Prolotherapy

Prolotherapy (“proliferation therapy”) is a regenerative technique in which we inject a hypertonic dextrose solution into painful ligaments, tendons or joints. It stimulates the body to produce its own repair tissue.

On this page10

1. How does it work?
2. What can you expect?
3. Scientific substantiation
4. Where your pain comes from
5. Why does that tissue not heal itself?
6. What initiates the injection in your body
7. Number of treatments
8. Complaints that we treat with prolotherapy
9. This is how a session goes
10. Frequently asked questions

How does it work?

A filtered dextrose solution (usually 15-25%) is mixed with a local anesthetic (lidocaine) and injected with thin needles into specific attachment points of tendons and ligaments. The doctor works on the basis of anatomical landmarks or under ultrasound guidance.

Multiple injection points are often treated per session. The injected dextrose causes a controlled, mild inflammatory response that causes the body to direct fibroblasts to form collagen — effectively repairing the tissue.

What can you expect?

A session lasts 20-40 minutes. The injections have a short stinging effect; Afterwards, a dull, pressing pain occurs at the treatment site for 24-72 hours — this is the desired inflammatory response and is part of the recovery process.

Important: painkillers such as ibuprofen are not recommended because they slow down the recovery process. Paracetamol is allowed. Take it easy with sports for the first 3-5 days; then build up gradually.

Scientific substantiation

Moderate evidence in knee osteoarthritis, lateral epicondylitis (tennis elbow) and Achilles tendonitis. The mechanism of action is still being investigated. In 2019, the American College of Rheumatology advised restraint in knee osteoarthritis due to varying study quality.

Where your pain comes from

Ligaments are the bands that hold your joints together. Tendons connect the muscles to the bone. Together they keep a joint in place and moving. If they are damaged or stretched, it hurts.

And that happens often. The vast majority of orthopedic pain complaints arise from damaged or unstable ligaments, cartilage, tendons and muscle attachments. Due to an accident, a sports injury or years of overuse, they can tear, stretch and become less elastic. Think of an old elastic: it can hold less and is more likely to break.

A completely torn ligament requires a surgeon to repair. But most complaints do not come from such a complete tear. They come from tissue that has become weakened, overstretched, overloaded and unstable.

It doesn't stop there. When ligaments and tendons can no longer stabilize a joint, joint instability occurs. This can lead to pain, dysfunction, osteoarthritis, cartilage damage and many more chronic problems.

Why does that tissue not heal itself?

Ligaments have little blood supply. As a result, they naturally heal poorly. If a ligament is damaged or stretched, it often only partially recovers. Compare it to a muscle injury or a wound on your skin: they are full of blood vessels and usually heal quickly.

Maybe you recognize that. An old injury that never quite got better. Or pain without a clearly identifiable cause, for which you have already tried rest, physiotherapy or chiropractic. Prolotherapy is little known in the Netherlands, but it is an effective treatment, precisely because it does not address the pain, but the weakened structure underneath.

What initiates the injection in your body

When a tendon, ligament, joint or muscle attachment is injured, your body responds with an inflammatory response. That sounds wrong, but it's your body's natural way of repairing damage. Don't confuse it with a bacterial infection — there's a bacteria behind that, not here.

We are calling for exactly that response. The high concentration of glucose causes an osmotic shock reaction at the site where we puncture. We also use the needle to make small, controlled wounds. Your body therefore treats the old, poorly healed injury as if it were a fresh injury. Blood supply improves and more repair cells and growth factors come to the area. It is part of this that you will feel pain, stiffness and soreness for a few days afterwards.

This is also where the advice about painkillers comes from. Anti-inflammatories (NSAIDs) such as diclofenac, ibuprofen or naproxen do relieve the pain, but they inhibit the healing response that we need. For this reason, they are also not a good idea after an acute muscle, tendon or ligament injury.

What happens next is the core of the treatment. Your body produces new, healthy connective tissue: collagen. Ligaments and tendons proliferate — they become thicker and stronger and can perform their duties again. The back, neck, pelvis and joints become more stable. Overworked muscles and muscle knots can finally relax. And the pain decreases greatly.

Glucose is the oldest and most commonly used drug for this purpose worldwide, due to its safety and effectiveness. There are also other substances that can provoke or stimulate such a healing response. For example, a lot of research has been done into ozone gas and Platelet Rich Plasma in recent years.

Number of treatments

First we assess whether you are eligible. After that, the number of treatments depends on what you have, because prolotherapy is used for a wide variety of conditions. For simple injuries, 1 to 3 treatments are enough. In extensive and severe cases there may be more than 10. For the average patient with back problems, we start with a series of 6 weekly treatments. We always do Prolotherapy of the spine together with chiropractic and manual therapy — that gives the best results.

The vast majority of patients have good results, even with complaints that have existed for years. As with any medical treatment, results vary; your overall health and lifestyle play a role. The treatment itself is safe: we only prick, we do not cut, and there are virtually no side effects.

Complaints that we treat with prolotherapy

• Back pain, facet syndrome, lumbago, acute back problems, chronic back problems
• Neck pain and whiplashMore about Neck pain & whiplash
• Pelvic pain, sacroiliac syndrome and pelvic instabilityMore about Pelvic instability
• Shoulder instability and shoulder pain
• Tendonitis and chronic tendon problems
• Tennis elbow and golfer's elbow
• Hip pain and hip osteoarthritisMore about Hip Osteoarthritis
• Knee pain and knee osteoarthritisMore about Knee osteoarthritis
• Ankle complaints

This list is not complete. On our pages and blog posts you can read more about the conditions and complaints that we treat.

This is how a session goes

Each process is tailor-made, but this is what a typical course looks like — from first intake to pain-free and maintenance. You always know exactly where you stand.

1. Marking & preparation

   Doctor identifies the exact treatment points on tendons and ligaments. Disinfect skin. Prepare dextrose solution.

2. Series of injections

   Multiple injections (often 5-15) at specific attachments. Short stinging sensation; local anesthetic can relieve discomfort.

3. First response

   Rest briefly. Doctor checks whether you feel well. No ibuprofen — paracetamol is allowed for discomfort.

4. Recovery response

   Dull pain at treatment site 1-3 days — this is DESIRED, it is the inflammatory response that starts recovery. Exercise slowly for 3-5 days.

Frequently asked questions

Is it the same as a corticosteroid injection?

No. Corticosteroids inhibit inflammation; prolotherapy actually induces a recovery response so that the tissue becomes stronger.

Can I exercise afterwards?

Take it easy for the first 3-5 days; then build up gradually.

Will it be reimbursed?

Usually not through basic insurance; sometimes via additional packages. Check via our reimbursement tool.

Is it painful?

The injection isn't too bad; the afterstimulus pain lasts 1-3 days and is part of the mechanism of action.

How long does the effect last?

With good response, years to permanent, because the tissue is actually strengthened.

Not suitable for local infection, blood clotting disorders, use of anticoagulation (relative), allergy to dextrose or lidocaine, acute septic arthritis or uncontrolled diabetes. Standard 3-6 sessions with 2-6 weeks interval.