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What is Prolotherapy? Prolotherapy vs Prolozone Therapy

Prolotherapy has built a world-wide reputation for achieving results when all other treatments have failed. There are two types of Prolotherapy. Prolozone Therapy and Dextrose Prolotherapy.

It is always important to fully understand how each type of Prolotherapy injection works before making a decision about whether it is right for you. This is why we have collated all the best information about the treatments, and condensed it all into one simple guide.

The more you read, the more you will understand why both every-day people and professional athletes such as Tiger Woods and Rafael Nadal, all hail Prolotherapy as a miracle treatment that helped to change their lives. The below video is a collection of testimonials of some of these people.

(More video reviews can be found on the review section of this website)

This is a list of what is included in the guide:

  1. Definition of Prolotherapy
  2. Benefits of Prolotherapy
  3. Types of Prolotherapy injections
  4. How prolotherapy works?
  5. Prolozone Therapy verses Dextrose Prolotherapy
  6. How is a Prolotherapy injection performed?
  7. How often do I need the treatment?
  8. How long does Prolotherapy take to work?
  9. Prolotherapy risks & side-effects
  10. Do Prolotherapy injections hurt?
  11. Prolotherapy contraindications
  12. Prolotherapy aftercare
  13. Prolotherapy success rate
  14. How to enhance Prolotherapy results
  15. Prolotherapy cost
  16. Prolotherapy reviews
  17. History of Prolotherapy
  18. How to find Prolotherapy near me

Definition of Prolotherapy

What is prolotherapy? It makes sense to start off with a definition according to the Merriam-Webster dictionary:

“Prolotherapy is a non-surgical regenerative treatment. Short for “proliferation” therapy, Prolotherapy works by stimulating the body’s own natural healing mechanisms to repair injured musculoskeletal tissue.”


The use of prolotherapy in regenerative medicine-

Repair: When an injury occurs, the body stimulates a natural process to attempt to repair the damaged tissue. Most soft tissue and connective tissue injuries will heal on their own this way. For those that don’t, outside help is needed.

Prolotherapy injections help to increase the number of healing compounds in an injured area or joint, providing additional tools for the damaged tissue to repair.

Improves tissue strength: Many soft tissue and connective tissue structures in the body can suffer from weakness and laxity due to a lack of blood circulation, the most common being ligaments, tendons, discs and meniscus. Prolotherapy helps to strengthen the fibres within these structures which can help to provide pain relief.

Improves Stability: The main connective tissue structures involved in keeping a joint stable are ligaments and tendons. If they are weak, the laxity can cause a joint to move at angles that it wasn’t designed to. This can eventually lead to an injury and joint pain. Prolotherapy works to reinforce the fibres of ligaments and tendons, ensuring that they can perform their job of stabilising a joint properly during movement. An example of a ligament is the iliolumbar ligament in the back. If this is weak, then it can lead to low back pain. An example of a tendon is the supraspinatus tendon, which is part of the rotator cuff complex.

Types of Prolotherapy

Dextrose Prolotherapy –   uses a sugar in the form of a dextrose solution to act as an irritant. It’s aim is to induce an inflammatory response in an attempt to stimulate the release of healing compounds.

Prolozone Therapy – uses an activated form of oxygen called Medical Ozone (O3) to stimulate stem cell production and the release of healing compounds, without having to induce an inflammatory response.

Types of prolotherapy showing medical ozone and dextrose

What areas of the body can be treated?

Prolotherapy treatment can treat the majority of injuries and chronic musculoskeletal pain conditions in the following areas: Neck pain, low back pain, shoulder pain, hip pain, knee pain, elbow pain, wrist pain, hand pain, ankle pain, foot pain. Prolotherapy can also be used as part of a knee arthritis treatment program for both knee osteoarthritis and rheumatoid arthritis. If you would like specific clarification on whether Prolotherapy treatment can help you or not, feel free to send us an email after you have read this guide.

Areas of the body that prolotherapy can treat

How prolotherapy works?

