Acta Scientific Orthopaedics (ISSN: 2581-8635)

Review Article Volume 5 Issue 10

Current Clinical Considerations in the Use of Dextrose Prolotherapy in Sport and Exercise Medicine

Mark Wilson1*, Anna Topping1, and Stephan Praet2

1Australasian College of Sports and Exercise Physicians, Australia
2Ochre Health Medical Centre, Health Hub, Bruce ACT, Australia

*Corresponding Author: Mark Wilson, Australasian College of Sports and Exercise Physicians, Australia.

Received: February 25, 2022; Published: September 08, 2022.


Introduction: Prolotherapy is an injection-based therapy used for multiple acute and chronic musculoskeletal pain drivers. The aim of this clinical discussion is to review the clinical considerations in the use of prolotherapy in sport and exercise medicine. We will also compare intervention options and provide valuable clinical pearls.

Methodology: The focus of this clinical discussion is on the application of prolotherapy in clinical practice.

Summary: it is hoped that this narrative review guides clinicians on possible uses of prolotherapy in clinical practice, based on the current evidence of efficacy, complications and risk profile. The integration of clinical experience, combined with a review of the best evidence in the field, may assist in clinical decision making.

Keywords: Dextrose Prolotherapy; Sport; Exercise; Medicine


  1. Hackett GS. “Joint stabilization through induced ligament sclerosis”.Ohio State Medical Journal 49 (1953): 877-884.
  2. Hackett GS., et al. “Ligament and Tendon Relaxation Treated byProlotherapy”. Oak Park: Gustav A. Hemwall (1993).
  3. Hackett GS and Huang TC.“Prolotherapy for sciatica from weak pelvic ligaments and bone dystrophy”. Clinical Medicine (Northfield, Il) 8 (1961): 2301-2316.
  4. Rabago David MD., et al. “A Systematic Review of Prolotherapy for Chronic Musculoskeletal Pain”. Clinical Journal of Sport Medicine5 (2005): E376.
  5. Dean Reeves K., et al. “Short Term Analgesic Effects of 5% Dextrose Epidural Injections for Chronic Low Back Pain: A Randomized Controlled Trial”.Anesthesia and Pain Medicine 1 (2016): e42550.
  6. Reeves KD and Hassanein K. “Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity”. Alternative Therapies in Health and Medicine2 (2000): c68-80.
  7. Wheaton MT and Jensen N. “The Ligament Injury-Osteoarthritis Connection: The Role of Prolotherapy in Ligament Repair”. Journal of Prolotherapy4 (2011): 790-812.
  8. Ekwueme EC., et al. “Prolotherapy induces an inflammatory response in human tenocytes in vitro”. Clinical Orthopaedics and Related Research®8 (2017): 2117-2127.
  9. Hauser RA., et al. “A systematic review of dextrose prolotherapy for chronic musculoskeletal pain”. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders 9 (2016): CMAMD-S39160.
  10. Fullerton BD. “Prolotherapy for the thoracolumbar myofascial system”. Physical Medicine and Rehabilitation Clinics of North America 1 (2018): 125-138.
  11. Padhiar N., et al. “The effectiveness of prolotherapy for recalcitrant medial tibial stress syndrome: a prospective case series”. Journal of Foot and Ankle Research 1 (2020): 32.
  12. Maniquis-Smigel L., et al. “Short-term analgesic effects of 5% dextrose epidural injections for chronic low back pain: A randomized controlled trial”. Anesthesia and Pain Medicine 1 (2016): e42550.
  13. Lyftogt J. “Subcutaneous prolotherapy for Achilles tendinopathy: The best solution?” Australasian Musculoskeletal Medicine 2 (2007): 107.
  14. Lam KHS., et al. “Ultrasound-Guided Nerve Hydrodissection for Pain Management: An Updated Review of Anatomy and Techniques”. Journal of Pain Research 13 (2020): 1957-1968.
  15. Stecco C and Schleip R. “A fascia and the fascial system”. Journal of Bodywork and Movement Therapies1 (2016): 139-140.
  16. Klingler W., et al. “Clinical relevance of fascial tissue and dysfunctions”. Current Pain and Headache Reports8 (2004): 439.
  17. Trescot A. “Everything old is new again: New developments in prolotherapy”. Techniques in Regional Anaesthesia and Pain Management 1-2 (2015): 14-18.
  18. Osborne MD., et al. “Nonsurgical Interventions”. In The Hip and Pelvis in Sports Medicine and Primary Care (2017): 251-279.
  19. Conaway E and Browning B. “Neural prolotherapy for neuralgia”. Journal of Prolotherapy 6 (2014): e928-931.
