No claims are made regarding guaranteed outcomes, permanent structural repair, or disease modification.
Where it's used
Conditions we most often use prolotherapy for.
We most often use prolotherapy for long-standing ligament and tendon-attachment problems that haven't fully improved with rehab, activity changes, or PRP. The most common is sacroiliac (SI) joint dysfunction involving the ligaments around the joint.
SI joint dysfunction
Posterior pelvic pain, ligamentous laxity at the sacroiliac complex.
Ligamentous laxity
Chronic, image-supported laxity in spinal or peripheral ligaments.
High hamstring tendinosis
Proximal hamstring origin pain, runners, cyclists, prolonged sitting.
Chronic low back pain
With ligamentous involvement, supraspinous, interspinous, iliolumbar.
Peripheral joint instability
Mild instability in shoulder, knee, ankle, non-surgical candidates.
Chronic enthesopathy
Long-standing pain where tendons attach to bone, such as tennis elbow or plantar fasciitis, when PRP isn't the right fit.
Post-traumatic instability
Persistent symptoms after sprain/strain that didn't fully recover.
Case-by-case
Other chronic ligamentous and entheseal pathology, evaluated individually.
The procedure
What to expect during a visit.
Prolotherapy builds its effect over several sessions. A typical course is 3 to 6 sessions spaced 3 to 6 weeks apart. Each session is a single in-clinic visit.
Targeted exam
Provocation testing and palpation localize the ligamentous or entheseal targets. Ultrasound confirms anatomy.
Solution preparation
Dextrose 12.5–25% in saline, pharmaceutical-grade. Concentration tuned to tissue and tolerance.
Image-guided injection
Small volumes delivered to each target structure under ultrasound or fluoroscopic guidance.
Series & reassessment
Sessions are spaced 3 to 6 weeks apart, and we reassess at each one.
Talking it through
When prolotherapy is the right tool.
Prolotherapy is used for long-standing pain where a tendon or ligament attaches to bone. For arthritis inside the joint, nerve pain, or damage that needs surgery, other treatments usually fit better, and we talk those through with you.
What we look at together
- Sacroiliac (SI) joint pain that shows up on hands-on exam tests
- Long-standing loose ligaments or pain where tendons attach to bone, lasting more than 3 months
- High hamstring pain where the tendon attaches near the sit bone
- Symptoms that continue despite physical therapy, activity changes, and other conservative care
- Time for a course of 3 to 6 sessions over a few months
Frequently asked
Prolotherapy questions.
How is this different from a steroid injection? +
They work in opposite directions. A steroid calms local inflammation and can bring fast relief, but repeated steroid injections may weaken ligaments and tendons over time. Prolotherapy sets off a small, controlled inflammation that brings in the body's repair processes. It takes longer to work, and its aim is to support the tissue.
How is this different from PRP? +
PRP delivers concentrated biologic signaling (platelets, growth factors). Prolotherapy delivers dextrose, a sugar solution that draws water out of nearby cells and sets off the body's own repair signaling. PRP is often the better choice for tendon and joint problems. Prolotherapy is often the better choice for ligament problems, especially in the SI joint and spine, where a small, targeted stimulus is what's needed.
How many sessions will I need? +
A typical course is 3 to 6 sessions, spaced 3–6 weeks apart. We reassess at each visit and adjust the plan with you. Some patients come back for a single maintenance session once a year after the first course.
Is prolotherapy painful? +
The injection itself is brief, typically described as moderate pressure with a sharp pinch. We can add local anesthesia for sensitive sites. Patients often report increased soreness at the treated site for 1–3 days afterward: this is part of the controlled inflammatory response and is expected. We avoid NSAIDs during that window so the response isn't blunted.
Does insurance cover prolotherapy? +
No. Most insurance plans do not cover prolotherapy. We discuss the cost with you when you book your service and supply HSA/FSA reimbursement documentation where applicable.
Related therapies
Related treatments.
Schedule a call
Find out if prolotherapy fits your pain.
Dr. Glowney examines you, localizes the pain generator, and recommends honestly: sometimes that's prolotherapy, sometimes PRP, sometimes a different path entirely. The consultation is the same regardless of what comes next.
720-550-6175