To first understand how prolotherapy treatment works, it’s important to understand why many chronic musculoskeletal pain conditions struggle to heal on their own, and why physical therapy or other injection therapy treatments fail to provide pain relief.

One of the most common reasons is that the ligaments and tendons around an injured area are weak, and aren’t able to provide a stable environment for the injury to heal properly. That injured area may be a joint, muscle, spinal disc or even a ligament or tendon. Whether it’s low back pain or knee pain, if their neighbouring ligaments and tendons are weak, then that structure will struggle to heal properly.

The below video describes the difference between tendons and ligaments.


As previously explained, the reason why ligaments and tendons can become weak is due to the fact that they both have a poor blood supply. On top of that, as we age, general blood circulation becomes less efficient due to the thickening and stiffening of our blood vessels. This means that over time, ligaments and tendons don’t have the capacity to stay as strong as they once were, as they aren’t receiving the same level of oxygen and nutrients from their blood supply anymore.

Collagen fibres of ligaments and tendons

Ligaments and tendons are made of collagen.

Both Prolozone Therapy and Dextrose Prolotherapy help to stimulate the deposition of new collagen fibres within connective tissue. When new collagen matures, it shrinks. This shrinking process helps to tighten up ligaments and tendons, resulting in increased strength and stability and a reduction in joint pain.

Treating these structures around the site of an injury helps to create a stable environment for the injury to heal properly. It fixes the main issue that was preventing the injury from healing on its own or with physical therapy.

Quote about how prolotherapy works

Prolozone Therapy verses Dextrose Prolotherapy

The main benefit that Prolozone Therapy has over dextrose prolotherapy is in it’s anti-inflammatory properties. I will explain how these properties speed up the healing process.

If an injured area is inflamed, it can cause pressure within that area. This pressure can prevent circulation getting to it. We need adequate levels of circulation to heal.

Prolotherapy helping to increase circulation to an injury

Oxygen is the main component of our circulation that helps to heal an injured connective tissue. As described earlier in the guide, the medical ozone component of Prolozone injections is an activated form of oxygen. It helps not only to reduce inflammation to allow circulation back in, but also to provide a direct supply of oxygen to enhance the repair process.

Due to dextrose prolotherapy being an irritant, it doesn’t have this ability to reduce inflammation and increase oxygen levels in the same way, therefore it doesn’t help an injury to repair as quickly as Prolozone Therapy. Dextrose prolotherapy is know to be much more painful, so many practitioners will mix a local anesthetic called lidocaine in with the dextrose solution.

How is a Prolotherapy injection performed?

There are two types of areas in the body that injection therapy can be performed, intra-articular or extra-articular.

An intra-articular injection is an injection performed into the middle of a joint. This is typically used for joint pain that is being caused by internal structures, such as cartilage with knee osteoarthritis, or a sprain of an internal ligament. Examples of internal ligaments are the cruciate ligaments in the knee.

Diagram of internal ligaments that an injection can treat

Meniscus injuries in the knee can also be treated with an intra-articular injection.

Extra-articular injections are performed into connective tissue structures outside of a joint, such as external ligaments, tendons, muscles and bursa. An example of external ligaments are the capsular ligaments of the spine which wrap around the outside of each spinal joint. Weakness in these ligaments can lead to neck pain and back pain.

Prolotherapy doctor pointing towards the ligaments of the spine

How often do I need the treatment?

Prolozone Therapy – the optimal gap between appointments is normally 2 weeks.

Dextrose Prolotherapy – the gap can be between 3 and 6 weeks depending on the condition being treated.

You may be wondering why this gap is much longer than Prolozone Therapy? This is due to the different healing stages and the way that dextrose stimulates the repair process compared to medical ozone.

Dextrose has to first create inflammation in order to promote the production of healing compounds. This inflammatory stage can take up to 6 days.  In comparison, medical ozone bypasses the inflammatory stage and starts stimulating the production of these compounds immediatly after an injection. As a result, Prolozone Therapy completes the repair work in a much shorter time-frame.

