Prolotherapy, (also referred to as sclerosing injections), is an injection-based therapy for chronic musculoskeletal pain which has been used for over 60 years1. Prolotherapy works by prompting your body’s natural repair mechanisms to heal injured or weakened joints, ligaments and tendons. (Ligaments are the tough tissues which connect bones to one another, whilst tendons are a similar type of tissue connecting muscles to bones).
It is a natural, non-surgical method of stimulating growth when ligaments or tendons have been stretched/damaged or torn. This technique can be used in most joints that are unstable, and is often used for sacroiliac joint (the joint that connects the sacrum to the hip bone) dysfunction with instability or chronic low back pain.
How Does It Work?
Prolotherapy involves injecting a solution such as dextrose (glucose sugar water) into painful ligament and tendon sites, and/or into adjacent joints2. The solution is safe and water-soluble, which is easily excreted from the body after having the initial desired effect. It works by causing cells to lose water, which leads to a localised inflammatory reaction, stimulating the growth of collagen fibres and connective tissue. This process is thought to thicken, tighten and strengthen the weak tissue, resulting in a stronger tendon or ligament that can hold body structures in place more effectively.
As the weakened area heals, pain is usually reduced or eliminated. This biological process can often take up to six to eight weeks, which explains why you may not feel benefits immediately. A series of three injections are usually given six weeks apart to encourage optimal tissue growth. A local anaesthetic is used to ensure minimal discomfort with the injections. Prolotherapy is often used as an alternative to cortisone injections, which can often weaken connective tissue with long term use3.
Although prolotherapy has been used for many years, few controlled studies have properly evaluated the efficacy of this therapy. Most of these studies have been carried out for low back pain in general, with contradictory findings2,4-6. Nevertheless, there is good evidence supporting the specific use of prolotherapy around the sacroiliac joint, with one study reporting a functional improvement in 78% of treated patients7. Furthermore, irrespective of the solution, the actual motion of injecting into the ligament has been shown, in some patients, to induce inflammation, resulting in significant long-term pain relief and reduced disability6.
Due to the local inflammation caused by prolotherapy, some bruising, pain, stiffness and/or swelling in the injected area may occur for the few days following the procedure. If pain persists you should follow up with your doctor.
Apart from a small amount of local bleeding and bruising, other possible side effects for the procedure are uncommon. Infection is rare, and minimised by the use of sterile techniques. Allergic reactions to the injected substances rarely occur.
Recovery Following Prolotherapy
You will be sore for several days following the injections. This is good, it means that an inflammatory reaction is occurring, which should strengthen the ligament. However, if this flare up of pain should persist for more than a week, please contact your doctor. Most importantly, you must avoid taking anti-inflammatories such as ibruprofen, aspirin, corticosteroids and curcumin during this treatment. Gentle heat, rather than ice, can be used for pain relief.
Exercises that stretch or strain the treated tissues should be avoided. During the course of treatment, and for at least 6 weeks after the final pelvic prolotherapy injections, avoid deep squats or lunges, heavy lifting and yoga. Focus on upper body exercise, walking, low resistance cycling, and swimming (no breast stroke). You may wish to continue to wear your SIJ support belt initially during exercise. From the 6 week mark, a physiotherapist can teach you to engage your core muscles (pelvic floor, diaphragm and trunk), as well as strengthening your gluteal and leg muscles. The next stage is sport-specific training and gradual return to running and sport.
Hackett GS. Joint stabilization through induced ligament sclerosis. Ohio.Med 1953;49:877-84.
Klein RG, Eek BC, Delong WB et al. A randomized double-blind trial of dextroseglycerinephenol injections for chronic, low back pain. J Spinal Disord. 1993;6:23-33.
Paoloni JA, Orchard JW. The use of therapeutic medications for soft tissue injuries in sports medicine. Med J Aust. 2005;183:384-8.
Dechow E, Davies RK, Carr AJ et al. A randomized, double-blind, placebocontrolled trial of sclerosing injections in patients with chronic low back pain. Rheumatofogy (Oxford) 1999;38:1255-9.
Ongley MJ, Klein RG, Dorman TA et al. A new approach to the treatment of chronic low back pain. Lancet 1987;2:143-6.
Yelland MJ, Glasziou PP, Bogduk N et al. Prototherapy injections, saline injections, and exercises for chronic low-back pain: a randomized trial. Spine 2004;29:9-16.
Cusi M, Saunders J, Hungerford 8 et al. The use of prolotherapy in the sacroiliac joint. Br.J Sports Med 2010;44:100-4.
Disclaimer Please note the contents contained in this Patient Fact Sheet are not intended as a substitute for your own independent health professional’s advice, diagnosis or treatment. At Metro Pain Group, we assess every patient’s condition individually. As leaders in pain intervention, we aim to provide advanced, innovative, and evidence-based treatments tailored to suit each patient. As such, recommended treatments and their outcomes will vary from patient to patient. If you would like to find out whether our treatments are suitable for your specific condition, please speak to one of our doctors at the time of your consultation.