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Prolotherapy Frequently Asked Questions

Back Pain? Neck Pain? Shoulder Pain? Knee Pain?
Prolotherapy Can Help

Questions US Surgeon General C. Everett Koop Endorses Prolotherapy...

Q: What is Prolotherapy?

A: Prolotherapy is an injection technique for the treatment of musculoskeletal pain. The prefix "prolo" comes from the word, "proliferate," since this treatment stimulates the body's natural ability to create new connective tissue. Frequently, the underlying cause of musculoskeletal pain is weak ligaments (connective tissue that connects bones to each other) or weakness at the sites where tendons attach to bones (e.g., rotator cuff injuries). Prolotherapy is sometimes also called Regenerative Injection Technique (RIT), because the injections stimulate connective tissue to regenerate. Simply put, Prolotherapy causes ligaments and tendons to heal themselves.


Q: Does published research support Prolotherapy?

A: Yes. Prolotherapy research has been published in such prestigious medical journals as, Archives of Physical Medicine and Rehabilitation, The Journal of Orthopaedic Medicine, The Journal of Neurological and Orthopedic Medicine and Surgery, The Journal of Spinal Disorders, as well as popular publications as the Mayo Clinic's Health Letter publication. Click here to read prolotherapy articles.

Q: How does Prolotherapy work?

A: Prolotherapy works by stimulating the production of new connective tissue. It does this by creating a local, controlled inflammation, which signals specific cells in the area (fibroblasts) to strengthen ligaments and tendons. It also increases blood flow and nutrients to the area.


Q: What are ligaments?

A: Ligaments are tightly woven strands of connective tissue that hold bone together to form joints. There are a lot of nerves where ligaments attach to bones, and in capsules that surround many joints. When a ligament gets stretched or weakened these nerves can be activated even by normal, routine tasks like picking up a cup of coffee (wrist, elbow, and/or shoulder pain), bending at the waist (low back pain), or walking up or down stairs (ankle, knee or hip pain).



"I have been a patient who has benefited from Prolotherapy....My intractable pain was not intractable and I was remarkably improved."

—Excerpt from the book:
Prolo Your Pain Away: Curing Chronic Pain with Prolotherapy
Beulah Land Press, 2000
By Ross Hauser, MD and Marion Hauser, MS, RD

Former US Surgeon General

What people are saying about Dr. Neustadt's Prolotherapy...
"Prolotherapy was the right choice for me. My knee joint was painful, hot to the touch, and the knee cap snapped and popped. X-rays showed the joint had deteriorated significantly. After three treatments the ligaments and tendons had regained normal function and flexibility and I was pain free.
  "Prolotherapy is a proven technique that has been around since the 1930s and I had read about it in golf magazines. Unlike cortisone, an injection which masks the pain, Prolotherapy restores joint integrity. Prolotherapy costs significantly less than orthopedic surgery and with no downtime. I had not realized that over time I had given up horseback riding, golfing, hiking, snowshoeing, and cross country skiing because it hurt. I no longer use the excuse 'I can't, I have bad knees.' I'm enjoying an active life again thanks to Dr. Neustadt and Prolotherapy."

 - Joan, Bozeman, MT

"After being told by two different doctors that I would need hip surgery because I had bone rubbing on bone, my daughter told me about prolotherapy. I looked it up on the internet to see what was involved and my husband contacted Dr. Neustadt in Bozeman, MT. I was in such pain that I could not walk without a cane and then the walking was very slow and painful.

"Dr. Neustadt looked at the x-rays I brought in and said the bone was not rubbing on bone and I would be a candidate for pro-lo-therapy. I saw him five consecutive months for treatment and I'm walking 85% pain free. I'm so grateful to Dr. Neustadt for his help and caring manner. Also, I can wear heels again when I dress up to go out. Thank you Dr. Neustadt."

 –Celia, Miles City, MT

"I suffered constant, severe lower back pain from sacroiliac joint` instability, even unable to sleep through the nights. After a year of chiropractic and physical therapies, I was not 100% improved, and was recommended to Dr Neustadt for Prolotherapy. After my treatments I had full mobility of my sacroiliac joint and was pain free; able to enjoy daily activities and sleep comfortably again.  

Paula, Bozeman, MT

Q: What substances are injected in Prolotherapy?

A: There are two solutions that Dr. Neustadt uses. One is dextrose diluted with lidocaine. This solution has been used for more than 70 years, and has been repeatedly shown in studies to be safe and effective. The second solution is called Platelet Rich Plasma (PRP). PRP is created by withdrawing some blood from the patient, spinning down the blood to concentrate the platelets and growth factors, then putting the PRP into syringes and injecting it into the damaged area (tendon,ligament, joint). PRP has been the subject of many studies and is also safe and effective. Dextrose prolotherapy is typically used for chronic pain when little degeneration is suspected, and PRP is used when more severe tendon, ligament or joint degeneration exists.


Q: How long has Prolotherapy been practiced?