How Many treatments do I need?

The average number of prolotherapy treatments required ranges from between three and six. On occasions, some people may only require one treatment, and some as many as seven or eight follow-up treatments. The number you need depends on how debilitating your condition or joint pain is.

There are many factors that can influence the number of treatments that a person needs. These factors include age, muscle health, and body alignment.

Graphic showing what things effect prolotherapy results

Age has a direct effect on the rate of repair and the bodys ability to produce the compounds needed to heal.

Muscles play a large role in supporting an injured area. If they are tight and weak, then they are unable to create an optimal environment for healing to take place.

If the structures around an injured area aren’t in proper alignment, then this can potentially undo the repair work of Prolotherapy treatment. For example, the alignment of your hips and ankles have a direct effect on the angle of your knee. So, if you came into the clinic with a knee injury, we would also examine your hips and ankles during the consultation. If you came in with a low back pain, then we would also examine your hips and pelvis.

During your consultation, if a misalignment or an issue with any of your muscles is identified, then it can be addressed during the same appointment as prolotherapy injections. Gentle massage and stretching techniques are the most common way that we help to address these issues. Your practitioner may even prescribe simple exercises for you to perform at home.

How long does it take before I start seeing results?

An impatient person waiting for prolotherapy injections to work

Different people will experience repair and pain relief at different stages. This usually depends on the type and location of condition that is being treated.

Prolozone Therapy – the usual pattern involves up to a seven-day long window of symptom relief due to its anti-inflammatory effects. This is followed by a milder version of the original symptoms returning until the next appointment. With each appointment, the intensity of the symptoms returning should subside until they go completely.

Dextrose Prolotherapy – the pattern is slightly different to prolozone injection therapy due to the timing of the repair process and the different healing stages. There is an initial window of symptom relief that can last up to 14 days. The initial stabilization induced by the dextrose during this window then starts to subside, and a milder form of the original symptoms will return until the next appointment. Again, the intensity of the returning symptoms will subside until they have gone completely.

Sometimes, a patient will experience a complete reduction of their symptoms in between an appointment. This doesn’t mean that full healing has taken place. The treatment may have repaired the injury enough to reduce the pain, but if there are still fibres that need strengthening, then finishing a course of treatment too early can run the risk of the injury returning.

Your doctor or practitioner will determine the stage of healing that your injury is at during the examination performed at the beginning of each appointment.

In some cases, patients don’t experience any symptom relief until after their third appointment. There are many reasons for this. The most common is because the condition of the injury was quite severe to start with. Another is that the structures around the injured area are in poor health and need attention too.

As explained previously, the speed of the healing process can be dictated by the health of the structures around an injured area.

During your consultation and examination, your doctor or practitioner will be able to provide you with an estimated number of treatments that may be required for your particular condition.

Prolotherapy Risks & Side-effects

There have only been a small handful of side effects reported by patients:

  • Mild pain and irritation at the injection site. This is likely to last no longer than 72 hours.
  • Bruising can develop over the course of 24 hours following the treatment. If you are aware that you bruise easily, then your practitioner can limit this by placing a cold pack over the injection site for a few minutes before the procedure.
  • A light-headed feeling during or immediately after the treatment. This normally passes within a few minutes.
  • Temporary headaches are common if you are receiving treatment in the neck. This tends to come on several hours after the treatment or the next day.

The only adverse risks associated with Prolotherapy are the following:

  • Temporary nerve damage
  • Allergic reaction to any of the substances used
  • Infection

These risks are extremely low. Both dextrose and medical ozone are naturally anti-bacterial, so the risk of infection is considerably lower than other injections.

Do the injections hurt?

It is normal to experience a brief sharp scratch as the needle first pierces the skin. To reduce this sensation, many practitioners will use a cold spray to numb the injection site.

