Injection treatments explained

Prolotherapy

What it is, what the research does and does not show, and how we approach ligament laxity and hypermobility instead.

What is prolotherapy?

Prolotherapy (short for proliferative therapy) is the injection of a mild irritant solution into or around a ligament, tendon or joint. The most common solution is concentrated dextrose (a form of glucose), usually between 12.5% and 25%, often mixed with a small amount of local anaesthetic. The aim is to provoke a brief, controlled inflammatory response that encourages the tissue to lay down new collagen and, in theory, become stiffer and less painful.

It has been in use since the 1950s and in Australia is mostly performed by doctors trained in musculoskeletal medicine. It is sometimes grouped with PRP under the umbrella of regenerative injection therapies, although the two are different treatments with different evidence bases.

What is it used for?

Practitioners most commonly use prolotherapy for:

• Knee osteoarthritis
• Chronic tendon pain, such as tennis elbow and rotator cuff tendinopathy
• Sacroiliac joint pain and chronic low back pain thought to involve ligament laxity
• Ligament laxity and joint instability, including in people with hypermobility

A typical course involves three to six injection sessions, spaced two to six weeks apart, usually alongside an exercise programme. A post-injection flare of pain for one to three days is common. Serious complications are rare when the procedure is performed with sterile technique, and infection risk is similar to any other injection.

What does the research show?

The honest summary is that the research base is small, the trials are mostly short, and the quality is low to moderate. Prolotherapy has a good safety record, which is not in dispute. Whether it works better than the alternatives, and for whom, is less settled than its advocates suggest and less dismissed than its critics suggest.

Why the quality matters

Three features of this literature are worth knowing about before weighing any single study. First, the trials are small, which means a positive result is more likely to be chance or bias than it would be in a trial of several hundred people. Second, the protocols vary widely (dextrose concentration, where it is injected, how many sessions, what else is done alongside), so pooling them is of limited value. Third, a substantial share of the research, including some of the systematic reviews, is authored by clinicians who provide prolotherapy, and a good deal of it appears in a journal run by practitioners that is not indexed in the major medical databases. None of that makes the findings wrong, but it does mean the evidence should be read with some care.

How we approach ligament laxity and hypermobility

Dr Samra's practice is built on an exercise-led approach to joint laxity, with injections reserved for specific, identifiable ligament injuries. In practical terms, that means:

• Assessment first. In hypermobility the lax joints and the painful joints are not always the same ones. We examine, review imaging and use ultrasound in the room to work out which structures are driving the problem.
• Strength and neuromuscular control, delivered with our exercise physiologists. A graded strengthening programme is the foundation of every published approach to hypermobility management. We will be honest that the trial evidence for exercise in hypermobility is also thinner than we would like [10], but it carries no procedural risk and it keeps working after the last appointment.
• PRP for a specific injured ligament. Where one ligament has been injured and is healing slowly, such as an ankle syndesmosis or a medial collateral ligament, ultrasound-guided PRP is something Dr Samra offers and has researched. It is a treatment for a particular ligament injury, not for generalised hypermobility.
• Bracing, taping and load management where they help a particular joint through a particular phase.

If that approach is what you are looking for, we would be glad to see you. If you need specialist hypermobility or hEDS care, your GP can refer you to a rheumatologist or a physician with a specific focus in that area, and we are happy to work alongside them on the musculoskeletal side.

Finding a prolotherapy practitioner

We do not want to leave you without a path. Prolotherapy is a core skill of doctors trained in musculoskeletal medicine, and the Australian Association of Musculoskeletal Medicine is their professional body. Their website is the best starting point for finding a practitioner. Your GP may also know of clinicians in your area who offer it. We are not able to make the referral for you or vouch for any particular practice, and we would encourage you to ask any practitioner the same questions about evidence that are set out above.

This page provides general information about prolotherapy and is not a substitute for individual medical advice. It does not describe a service offered at this practice. Progressive Sports Medicine, 121 Norton Street, Leichhardt NSW 2040. Last reviewed October 2026.