A: The concept of strengthening ligaments goes back to the time of Hippocrates. Reports of shoulder joint instability and its many repair methods date back to Hippocrates' treatise, "On Joints." Hippocrates described the practice of using cautery to cause the capsule to scar and thus tighten around the joint. While his technique is no longer used, the underlying concept is similar to Prolotherapy—strengthen the ligaments.

In the 1930s many case reports emerged in France and the United States of musculoskeletal disorders, such as TMJ, knee pain, and sacroiliac joint (SI joint, which holds your pelvis to your lower back), being successfully treated with Prolotherapy. In 1956, George Hackett, MD, a surgeon, published the first edition of the textbook Ligament and Tendon Relaxation Treated by Prolotherapy. Dr. Hackett reported a 12-year success rate of 82% in the treatment of 1,800 patients with back pain using Prolotherapy.

Then, in 1983, microscopic examination of rabbit tendons after Prolotherapy treatment confirmed the that Prolotherapy stimulates connective tissue repair. This study was published in the journal, Connective Tissue Research (Liu YK, Tipton CM, Matthes RD, Bedford TG, Maynard JA, Walmer HC. An in situ study of the influence of a sclerosing solution in rabbit medial collateral ligaments and its junction strength. 1983;11[2-3]:95-102). Another landmark study was published in 1987 in the prestigious journal Lancet by Dr. Thomas Dorman. The study demonstrated the effectiveness of using Prolotherapy to treat back pain (Ongley MJ, Klein RG, Dorman TA, Eek BC, Hubert LF. A new approach to treatment of chronic low back pain. 1987;2:143-146). Interestingly, Dr. Dorman was Dr. Neustadt's mentor. Dr. Neustadt spent more than 300 hours studying directly with Dr. Dorman at Dr. Dorman's private clinic, the Paracelsus Clinic in Kent, WA.

More recently, in 2005, the Mayo Clinic featured Prolotherapy in its Health Letter publication, which stated that Prolotherapy stimulates tissue growth and is used for tendon and ligament pain (Alternative Treatments. Dealing with Chronic Pain. Mayo Clinic Health Letter. 2005 Apr;23(4):1-3). Numerous clinical trials have proven Prolotherapy to be helpful in the treatment of musculoskeletal pain. You may read additional research on Prolotherapy by clicking here.


Q: Where did Dr. Neustadt receive his training in Prolotherapy?

A: Dr. Neustadt trained under the supervision of Thomas Dorman, MD, one of the leading practitioners and teachers of Prolotherapy. Dr. Neustadt spent more than 300 hours learning from Dr. Dorman at Dr. Dorman's clinic in Kent, WA. Additionally, Dr. Neustadt has completed advanced certification courses in Prolotherapy taught by the Naturopathic Academy of Therapeutic Injections (NATI; NATI is the only organization in the country that requires participants to inject each other during seminars to learn proper, safe techniques. All other organizations only offer lectures or practice on cadavers. Dr. Neustadt is a Contributing Editor to the Journal of Prolotherapy, a position that is a  testament to the high esteem in which his work is regarded by his colleagues.


Q: Which conditions can be helped by Prolotherapy?

A: Prolotherapy is an excellent treatment for musculoskeletal pain. The underlying cause of this pain is often a weakened ligament or tendons. Prolotherapy can restore joint integrity and relieve pain from arthritis; whiplash; sciatica; disk problems; low back pain; rotator cuff (shoulder) pain; elbow and forearm pain caused by lateral epicondylitis (tennis elbow), medial epicondylitis (golfer's elbow) or other dysfunction in the elbow; old sports injuries that are now acting up; knee pain such as from osteoarthritis, ACL or PCL injuries, chondromalacia patella (runner's knee) and meniscus damage; TMJ (temporomandibular joint) dysfunction; chronic headaches; and wrist, hand, ankle and toe pain.


Q: Is Prolotherapy safe?

A: Yes, Prolotherapy is very safe. Dr. Gustav Hemwall, who practiced Prolotherapy for forty years, treated over 10,000 patients with more than 4 million injections, without ever experiencing any serious adverse effects. Prolotherapy has been practiced safely for over 70 years. Since 1955, one fatality and four cases of substantial neurologic impairment have been reported in the medical literature (all were attributed to the use of a strongly inflammatory proliferant that Dr. Neustadt does not use). Prolotherapy is much safer than the long-term use of non-steroidal anti-inflammatory (eg, Ibuprofen, Alleve, Motrin, aspirin) and analgesic (eg, Tylenol) medicines, undergoing a surgical procedure, or of enduring the effects of chronic pain on the body.


Q: Is Prolotherapy painful?

A: A shot is a shot, but I always tell my chronic pain patients that the pain of the injections is nothing compared to what they live with every day. For most patients this is true, and very few patients require painkillers to undergo the treatment.


Q: Are there side effects from the injections?

A: The only common side effects of the injections are soreness and bruising at the injection site and temporary stiffness. These tend to last less than a few days. Some injection discomfort is expected but it can be lessened with some topical technique or anesthetic creams. Most people tolerate the procedure very well.