The sensation experienced during the procedure differs from patient to patient. Some experience no pain at all, and others can experience a bee-sting type sensation that can last for up to a couple of minutes. That sting is then likely to turn into a dull ache, which subsides within five minutes.

The usual pattern is, the more inflamed an injury is, the more discomfort an individual is likely to experience during the procedure. As mentioned previously, Dextrose prolotherapy is known to be considerably more painful than prolozone injections.

It is important to be aware that there are many ways that your practitioner can reduce the pain of the injections if needed. This will be discussed during your consultation.

Prolotherapy contraindications

You are not suitable for a prolotherapy procedure if you are aware of having any of the following conditions:

  • Cellulitis – a painful skin infection. Characteristic symptoms are redness and swelling.
  • Bleeding disorders – such as hemophilia or any other known conditions effecting the bloods ability to clot.
  • If you are taking any anti-coagulant medication.
  • Septic arthritis – a form of arthritis caused by an infection.
  • Presence of an abscess around the proposed injection site.

Please make your practitioner aware of any allergies to the following substances and materials:

  • Hypo-allergenic plasters
  • Nitrile gloves
  • Anti-bacterial wipes
  • Ethyl-Chloride (numbing spray)
  • Stainless steel (Hypodermic needle material)
  • Medical Ozone
  • Procaine

Modifications and adaptations to your treatment can be made if you have any allergies.

Treatment Aftercare

Two seniors stretching as part of their prolotherapy aftercare

The following information is advised after each appointment:

  • If the injection site is sore, then you can use an ice-pack during the first 6-12 hours after the procedure. Do not use for any longer than 10 minutes at a time.
  • Strenuous sports and fitness activities may need to be modified for 2 weeks after each procedure to give the injected site a chance to repair, regenerate and strengthen.
  • If your practitioner gives you any exercises, it is advised to perform them as suggested, and stop any previous pain management activities unless instructed otherwise.
  • Keep the injection sites clean and avoid hot tubs, swimming pools, and lakes for 3 days following the procedure. Showering the same day is fine.
  • It is fine to carry on with your daily activities immediately after your appointments.
  • Some individuals can feel tired after the treatment, this is normal and you can rest for the remainder of the day.

Prolotherapy success rate

A bar chart showing different percentages

In our experience, 95% of our patients experience results with Prolotherapy. This is a much higher figure than what is stated in many studies. The reason for this is that we often combine the treatment with other therapy modalities to enhance the results. More information about these therapies can be found under the next heading.

There are many different variables that can influence the success rate of Prolotherapy. Despite these variables, it remains a treatment that has built its reputation on achieving results when all other treatments have failed. There are many published systematic reviews and randomized controlled trials proving the positive effects of the treatment.

After your doctor or practitioner has examined you during your consultation, they will be able to provide you with information on the level of success you are expected to experience.

How to enhance prolotherapy results

A graphic showing how to speed up prolotherapy results

As previously described in this guide, there are many factors that can affect both the level of results achieved, and speed at which you achieve those results.

Two of those factors are:

  • Muscle health
  • Body alignment

Muscle health – Muscles have three main roles in the body. They help the body to move, keep stable, and abosrb shock. When muscles around an injured area are tight or weak, then they aren’t able to perform their roles effectively. As a result, this can slow down the repair process of an injury through lack of stable movement and support.

Body alignment – If the structures surrounding an injured area aren’t in proper alignment, then it can create unnecessary force transfering through that area at angles that the body weren’t designed to move in. This creates a poor environment for the injury to heal properly and can lead to chronic pain.

During a consultation and examination, your practitioner will conduct a comprehensive assessment of both your symptomatic area, and the structures that connect to it. This is done with the aid of computer analysis technology. The data and images collected will help us to identify misalignments and muscle problems around the area that may not have been picked up by an x-ray or MRI scan. If any issues are identified, then we can use the following additional therapies to enhance the effects of the prolotherapy injections:

Percussion massage: this is a form of massage that targets dysfunctional fibres with a specialised vibrating device to increase muscle tone and flexibility. On certain parts of the body, we can use the device over the injection site to increase the absorption of the injected substances.

