Prolotherapy Research and Treatment Guidelines

This article will cover information on Prolotherapy including general questions on Prolotherapy treatments, side effects, research, reviews and medical studies.

Ross Hauser, MD

Prolotherapy is an in-office injection treatment that research and medical studies have shown to be an effective, trustworthy, reliable alternative to surgical and non-effective conservative care treatments. In our opinion, based on extensive research and clinical results, Prolotherapy is superior to many other treatments in relieving the problems of chronic joint and spine pain and, most importantly, in getting people back to a happy and active lifestyle. This is why it is the Caring Medical treatment method of choice.

In our clinics, we offer our method of Prolotherapy. We call this method H3 Prolotherapy. We consider it the evolution of the traditional Hackett-Hemwall type Prolotherapy into Hackett-Hemwall-Hauser Prolotherapy. The Hauser Prolotherapy technique has developed over 27 years of continual service. For those of you first exploring the treatment and not sure what these names are or mean, consider H3 Prolotherapy as the evolution of Prolotherapy protocols based on 80 years of research and clinical observation and based on tens of thousands of treatments.

While we treat with H3 Prolotherapy methods we will refer to these treatments simply as Prolotherapy for the remainder of this article.

Is Prolotherapy like cortisone?

The difference between Prolotherapy and Cortisone is extensive.
Cortisone when injected into the joint can successfully mask pain. Many people have very successful treatments with Cortisone. We typically see patients who have a long history of Cortisone injection and these injections are no longer effective for them.
Cortisone has been shown, in many studies, to accelerate degenerative osteoarthritis through cartilage breakdown.(1)
Over the years we have seen many patients who have received corticosteroid (cortisone) injections for joint pain. Unfortunately for many, excessive cortisone treatments lead to a worsening of chronic pain. Again, while some people do benefit from cortisone in the short-term – the evidence however points to cortisone causing more problems than it helps.

Prolotherapy is a regenerative injection treatment used to treat joint and spine pain by repairing damaged and weakened ligaments and tendons.

Prolotherapy is considered a viable alternative to surgery, and as an option to pain medications, cortisone and other steroidal injections.
The Prolotherapy procedure is considered a safe, affordable option that allows the patient to keep working and/or training during treatment.
H3 Prolotherapy difference: It is typically best to treat all or most of the ligaments of an unstable joint if that joint or its surrounding structures are painful. Multiple joints and structures can be treated with each visit.

What is the evidence for Prolotherapy?

For patients who are looking into Prolotherapy, please understand that this is a specialty procedure with technique and experience being a key component. What we present on our website is based on our experience and research and does not apply to all practitioners or injection therapies.

In July 2016, our doctors at Caring Medical published findings on the effectiveness of Prolotherapy treatments in the medical journal: Clinical Insights: Arthritis and Musculoskeletal Disorders, here are the summary highlights:

Our doctors reviewed 32 studies on dextrose prolotherapy for chronic musculoskeletal pain. The following conclusions are made:

Prolotherapy is supported in the treatment of tendinopathies in patients who fail conservative therapies;
Prolotherapy is supported in the treatment of knee osteoarthritis
Prolotherapy is supported in the treatment of finger joint osteoarthritis in patients who do not respond to conservative therapies;
Prolotherapy is supported in the treatment of back pain and
Prolotherapy is supported in the treatment of pelvic pain in patients who fail to respond to conservative therapies. . .

Overall, Prolotherapy has been demonstrated to be efficacious and should be considered as a treatment for pain and dysfunction associated with chronic musculoskeletal conditions, particularly tendinopathies and osteoarthritis.

Hauser RA, Lackner JB, Steilen-Matias D, Harris DK. A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain. Clinical Medicine Insights Arthritis and Musculoskeletal Disorders. [Google Scholar]

Prolotherapy for Knee Pain

In this video, Ross Hauser, MD explains a Prolotherapy knee treatment as performed at our Caring Medical clinics. This is not typical of the way treatment may be performed in other doctor’s offices.

