Proliferative therapy · ligament & enthesis
Prolotherapy.
An image-guided injection to stimulate inflammation and your body's own tissue-repair response.
PROLOTHERAPY
What is prolotherapy?
Prolotherapy injects a hypertonic dextrose solution at the enthesis or ligamentous structure, the point where tissue is mechanically loaded but biologically under-vascularized and slow to heal. The osmotic and chemical environment created by the dextrose triggers a controlled inflammatory cascade: localized cellular signaling, recruitment of repair cells, and stimulation of collagen remodeling at the treated structure.
It's the opposite of a corticosteroid. Steroids suppress local inflammation, useful short-term but damaging to ligamentous and tendinous tissue over time. Prolotherapy works by provoking a healing response in tissue that has stopped healing on its own.
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 earns its place
Conditions we most often use prolotherapy for.
Prolotherapy is best for chronic ligamentous and entheseal pathology that hasn't fully responded to rehab, activity modification, or PRP. The signature indication is SI joint dysfunction with ligamentous involvement.
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
Recalcitrant entheseal pain, tennis elbow, plantar fasciitis when PRP isn't right.
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 works through cumulative stimulus, a typical course is 3–6 sessions spaced 3–6 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
Repeat sessions at 3–6 week intervals, reassessing response. Most patients note progress after 2–3 sessions.
Is this you?
When prolotherapy is the right tool.
Prolotherapy works for chronic ligamentous and entheseal pathology, pain that lives at the attachment of tendon or ligament to bone. It's not the right tool for joint-space arthritis, neural pain, or structural surgical pathology.
✓ Likely a fit
- SI joint dysfunction confirmed by provocation testing
- Chronic ligamentous laxity or entheseal pain > 3 months
- High hamstring tendinosis at the proximal origin
- Failed PT, activity modification, and conservative care
- Willing to commit to a 3–6 session course over months
Frequently asked
Prolotherapy questions.
How is this different from a steroid injection? +
They work in opposite directions. Steroid suppresses local inflammation, fast relief but tissue-degrading over time, especially for ligaments and tendons. Prolotherapy provokes a controlled inflammatory cascade that recruits repair processes. Slower onset, but supports tissue rather than degrading it.
How is this different from PRP? +
PRP delivers concentrated biologic signaling (platelets, growth factors). Prolotherapy delivers an osmotic stimulus (dextrose) that triggers the body's own repair signaling. PRP is often the better tool for tendon and joint pathology; prolotherapy is often the better tool for ligamentous pathology, especially SI joint and spinal ligaments, where small-volume, 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. Most patients report progress after 2–3 sessions; we reassess at each visit and adjust the plan. Some patients need a single annual maintenance session after the initial 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 classify prolotherapy as investigational or not medically necessary. We provide transparent per-session pricing during consultation and supply HSA/FSA reimbursement documentation where applicable.
Related therapies
Adjacent options.
Schedule a prolotherapy consultation
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.
Or call 720-550-6175