Stretching techniques: this involves gentle stretching of certain structures that commonly cause misalignments in the body. For example, the pelvis is the most common part of the body to misalign. It can cause joint pain in many different parts of the body, from the neck to the feet.

Exercise prescription: we will often prescribe certain exercises to compliment the effects of the massage and stretching. These exercises can help an individual to sustain the results of the injections, and prevent their injury and joint pain from returning.

Prolotherapy cost uk

The cost of prolotherapy at our clinic is considerably lower than most other clinics. The main reason for this is that we feel the treatment should be accessible to as many people as possible.

Prolotherapy uk cost – Each appointment costs £170 and includes the following:

  • Prolozone therapy
  • Percussion massage
  • Advanced stretching techniques
  • Prescription of strengthening and stabilisation exercises

The consultation and examination fee is £80.

Prolotherapy Reviews

Meet Arther. He came to the clinic suffering from constant pain caused by knee arthritis. There were many daily activities that caused him discomfort. These included walking, running, cycling, and getting up off a low chair.


Meet Janette. Her pain in her low back was so bad that she could barely get out of bed, and couldn’t leave her home for nearly a whole year. After a single course of treatment she was able to get out of her house and return back to normal living again.


Meet Diana.  She came to the clinic suffering from pain caused by hip arthritis.  She couldn’t walk without using a crutch and always had to hold on going upstairs one step at a time. Diana also couldn’t stand or sit for extended periods of time. After the treatment, she was able to drive, walk with friends, go on hikes and perform ballet with 95% less pain than before.


Meet Dean. He came to the clinic suffering from debilitating shoulder and elbow pain. It stopped him from drumming and playing football. The discomfort also affected Dean at work, and he struggled to perform any activities for a prolonged period of time. After the treatment, he was able to return to playing the drums and football.

History of the treatment

The history of Prolotherapy dates back to ancient times, with the Egyptians using it to treat crippled animals. It was performed using a hot iron cautery.

Prolotherapy was first used in humans in 400 BC, when Hippocrates developed a way to repair a dislocated shoulder by using a hot poker as an irritant in the armpit.

Fast-forward to 1835. Dr. Alfred Velpeu was known as the father of Prolotherapy treatment, and started using iodine injections to heal his patients. Later on that century, Dr Rene Lerich started piloting the first research into the treatment on ligaments and painful areas.

From the 1940’s onwards, practitioners such as Dr Earl Gedney and Dr George Hackett revolutionised the treatment into what it is today. Dr Hackett was a trauma surgeon based in Ohio. He began studying the effects of dextrose injections as an irritant to help increase the thickness of ligaments in order to provide pain relief.

One of his students, Dr.Gustav Hemwall, then developed the library of scientific data further by making important discoveries that are still recognised today. He treated more than 10,000 patients worldwide, and reported his clinical experiences in a study on 8,000 of those patients.

In 1974, Dr. Hemwall presented a survey of 2,007 patients to the Prolotherapy Association. Pain relief was noted in a staggering 99% of those patients.

How to find Prolotherapy near me

We offer the treatment at two different clinics in the UK. London and Bedford.

Unfortunately, the treatment isn’t that common elsewhere in the UK at the moment. One of the reasons may be due to there not being many prolotherapy training courses available in Europe.

There used to be Prolotherapy NHS orthopaedic doctors that performed the treatment, but cuts to NHS funding over the years has meant that they don’t offer it in a primary care setting anymore.

If you would like to go ahead and book an appointment or would like to ask us a question, then head over to our contact page for more information on how to do so.

Prolotherapy verses PRP

Platelet rich plasma (PRP) and dextrose prolotherapy have a very similar healing process  and healing response when it comes to repairing connective tissue. They are both irritants which aim to provide pain relief through stimulating growth factors. Prolozone Therapy has a much faster healing response.  Platelet rich plasma (PRP) tends to be the most expensive out of the three treatments.

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