Video learning and demonstrated points:

Prolotherapy is an injection technique that stimulates growth factor cells that work to repair damaged joints.
Prolotherapy can be very helpful in patients with knee instability or hypermobility caused by damaged knee ligaments and tendons. Knee instability is a cause of knee osteoarthritis and degenerative wear and tear.
In this video, Ross Hauser, MD is seen demonstrating intra-articular (inside the knee) as well as injections surrounding the outside of the knee.
In addition to knee osteoarthritis, Prolotherapy injections can help patients with problems that will eventually lead to degenerative knee disease.
Patellofemoral pain syndrome and patellofemoral tracking problems.
Weakened and damaged ligaments and tendons and their attachments to the bones and muscles that make the knee work.
In the video you see that Dr. Hauser is injecting into the:
- The knee’s medial joint line, at the medial collateral ligament location
- The pes anserine tendon
- The medial patellar retinaculum tendon
- The distal quadriceps attachments
- The lateral joint line where the lateral collateral ligament is located
- The attachment of the iliotibial band
- The capsular knee ligament attachments

Published research papers from our doctors at Caring Medical on Knee Disorders

Prolotherapy knee cartilage regeneration: Standard Clinical X-ray Studies Document Cartilage Regeneration in Five Degenerated Knees
- This paper was published in the Journal of Prolotherapy.
- Hauser R, Cukla J. Standard Clinical X-ray Studies Document Cartilage Regeneration in Five Degenerated Knees After Prolotherapy. Journal of Prolotherapy. 2009;1(1):22-28. [Google Scholar]
Outcomes of Prolotherapy in Chondromalacia Patella Patients: Improvements in Pain Level and Function
- This paper was published in the journal Clinical medicine insights. Arthritis and musculoskeletal disorders.
- Hauser RA, Sprague IS. Outcomes of prolotherapy in chondromalacia patella patients: improvements in pain level and function. Clin Med Insights Arthritis Musculoskelet Disord. 2014 Feb 17;7:13-20. doi: 10.4137/CMAMD.S13098. PMID: 24596471; PMCID: PMC3937178. [Google Scholar] [Pubmed]
Prolotherapy as an Alternative Treatment for Osteochondritis Dissecans: Two Cases of Young Baseball Players
- Hauser RA. Prolotherapy as an Alternative Treatment for Osteochondritis Dissecans: Two Cases of Young Baseball Players. Journal of Prolotherapy. 2011;3(1):568-71. [Google Scholar]
Bone Marrow Prolotherapy for Degenerative Joint Disease
- This paper was published in the journal Clinical medicine insights. Arthritis and musculoskeletal disorders.
- Hauser RA, Orlofsky A. Regenerative injection therapy with whole bone marrow aspirate for degenerative joint disease: a case series. Clin Med Insights Arthritis Musculoskelet Disord. 2013 Sep 4;6:65-72. doi: 10.4137/CMAMD.S10951. PMID: 24046512; PMCID: PMC3771705. [Google Scholar] [Pubmed]
A Retrospective Study on Dextrose Prolotherapy for Unresolved Knee Pain at an Outpatient Charity Clinic in Rural Illinois
- This paper was published in the Journal of Prolotherapy.
- Hauser RA, Hauser MA. A retrospective study on dextrose Prolotherapy for unresolved knee pain at an outpatient charity clinic in rural Illinois. Journal of Prolotherapy. 2009;1(1):11-21. [Google Scholar]
Platelet Rich Plasma Prolotherapy as First-line Treatment for Meniscal Pathology
- This paper was published in the medical journal Practical Pain Management
- Hauser RA, Phillips HJ, Maddela H. Platelet rich plasma Prolotherapy as first-line treatment for meniscal pathology. Pract Pain Manag. 2010 Jul;10(6):53-64. [Google Scholar]

Articles for patients looking for options to eventual knee replacement

Chronic knee problems from active lifestyle, physically demanding work, or sports related knee injuries

Meniscus tears

Patella / Knee Cap

In this video David Woznica, MD, of Caring Medical Regenerative Medicine Clinics explains Prolotherapy treatments.

The multiple Prolotherapy injection technique demonstrated in video, stimulate healing and repair of the tendon attachments, the knee ligaments and addresses problems of the cartilage that sits behind the knee cap and in the trochlear groove. When more significant degenerative damage has occured, we may utilize Platelet Rich Plasma Therapy, the use of your own blood platelets reintroduced into the knee.

