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.

Several injection points are often treated per session. The injected dextrose causes a controlled, mild inflammatory response in which the body sends fibroblasts (cells that produce connective tissue) to form collagen — with the aim of 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. Many orthopaedic pain complaints are linked to damaged or unstable ligaments, cartilage, tendons and muscle attachments. Through an accident, a sports injury or years of overload, these can tear, stretch and become less elastic. Think of an old elastic band: it can take less and snaps sooner.

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.

Perhaps you recognise this. An old injury that never fully healed. Or pain without a clear cause, for which you have already tried rest, physiotherapy or chiropractic care. Prolotherapy is not well known in the Netherlands. The aim is not to dampen the pain, but to strengthen the weakened structure underneath; the evidence for this is moderate.

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. The aim is for your body to produce new connective tissue (collagen), so that ligaments and tendons become stronger and can do their job better again. As a result, joints can become more stable and overloaded muscles can relax. How much the pain decreases varies from person to person.

Glucose is the oldest and most widely used agent for this worldwide, mainly because it is safe. There are also other substances that can trigger or stimulate such a healing response. Ozone gas and Platelet Rich Plasma, for example, have been studied a lot 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 very wide range 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 complaints we start with a series of 6 weekly treatments. After each treatment we look together at whether continuing makes sense; you are not tied to the whole series. We always combine prolotherapy of the spine with chiropractic and manual therapy, so that the treatments complement each other.

Many patients notice improvement, even with complaints that have existed for some time; how much differs from person to person. As with any medical treatment, results vary; your general health and lifestyle play a part. The treatment itself is safe: we only inject, we do not cut, and side effects are usually mild and temporary, such as soreness or swelling at the injection site.

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

Every course of treatment is tailored, but this is what a typical course looks like — from the first intake to recovery and maintenance; how quickly that goes differs from person to person. 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 a good response, the effect often lasts a long time; how long varies from person to person.

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.