A Review of the Evidence for Regenerative Injection Therapy (Prolotherapy)
Jonas Skardis DOM, DAAPM, CNAARIP., E J of Age Management Medicine. July 2007
Regenerative Injection Therapy, also known as prolotherapy. is a relatively simple.
minimally invasive intervention for the rebuilding of axial and peripheral joint
connective tissue. Various substances. most prominently dextrose. can be utilized
via injection. to stimulate regeneration of injured and/or degenerated ligaments.
tendons. and cartilage.
“Injection Therapy for Enthesopathies Causing AxialSpine Pain and “The Failed Back
Syndrome:” A Single Blinded, Randomized and Cross-Over Study.
Wilkinson H., Pain Physician. 8: 167-176. 2005
This singe-blinded, randomized and cross-over study by a neuro-surgeon on the staff
of Mass General characterized prolotherapy as a “minimally invasive” therapy aimed
at periosteal trigger points at sites of enthesopathy. Success rates were similar to
other studies at 80%
“Randomized Prospective Double-blind Placebo-controlled Study
Prolotherapy for Knee Osteoarthritis With or Without ACL Laxity.”
Reeves KD, Hassanein K, Alternative Therapies March 2000, 6(2):68-80
Ir! concentration! greater than 1 0%, dextrose has lollg.been Utilized as 9rLQsmotiQ
shock agent – a thicker substance to burst some cells in a locale and spill
inflammatory eicosanoids and other substances. This simple act signals an immune
response that results in a 3-5 day inflammatory cascade. followed by 2-4 weeks of
CONCLUSION: Prolotherapy injection with 10% dextrose resulted in clinically and
statistically significant improvements in knee osteoarthritis. Preliminary blinded
radiographic readings (l- year films, with 3-year total follow-up period planned)
demonstrated improvement in several measures of osteoarthritis severity. ACL
laxity. when present in these osteoarthritic patients, improved.”
“Randomized, Prospective, Placebo-controlled Double-Blind Study of Dextrose
Prolotherapy for Osteoarthritic Thumb and Finger [DIP, PIP, and trapeziometacarpa]]
Joints: Evidence of Clinical Efficacy.”
Reeves KD, Hassanein K.
Journal of Alternative and Complementary Medicine
© Researchers determined that dextrose-based prolotherapy is a safe and effective
treatment for mitigating finger joint pain.
“Retrospective Case Series on
Patients with Chronic Spinal Pain Treated with
Hooper AR, Ding M., J of Alternative and Complementary Medicine 2004110(4):670-674
RESULTS: 91% of patients reported reduction in level of pain, 84.8% of patients
reported improvements in activities of daily living, and 84.3% reported an
improvement in the ability to work
“Long Term Effects of DextroseProlotherapy for Anterior Cruciate Ligament Laxity.”
Reeves KD. Hassanein KM.. Alternative Therapies May/June 20031 9(3):58-62
‘Conclusion: in patients with symptomatic anterior cruciate ligament laxity
intermittent dextrose injection resulted in clinically and statistically significant
improvement in ACL laxity. pain, swelling. and knee range of motion.
Note: There are several studies that conclude that prolotherapy is no better than placebo.
These are hotly debated in the prolotherapy community due to significant design flaws in the
For instance. there is a study that injected ligaments associated with leg pain that excluded
patients with leg pain from the studyl Not surprisingly, it was concluded that there was no
difference between placebo overall
Another study that is often referenced to dispute the effectiveness of prolotherapy used a
saline injection as a placebo. It is widely known that saline injections will stimulate a healing
response. Comparing two therapies that initiate a healing response cannot be used to
maintain that one of the therapies doesn’t have an effect compared to no therapy at all. Even
with this ineffectual research, several individual markers showed that prolotherapy was up