Prolotherapy injections to restore stability to the knee cap will usually take 4 – 6 treatments. Patients come back every 4 to 6 weeks as we strengthen the knee ligaments and the attachments of the patella tendon and the quadricep tendon as well as address the cartilage issues behind the knee cap and in the trochlear groove where the patella slides against the thigh bone.

Knee Ligaments

Knee diagnosis

Meniscus

Pain AFTER knee arthroscopic surgery

Pain AFTER knee replacement

Prolotherapy and PRP (Platelet Rich Plasma) Injections for Knee Pain

Comprehensive Prolotherapy is an injection technique utilizing many healing factors. They can include or be used in conjunction with Dextrose, Blood Platelets, and stem cells. The stem cells and blood platelets are drawn from you the patient. We typically DO NOT offer stem cell therapy for knee pain as a first option. We may offer PRP treatments in conjunction with Prolotherapy at initial treatment visits.

WE OFFER PRP with PROLOTHERAPY. We do not offer PRP as a single injection treatment.

In this video, Ross Hauser, MD explains how one injection of PRP will likely not work

We will often get emails from people who had previous PRP therapy without the desired healing effects.
We explain to these people that their treatment probably did not work because the single PRP injection was not enough treatment to resolve their problem of degenerative knee damage, various tears, and their knee instability. The PRP may have tried to create a patch in the meniscus or the cartilage or address a tendon tear, but the instability and the wear and tear grinding that tears at the knee remained.

Articles:

Prolotherapy and Stem Cell Therapy for Knee Pain

Bone marrow derived stem cells

We do not offer stem cell therapy to every patient, in fact we offer this treatment very rarely. The treatment is usually offered only in the most advanced cases of knee degenerative disease. The articles below give a comprehensive review of when stem cell therapy will work, when it will not work, and the realistic options of when it should be considered.

Prolotherapy for Back Pain

Published research papers from our doctors at Caring Medical on low back pain

Dextrose Prolotherapy for Unresolved Low Back Pain: A Retrospective Case Series Study
- This paper was published in the Journal of Prolotherapy.
- Hauser RA, Hauser MA. Dextrose prolotherapy for unresolved low back pain: a retrospective case series study. Journal of Prolotherapy. 2009;3:145-55.[Google Scholar]

Caring Medical patients are often surprised to learn that Prolotherapy can heal most disc problems in neck and back. While we talk about Prolotherapy healing joint pain that results from ligament and tendon injuries, most people are unaware that disc problems results from ligament injuries or instability along the spine. Patients with degenerative disc disease, herniated discs, bulging discs, bone on bone, etc can all be healed with Prolotherapy.

Prolotherapy works to stabilize the ligaments of the spine allowing discs to get back into position and can even create space for a person who has lost space due to one or more degenerated disc. In Prolotherapy research from the doctors of Caring Medical, patients with more than four years of unresolved low back pain were shown to have had their pain improved, stiffness, range of motion, and quality of life measures even 12 months subsequent to their last Prolotherapy session.

Back pain by initial diagnosis

Spondylolisthesis, Spondylolysis, Spondylisis

Failed back surgery syndrome

Conservative Care Back Pain Options

Prolotherapy for Shoulder Pain

Ross Hauser, MD explains and demonstrates a Prolotherapy treatment to the shoulder.

This particular person is not sedated. The treatment is well tolerated. The treatment begins at 1:36.
The first injection was intra-articular, directly into the shoulder joint.
Next the acromioclavicular joint. Shoulder osteoarthritis, rotator cuff tendon issues including tears as well as tendinosis, responds well to Prolotherapy.
Next are the posterior shoulder structures including the posterior joint capsule as well as the various ligament attachments in the back of the shoulder.
Next the interior structures in the front of the shoulder are done including the ligaments as well as the various rotator cuff tendon attachments including the Supraspinatus tendon.
Prolotherapy is effective for rotator cuff tears, labral tears and biceps tendonitis, various tendonitis as well as shoulder instability.
Finally treating the acromioclavicular joint, or AC joint as the biceps tendon attachments.

