A traditional and complementary medicine (T&CM) treatment that stimulates tissue repair through controlled dextrose/irritant solution injections into joints, ligaments, and tendon attachment sites.
Indication
- Tendon attachment pain (enthesopathies such as lateral epicondylitis and Achilles tendinosis)
- Sacroiliac joint pain and selected low back pain conditions
- Chronic pain associated with mild-to-moderate knee osteoarthritis
- Chronic plantar fasciitis
- Some shoulder tendinopathies (low-grade rotator cuff problems)
Preparation
- Discontinuation of non-steroidal anti-inflammatory drugs (NSAIDs) 3-5 days before the procedure is recommended (with physician approval)
- Use of blood thinners is reported
- Active infection, fever, and skin lesions are screened for
- Diabetes control is evaluated (if a high-concentration dextrose solution is used)
- Allergy history and pregnancy status are clarified
How it's performed
- The treatment area is cleaned with skin antiseptic
- The physician identifies target points by clinical examination and, if needed, with ultrasound guidance
- Typically a 12.5%-25% dextrose or similar solution is prepared
- Small volumes are injected into the joint, tendon attachment site, or ligament with a fine needle
- Multiple points may be targeted in the same session
- After the procedure, the area is covered with a sterile dressing
Post-procedure
- Temporary pain and swelling at the injection site is expected during the first 24-72 hours
- Paracetamol and cold application are recommended during this period instead of NSAIDs
- The treatment protocol typically consists of 3-6 sessions at 3-6 week intervals
- An exercise program is gradually arranged by the physician
- Response is evaluated starting after the 2nd-3rd session
Risks
- Temporary pain, swelling, and tenderness at the injection site (most common)
- Local hematoma
- Very rare: local infection
- Nerve or vascular injury (minimized by experienced practitioners)
- Temporary glucose fluctuation may occur in patients with diabetes
FAQ
Can prolotherapy replace surgery?
No. Prolotherapy is a supportive method for mild-to-moderate problems where structural integrity is preserved. It is not an alternative for advanced meniscus tears, complete tendon ruptures, or conditions requiring surgery.
Is it the same as PRP?
No. PRP (platelet-rich plasma) contains growth factors derived from the patient's own blood, while classical prolotherapy uses an irritant solution such as dextrose. The indications and costs differ.
Who should perform it?
It should be performed in appropriately equipped settings by physicians who hold the Ministry of Health T&CM prolotherapy certificate and are experienced in injection procedures.
How long do side effects last?
Pain and swelling after the injection generally subside within 2-4 days. If swelling, increased warmth, or fever persists longer, a physician should be consulted.
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