Hypertonic Solutions/Prolotherapy


Prolotherapy ("Proliferative Injection Therapy") involves injecting an irritant solution into the body, generally in the region of tendons or ligaments, for the purpose of strengthening weakened connective tissue and alleviating musculoskeletal pain. Commonly, prolotherapy uses a high concentration dextrose (sugar water) solution, which is injected into the ligament or tendon where it attaches to the bone. This causes a localized inflammation in these weak areas, which theoretically increases the blood supply and flow of nutrients and stimulates the tissue to repair itself.


The literature that supports the use of prolotherapy for the purposes of cartilage damage or arthritis is scant, therefore its use for this purpose should be considered experimental.

The procedure is generally performed at the attachments of musculotendinous structures, trigger points and myofascial planes.

Common indications include low back pain, sacroiliitis, acute sprains and myofascial pain. Tennis elbow, plantar fasciitis and bursitis are reportedly amenable to this treatment. Several reports describe its use in the ACL-injured knee.


Varying and conflicting reports of treatment outcomes have been reported in the literature and there seems to be no consensus of opinion on its effectiveness. Rabago et al. noted two randomized controlled trials on osteoarthritis that reported decreased pain, increased range of motion, and increased patellofemoral cartilage thickness after prolotherapy. [A systematic review of prolotherapy for chronic musculoskeletal pain. Clin J Sport Med. 2005 Sep;15(5):376-80] Other studies are reported to be underway but have not been confirmed (Clinicaltrials.Gov, Joint Injections for Osteoarthritic Knee Pain, web page last updated October 16, 2006, Prolotherapy Versus Steroids for Thumb Carpo-Metacarpal Joint Arthritis) Hauser reviewed a study that did not show improvement with prolotherapy: http://www.getprolo.com/can_research_prove_prolotherapy.htm http://www.pain101.com/TreatmentMethods/SalineInjections.aspx

Negative Effects

These are relatively minor and usually amount to local, transient tissue pain and swelling.
Insurances generally do not cover this procedure.