Published research papers from our doctors at Caring Medical on Shoulder Disorders

Prolotherapy: A Non-Invasive Approach to Lesions of the Glenoid Labrum; A Non-Controlled Questionnaire Based Study
- This paper was published in The Open Rehabilitation Journal.
- Hauser RA, Dolan E, Orlofsky A. Prolotherapy: a non-invasive approach to lesions of the glenoid labrum; a non-controlled questionnaire based study. The Open Rehabilitation Journal. 2013 Dec 27;6(1).[Google Scholar]
A Retrospective Study on Hackett-Hemwall Dextrose Prolotherapy for Chronic Shoulder Pain at an Outpatient Charity Clinic in Rural Illinois
- This paper was published in the Journal of Prolotherapy.
- Hauser RA, Hauser MA. A retrospective study on Hackett-Hemwall dextrose prolotherapy for chronic shoulder pain at an outpatient charity clinic in rural Illinois. J Prolotherapy. 2009;4:205-16. [Google Scholar]

Articles

Repairing a SLAP tear without surgery

Rotator Cuff Tears

Shoulder Instability

In this video a general demonstration of Prolotherapy and PRP treatment is given for a patient with repeated shoulder dislocations

Danielle R. Steilen-Matias, MMS, PA-C narrates the video and is the practitioner giving the treatment:

PRP or Platelet Rich Plasma treatment takes your blood, like going for a blood test, and re-introduces the concentrated blood platelets and growth and healing factors from your blood into the shoulder. The treatment is explained further below.
In the shoulder treatment I treat all aspects of the shoulder including the ligament and tendon injections to cover the whole shoulder.
The patient in this video is not sedated in anyway. Most patients tolerate the injections very well. The treatment goes quickly. However we do make all patients comfortable including sedation if needed.
This patient in particular come to us for a history of repeated shoulder dislocations. His MRI findings showed multiple labral tears and rotator cuff problems.
The patient complained of shoulder instability typical of the ligament and tendon damage multiple dislocations can do.
With the patient laying down, treatment continues to the anterior or front of the shoulder. The rotator cuff insertions, the anterior joint capsule and the glenohumeral ligaments are treated.
PRP is introduced into the treatment and injected into the front of the shoulder. PRP is a form of Prolotherapy where we take concentrate cells and platelets from the patient’s blood and inject that back into the joint. It is a more aggressive form of Prolotherapy and we typically use it for someone that has had a labral tear, shoulder osteoarthritis, and cartilage lesions.
PRP is injected into the shoulder joint and the remaining solution is injected into the surrounding ligaments in this case it was in his anterior shoulder attachments to address the chronic dislocations.

Prolotherapy for Cervical Spine Instability and related symptoms

This section will also provide information on the following symptoms as they relate to neck pain and cervical spine instability

Headache and Migraine
TMJ
Whiplash Associated Disorder
Hearing problems
Vision problems
Swallowing difficulties
Dizziness
Drop Attacks
Vagus Nerve disorders

The Horrific Progression of Neck Degeneration with Unresolved Cervical Instability. Cervical instability is a progressive disorder causing a normal lordotic curve to end up as an “S” or “Snake” curve with crippling degeneration.

Since 1993, Ross Hauser, MD and Marion Hauser, MS, RD have developed Caring Medical Regenerative Medicine Clinics into one of the world’s leading clinics for Prolotherapy (including dextrose, PRP, and stem cells) with a commitment to helping the toughest chronic pain cases. Today, our work is heavily focused on the cervical spine.

Published research papers from our doctors at Caring Medical on Cervical Spine Instability and related symptoms

Chronic Neck Pain: Making the Connection Between Capsular Ligament Laxity and Cervical Instability
- This paper was published in the European Journal of Preventive Medicine
- Steilen D, Hauser R, Woldin B, Sawyer S. Chronic neck pain: making the connection between capsular ligament laxity and cervical instability. The Open Orthopaedics Journal. 2014;8:326-345. [Google Scholar]
The Biology of Prolotherapy and Its Application in Clinical Cervical Spine Instability and Chronic Neck Pain: A Retrospective Study
- This paper was published in the European Journal of Preventive Medicine
- Ross Hauser, MD, Steilen-Matias D, Gordin K. The biology of prolotherapy and its application in clinical cervical spine instability and chronic neck pain: a retrospective study. European Journal of Preventive Medicine. 2015;3(4):85-102. [Google Scholar]
Non-Operative Treatment of Cervical Radiculopathy: A Three Part Article from the Approach of a Physiatrist, Chiropractor, and Physical Therapists
- This paper was published in the Journal of Prolotherapy
- Ross Hauser, MD, Batson G, Ferrigno C. Non-operative treatment of cervical radiculopathy: a three part article from the approach of a physiatrist, chiropractor, and physical therapists. Journal of Prolotherapy. 2009;1(4):217-231.
Dextrose Prolotherapy for Unresolved Neck Pain
- This paper was published in Practical Pain Management
- Hauser R, Hauser M, Blakemore K. Dextrose prolotherapy for unresolved neck pain. Practical Pain Management. 2007;7(8):58-69.
Cervical Instability as a Cause of Barré-Liéou Syndrome and Definitive Treatment with Prolotherapy: A Case Series
- This paper was published in the European Journal of Preventive Medicine
- Hauser R, Steilen-Matias D, Sprague IS. Cervical instability as a cause of Barré-Liéou syndrome and definitive treatment with prolotherapy: a case series. European Journal of Preventive Medicine. 2015;3(5):155-166. [Google Scholar]

