Prolotherapy is a non-surgical treatment that consists of injecting a solution of sugar (usually dextrose) and an anesthetic (usually lidocaine) into ligaments, tendons, or joint capsules.
When anatomical structures like ligaments and tendons become too loose, they become weaker and do not protect joints from being dislocated or injured.
Prolotherapy is done in order to boost joint stability, improve biomechanics, performance and decrease pain in ligament or tendon attachments. 
While prolotherapy has been around since roman times, in 1950, Doctor George S. Hackett began injecting chemical irritants into muscle tissue. Hackett, MD eventually coined the commonly used term “prolotherapy” in “The rehabilitation of an incompetent structure by the generation of new cellular tissue.” 
Why it’s done?
The purpose of prolotherapy is to trigger “proliferation” or in simple terms, make new cells—specifically targeting the cells in ligaments, tendons and joint capsules. With prolotherapy, the goal is to “thicken” weakened tendons and ligaments in order to: Improve Strength, promote stability, improve function and ultimately decrease pain. 
If you experience any side effects that do not resolve within a few weeks, follow up with your doctor.
How you prepare
Prolotherapy is an outpatient procedure; so, you won’t need to stay overnight.
Corticosteroids, NSAIDs like Ibuprofen, Motrin or Aleve, blood thinning herbs, supplements or vitamins can interfere with Prolotherapy; so, patients will need to stop taking them for at least 5 days before.
If you are taking oral steroids, or anti-inflammatories for certain conditions, consult with your physician about stopping them or about the results while still taking them.
Make sure to eat a breakfast rich in protein before your treatment.
Before the procedure
During the initial visit, your physician will go through an examination as well as look at any imaging you may have such as x-rays or MRIs in order to determine if prolotherapy is an option for the location and problem. The skin is sterilized with rubbing alcohol or a similar solution before the prolotherapy injection.
How prolotherapy is administered
Using a small needle, the area is first numbed with a local anesthetic such as lidocaine. After the area has been properly numbed, the sugar solution is injected under ultrasound guidance. Prolotherapy is usually repeated several times in 2-to-6-week intervals over several months.  If after a few sessions to an area there is no relief, the solution is adjusted or treatment in that area is discontinued.
Patients often ask, “how bad does prolotherapy hurt?” There is some brief pain associated with prolotherapy due to the area previously being injured. During the injection, there will be some pain when the physician uses the needle to touch the bone in the area. This is to ensure safety by checking to make sure the needle is not on a nerve bundle, in an organ or a blood vessel. It is normal for the muscles in the area to twitch or spasm.
After receiving prolotherapy
Patients are monitored in office for 20 to 30 minutes after the procedure in order to make sure there are no reactions to the medicine, the injection and can be released.
Make sure to keep the area clean and dry (no showering), and leave the bandage on for 12-24 hours.
Strenuous Activities should be avoided for a minimum of 2 days. After 2 days, move the body part treated though its full range of motion. There will be an accompanying soreness with movement, this is normal and expected.
Please wait 2 weeks before resuming medications that were stopped prior to Prolotherapy.
Tylenol or tramadol can be used for pain as needed but do not exceed 3,000 mg a day.
Smoking and alcoholic beverages should be avoided for a week, caffeine should be limited.
For any additional questions, please call the office.
Prolotherapy success rates
The success rate for PRP Injections is around 70-80%. Research shows that it does decreased pain in the long run; which is why many professional athletes seek out PRP injections such as in 2011, when Kobe Bryant had PRP injections for his ankle and knee.
Prolotherapy success rates
Research suggests Prolotherapy has success rates as high as 80-90%  with notable improvement happening after the third or fourth injection.
1. Saboowala, H. (2020). “What is Prolotherapy?” Technique, Mechanism of Action, Effectiveness, Medical Uses, Adverse Events etc. (Kindle Edition) [E-book]. Dr.Hakim Saboowala.
2. Hackett, GS (1956). Ligament and tendon relaxation treated by prolotherapy. Springfield, IL: Charles C. Thomas. ISBN-13: 978-0398050665
3. Dagenais, S., Ogunseitan, O., Haldeman, S., Wooley, J. R., & Newcomb, R. L. (2006). Side Effects and Adverse Events Related to Intraligamentous Injection of Sclerosing Solutions (Prolotherapy) for Back and Neck Pain: A Survey of Practitioners. Archives of Physical Medicine and Rehabilitation, 87(7), 909–913. https://doi.org/10.1016/j.apmr.2006.03.017
4. Hauser, R. A., Lackner, J. B., Steilen-Matias, D., & Harris, D. K. (2016). A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders, 9, CMAMD.S39160. https://doi.org/10.4137/cmamd.s39160