  20. Güran Ş., et al. “Dextrose solution used for prolotherapy decreases cell viability and increases gene expressions of angiogenic and apoptotic factors”. Gulhane Medical Journal 2 (20018).
  21. Zügel M., et al. “Fascial tissue research in Sport and Exercise medicine: from molecules to tissue adaptation, injury and diagnostics: consensus statement”. British Journal of Sports Medicine 23 (2018): 1497.
  22. Cusi M., et al. “The use of prolotherapy in the sacroiliac joint”. British Journal of Sport and Exercise Medicine2 (2010): 100-104.
  23. Klein RG., et al. “Proliferant Injections for Low Back Pain:
    Histological Changes of Injected Ligaments and Objective Measurements of Lumbar Spine Mobility Before and After Treatment”. Journal of Neurological and Orthopaedic Medicine and Surgery 10 (1989): 123-126.
  24. Bordoni B., et al. “New proposal to define the fascial system”. Complementary Medicine Research4 (2018): 257-262.
  25. Chung MW., et al. “Effects of dextrose prolotherapy on tendinopathy, fasciopathy, and ligament injuries, fact or myth? A systematic review and meta-analysis”. Medicine46 (2020).
  26. Schleip R., et al. “Fascia is able to actively contract and may thereby influence musculoskeletal dynamics: a histochemical and mechanographic investigation”. Frontiers in Physiology 10 (2019): 336.
  27. Schleip R., et al. “Needle biopsy‐derived myofascial tissue samples are sufficient for quantification of myofibroblast density”. Clinical Anatomy3 (2018): 368-372.
  28. Wilke J and Krause F. “Myofascial chains of the upper limb: a systematic review of anatomical studies”. Clinical Anatomy7 (2019): 934-940.
  29. Schleip R and Klingler W. “Active contractile properties of fascia”. Clinical Anatomy7 (2019): 891-895.
  30. Pipelzadeh MH and Naylor IL. “The in vitro enhancement of rat myofibroblast contractility by alterations to the pH of the physiological solution”. European Journal of Pharmacology2-3 (1998): 257-259.
  31. Hung CY., et al. “Comparative effectiveness of dextrose prolotherapy versus control injections and exercise in the management of osteoarthritis pain: a systematic review and meta-analysis”. Journal of Pain Research 9 (2016): 847.
  32. Bourget-Murray J., et al. “A rare case of Haemophilus parainfluenzae septic knee following prolotherapy injections”.Journal of Clinical Orthopaedics and Trauma 10 (2019): S193-S196.
  33. Dan Y and Jing Z. “Dextrose prolotherapy induces the proliferation of new cells to repair soft tissue and to alleviate pain: current status and problems”. Chinese Journal of Tissue Engineering Research23 (2019): 3754.
  34. Rabago D and Nourani B. “Prolotherapy for osteoarthritis and tendinopathy: a descriptive review”. Current Rheumatology Reports6 (2017): 34.
  35. Rotunno A., et al. “Corticosteroids in sports-related injuries: Friend or Foe”. South African Family Practice6 (2015): 28-33.
  36. Reeves KD., et al. “Dextrose prolotherapy: a narrative review of basic science, clinical research, and best treatment recommendations”. Physical Medicine and Rehabilitation Clinics4 (2016): 783-823.
  37. Siadat AH and Isseroff RR. “Prolotherapy: Potential for the Treatment of Chronic Wounds?” Advances in Wound Care4 (2019): 160-167.
  38. Kim E and Lee JH. “Autologous platelet-rich plasma versus dextrose prolotherapy for the treatment of chronic recalcitrant plantar fasciitis”.PM and R2 (2014): 152-158.
  39. Rabago D., et al. “A systematic review of four injection therapies for lateral epicondylosis: prolotherapy, polidocanol, whole blood and platelet-rich plasma”.British Journal of Sports Medicine7 (2009): 471-481.
  40. Carayannopoulos A., et al. “Prolotherapy versus corticosteroid injections for the treatment of lateral epicondylosis: a randomized controlled trial”.PM and R8 (2011): 706-715.
  41. Bayat M., et al. “Is Dextrose Prolotherapy Superior To Corticosteroid Injection In Patients With Chronic Lateral Epicondylitis?: A Randomized Clinical Trial”.Orthopedic Research and Reviews 11 (2019): 167.
  42. Kim WM., et al. “A randomized controlled trial of intra-articular prolotherapy versus steroid injection for sacroiliac joint pain”.The Journal of Alternative and Complementary Medicine 12 (2010): 1285-1290.
  43. Dwivedi S., et al. “Utility of prolotherapy for upper extremity pathology”. The Journal of Hand Surgery3 (2019): 236-239.
