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Prolotherapy Injections

Mass General Brigham sports medicine specialists use prolotherapy injections to treat tendon and joint conditions. 

What is prolotherapy? 

Prolotherapy is a nonsurgical technique that uses injections to treat injured connective tissues. Connective tissues include tendons, ligaments, and cartilage. Prolotherapy is also known as proliferation therapy or regenerative injection therapy.

Studies have shown that prolotherapy may allow some patients may push back the need for surgery or avoid surgery on injured tissues altogether. Athletes and active patients may choose prolotherapy because it normally doesn’t require long breaks in activity.  

How does prolotherapy work? 

During prolotherapy, a doctor uses a needle to inject a solution into the patient’s damaged tissue. The injection is intended to trigger a mild inflammatory response. The goal is for this inflammation is to encourage the body’s natural healing response to reduce pain. 

The doctor marks the area for injection and sterilizes the region. In some cases, they may apply a numbing spray to reduce pain at the injection site. Your doctor also may use ultrasound to view the affected area. Once they identify the area, they inject the solution into and around the damaged tissue. 

Prolotherapy injections are typically composed of an “irritant” solution that contains dextrose (a simple sugar), saline, and a numbing medicine such as lidocaine. Patients receive monthly injections for 4 to 6 months, depending on the severity of the condition. They normally perform physical therapy exercises along with the injections, which has been shown to improve outcomes.

Are you a candidate for prolotherapy? 

Ask your health care provider if you may be a candidate for prolotherapy. Call Mass General Brigham Sports Medicine to learn more. 

You may be a candidate for prolotherapy if you have one of these conditions:

  • Chronic back pain
  • Sacroiliac pain. The sacroiliac joint is where the sacrum and the iliac bones meet. The sacrum is located at the base of your spine and sits in the middle of the iliac bones. The iliac bones are the large bones that make up your pelvis.
  • Osteoarthritis of the knee, ankle, foot, shoulder, elbow, fingers or hip
  • TendinopathyRotator cuff, lateral and medial epicondylosis (tennis or golfer’s elbow), patellar (Jumper’s knee), Achilles, IT band
  • Plantar fasciosis
  • Osgood-Schlatter disease
  • Chronic groin pain in athletes
  • Temporomandibular joint (TMJ) pain 
  • Hypermobility 

Prolotherapy should be used with caution in certain patients, including:

  • Pregnant patients during the first trimester
  • Immunocompromised patients. These include cancer patients who are actively receiving treatment, organ transplant recipients who are taking medications to suppress their immune system, people with HIV and people who take high-dose corticosteroids like prednisone or other medications to suppress their immune response.
  • Patients with bleeding disorders or patients on blood thinners. These patients are reviewed on an individual basis 

Prolotherapy isn’t recommended for people who: 

  • Have an active infection such as cellulitis, local abscess, or septic arthritis
  • Are unable to understand or comply with rehabilitation instructions following the procedure 

Possible risks and complications 

All medical procedures are associated with some level of risk. For example, patients may have side effects that occur with any needle injection. These include mild bleeding and temporary discomfort or pain flare lasting up to 7 days. There is also a risk of infection. We greatly reduce this risk by using sterile techniques. 

Serious complications are rare but can include:

  • Bleeding
  • Nerve damage
  • Allergic reaction
  • Feeling lightheaded
  • Pneumothorax. This is when air or gas builds up in the chest or pleural space around the lungs. It can cause part or all of a lung to collapse.

How do I prepare for treatment? 

Most patients have an outpatient procedure done in a clinic. Before your procedure, tell your doctor if you have:

  • Allergies
  • A bleeding disorder or you take any blood-thinning or anti-platelet medications
  • A history of getting lightheaded or fainting during procedures 

Depending on your medical history, you may need to stop or adjust some of your medications prior to the procedure. To have the desired inflammatory response, you should stop taking non-steroidal anti-inflammatory drugs (NSAIDS) 7 days prior to treatment. NSAIDs relieve fever and pain. They also reduce swelling from arthritis or a muscle sprain or strain. NSAIDs include aspirin, ibuprofen (Advil and Motrin), and naproxen (Aleve and Naprosyn).

Recovery tips 

Expect discomfort for 5 to 7 days after prolotherapy injections due to the inflammatory response. This may feel like a pain flare-up but it’s actually a good sign that your body is responding well to the treatment. You can expect temporary and local bruising, swelling, and tenderness at the injection site. 

Here are some tips for your recovery:

  • Avoid using ice as this can delay the desired inflammatory response. 
  • Avoid the use of NSAIDS for at least 10 days after treatment as this can interfere with the body’s response. If you’ve been told to take one aspirin a day for your heart, continue to take it. Tell your doctor about any medications you take. 
  • Use over-the-counter acetaminophen (Tylenol) to manage pain after the procedure. Don’t use acetaminophen if you’re drinking alcohol. Do not exceed 3000 mg of acetaminophen in a 24-hour period. 
  • Avoid swimming, hot tubs, Jacuzzi, or placing the injected body part under water in a bathtub for 48 hours after the injection. You can shower at any time.
  • You may prefer to rest after treatment but others return to work or activity immediately after treatment. 
  • Call your doctor or go to the Emergency Department if you develop fever, chills, swelling, redness or other signs of infection. 

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