Degenerative Disc Disease in the Cervical Spine

Cervical Spine instability and Whiplash Associated Disorders and Post Concussion Syndrome

Cervical Spine instability and TMJ

The evidence for TMJ injections into the jaw and cervical spine

Cervical Spine instability and hearing problems

Tinnitus is a symptom of cervical spine instability

Cervical Spine instability and vision problems

Chronic Neck Pain and Blurred or Double Vision Problems – Is the answer in the neck ligaments?

Cervical Spine instability and headaches

Ross Hauser, MD. Cause of occipital neuralgia and migraines seen on DMX and resolved with Prolotherapy

In this video, Ross Hauser, MD offers a brief introduction to causes and diagnosis of occipital neuralgia and migraines and treated with the aid of DMX (Digital Motion X-Ray and simple dextrose Prolotherapy cervical spine injections.

Cervical spine instability and symptoms of dizziness, fainting, drop attacks, and other neurological symptoms

Cervical spine fusion surgery

Prolotherapy for hip pain

Published research papers from our doctors at Caring Medical on Shoulder Disorders

Regenerative Injection Therapy (Prolotherapy) for Hip Labrum Lesions: Rationale and Retrospective Study
- This paper was published in The Open Rehabilitation Journal.
- Hauser R, Orlofsky A. Regenerative injection therapy (prolotherapy) for hip labrum lesions: rationale and retrospective study. The Open Rehabilitation Journal. 2013 Oct 18;6(1). [Google Scholar]

In the Journal of Prolotherapy, we sought to show how Prolotherapy could provide high levels of patient outcome satisfaction while avoiding hip surgery. Here is what we reported:

We examined Sixty-one patients, representing 94 hips, who had been in pain an average of 63 months We treated these patients quarterly with Hackett-Hemwall dextrose Prolotherapy.
This included a subset of 20 patients who were told by their medical doctor(s) that there were no other treatment options for their pain and a subset of eight patients who were told by their doctor(s) that surgery was their only option.

Patients were contacted an average of 19 months following their last Prolotherapy session and asked questions regarding their levels of pain, physical and psychological symptoms and activities of daily living, before and after their last Prolotherapy treatment.

Results: In these 94 hips,

pain levels decreased from 7.0 to 2.4 after Prolotherapy;
89% experienced more than 50% of pain relief with Prolotherapy;
more than 84% showed improvements in walking and exercise ability, anxiety, depression and overall disability;
54% were able to completely stop taking pain medications.

The results confirm that Prolotherapy is a treatment that should be highly considered for people suffering from chronic hip pain.

Published research on Prolotherapy:

Dr. Ross Hauser and our team have published a number of research papers, case studies, and scientific editorials in the Journal of Prolotherapy, including articles on Prolotherapy as an alternative to surgery; Prolotherapy for chronic back pain; cartilage regeneration in knees; Stem cell therapy for degenerative joint disease; Prolotherapy as for meniscus tears, and many, many more.

Our Prolotherapy research papers, case studies, & scientific editorials:

1 https://scholar.google.com/scholar?cluster=3169869242871934775&hl=en&as_sdt=0,31

1 Hauser RA. The deterioration of articular cartilage in osteoarthritis by corticosteroid injections. Journal of Prolotherapy. 2009;2:107-23. [Google Scholar]

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