  44. Dufour E., et al. “Ultrasound-guided perineural circumferential median nerve block with and without prior dextrose 5% hydrodissection: a prospective randomized double-blinded noninferiority trial”.Anesthesia and Analgesia 115 (2012): 728-733.
  45. Thor JA., et al. “Perineural injection therapy in the management of complex regional pain syndrome: a sweet solution to pain”. Pain Medicine10 (2017): 2041-2045.
  46. Poitras T., et al. “Selective sensory axon reinnervation and TRPV1 activation”. Molecular Neurobiology10 (2019): 7144-7158.
  47. Wu YT., et al. “Six-month efficacy of perineural dextrose for carpal tunnel syndrome: a prospective randomized double-blind controlled trial”.Mayo Clinic Proceedings 92 (2017): 1179-1189.
  48. Wu YT., et al. “Randomized double‐blinded clinical trial of 5% dextrose versus triamcinolone injection for carpal tunnel syndrome patients”. Annals of Neurology4 (2018): 601-610.
  49. Erdem Y., et al. “Comparison of Intraarticular Injections of Hyaluronic Acid versus Dextrose Applied with Periarticular Prolotherapy in the Treatment of Recreational Athletes with Knee Osteoarthritis”. Turkish Journal of Sport and Exercise Medicine1 (2020).
  50. Singh S., et al. “A Comparative study of intra-articular injection of steroid versus prolotherapy for pain relief in patients of osteoarthritis knee”.Indian Journal of Pain1 (2019): 25.
  51. Arias-Vázquez PI., et al. “Prolotherapy for knee osteoarthritis using hypertonic dextrose vs other interventional treatments: systematic review of clinical trials”.Advances in Rheumatology 59 (2019).
  52. Mofrad MK., et al. “Periarticular Neurofascial Dextrose Prolotherapy Versus Physiotherapy for the Treatment of Chronic Rotator Cuff Tendinopathy: Randomized Clinical Trial”. JCR: Journal of Clinical Rheumatology (2020).
  53. Bertrand H., et al. “Dextrose Prolotherapy Versus Control Injections in Painful Rotator Cuff Tendinopathy”. Archives of Physical Medicine and Rehabilitation 1 (2016): 17-25.
  54. Seven MM., et al. “Effectiveness of prolotherapy in the treatment of chronic rotator cuff lesions”. Orthopaedics and Traumatology: Surgery and Research3 (2017): 427-433.
  55. Cole B., et al. “Ultrasound-guided injections for supraspinatus tendinopathy: corticosteroid versus glucose prolotherapy-a randomized controlled clinical trial”.Shoulder and Elbow 3 (2018): 170-178.
  56. Louw WF., et al. “Treatment of temporomandibular dysfunction with hypertonic dextrose injection (prolotherapy): a randomized controlled trial with long-term partial crossover”. In Mayo Clinic Proceedings5 (2019): 820-832.
  57. Rammelsberg P., et al. “Longitudinal outcome of temporomandibular disorders: a 5-year epidemiologic study of muscle disorders defined by research diagnostic criteria for temporomandibular disorders”. Journal of Orofacial Pain1 (2003).
  58. Refai H., et al. “The efficacy of dextrose prolotherapy for temporomandibular joint hypermobility: a preliminary prospective, randomized, double-blind, placebo-controlled clinical trial”. Journal of Oral and Maxillofacial Surgery12 (2011): 2962-2970.
  59. Kim SR., et al. “Critical review ofprolotherapy for osteoarthritis, low back pain, and other musculoskeletal conditions: a physiatry perspective”. American Journal of Physical Medicine and Rehabilitation 83 (2004): 379-389.
  60. Yelland M., et al. “Prolotherapyinjections for chronic low back pain: results of a pilot comparative study”. Australian Association of Musculoskeletal Medicine 5 (2000): 20-30.
  61. Lai WC., et al. “Chronic lateral epicondylitis: challenges and solutions”. Open Access Journal of Sports Medicine 9 (2018): 243.
  62. Aljawadi A., et al. “The effectiveness of corticosteroid injections in the management of lateral epicondylitis review of literature”. Journal of Orthopedics and Muscular System Research (2019).


Citation: Mark Wilson., et al. “Current Clinical Considerations in the Use of Dextrose Prolotherapy in Sport and Exercise Medicine".Acta Scientific Orthopaedics 5.10 (2022): 07-16.


Copyright: © 2022 Mark Wilson., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Acceptance rate33%
Acceptance to publication20-30 days

Indexed In

News and Events

  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is July 10, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US