Q: Are imaging studies (eg, a MRI) necessary before getting Prolotherapy?

A: Not usually. There are very few cases when obtaining an image prior to the injections would be helpful. A good history of your condition taken by Dr. Neustadt and an excellent orthopedic physical examination are the most useful indicators for determining whether someone is a candidate for Prolotherapy.


Q: How many treatments are required?

A: The answer to this depends on the area being treated and the severity of the dysfunction. Generally, four to six treatments spaced every two to six weeks are required, but each case is different. You may require less or more treatments. The amount of overall discomfort should decrease more with each injection. Therefore, if you are not getting any benefit after two injections, therapy is reevaluated.


Q: How will I feel after Prolotherapy?

A: Frequently the treated areas may feel stronger immediately after Prolotherapy. Patients can generally expect to return to work that same day after the treatment with only a minimal of residual soreness from the injections. It is common to experience some stiffness, soreness, swelling, or even increased pain after Prolotherapy. These effects are usually mild and last less than three days; however, they may last up to seven days. It is normal to experience muscle soreness for a few weeks after the treatment. Then there is a "window period" of about two weeks as inflammation subsides but healing of the ligament is not complete. During this period there may be a return of some of the original pain. Starting around four weeks after a treatment, ligament strengthening is occurring. Re-evaluation and treatment is scheduled three to six weeks apart. These effects are part of the body's healing process and are considered therapeutic. The healing process stimulated by Prolotherapy continues for months, so it's expected that improvement may continue for many months after the last Prolotherapy injection has been given.


Q: Are there any activity restrictions following the injection?

A: Unlike surgery that can take weeks or months to recover from, there is usually no down-time with Prolotherapy. Patients can resume their normal activities that same day. Most of the time careful resumption of activities, as tolerated by the patient, facilitates healing and is encouraged. This can include normal exercise routines, walking, sports, and other activities. Physical therapy, massage, chiropractic and other treatment does not usually need to be stopped. Additionally, Dr. Neustadt prescribes specific exercises that can be done at home, in a pool, or on a stationary bike, to patients after treatment, depending on the areas treated.


Q: Are the effects of Prolotherapy permanent?

A: The benefits of Prolotherapy are generally regarded as permanent. By restoring structural integrity to the ligament and, therefore, the joint, the relief from pain and dysfunction can be permanent. Pain sometimes recurs episodically, but is usually less severe, and more easily treated with a single injection. Patients whose pain is cured should remember, however, that they are not immune to injury. There are no bionic joints.


Q: What is the success rate of Prolotherapy treatments?

A: As with all forms of treatment, no one can guarantee 100% success; however, a large number of scientific studies have validated the method. Dr. Hackett, originator of the technique, found a 35 to 40% increase in diameter and weight of tendons injected with proliferative solutions compared to control tendons. He also did a study with 656 patients over 19 years. Twelve years after completion of their Prolotherapy treatment, 82% of the patients considered themselves cured.

In 1974, Dr. Gustav Hemwall published the results of his data collection on 2,007 Prolotherapy patients. Of these, 1,871 patients completed treatment, and 1,399 (75.5%) reported complete recovery.

In 1995, Dr. Harold Wilkinson, professor and former chairman of the Division of Neurosurgery at the University of Massachusetts Medical Center, presented the results of 349 Prolotherapy treatments for chronic low back pain. Most of the patients were "failed surgery" patients whom no one could help. One treatment totally relieved 29% of the patients, and a total of 76% had significant pain relief with only one treatment. He also studied other areas of the body and found that 43% of people had complete pain relief and 89% had partial pain relief with only one treatment. He stated "a sizable portion of people with unresolved chronic pain had more than a year's pain relief with only one Prolotherapy injection".


Q: Will my insurance company pay for Prolotherapy?

A: Insurance companies do not pay for Prolotherapy; however, many insurance plans will reimburse the cost of your initial evaluation and subsequent office visits with Dr. Neustadt.


Q: How much does Prolotherapy cost?

A: Compared to many treatments that are much less permanent and carry greater risk, it is very cost-effective. Prolotherapy treatments generally cost $175-325, depending on the area being treated and the number of injections required. However, the cost may be more if multiple areas need to be treated in one session (eg, both knees, lower and upper back, etc.). If PRP is being done, a nominal fee to draw and process the blood is added onto the cost of the injections. The total cost of a course of treatment may easily be less than the cost of an MRI scan and a series of X-Rays, not to mention surgery. Insurance companies, in general are slow to realize the tremendous gain in cost-effectiveness that Prolotherapy offers them. Many practitioners of Prolotherapy thus must charge their patients on a cash/fee-for-service basis.


Q: How can I learn more about Prolotherapy?

A: Dr. Neustadt would be happy to talk to you further about Prolotherapy. Additionally, there are many other excellent resources out there. A few on the internet are, (, the American Association of Orthopedic Medicine (, (, and ( Some books that might be helpful are, Prolo Your Pain Away by Ross A. Hauser, and Prolotherapy: Living Pain Free by Ross A. Hauser. These, and many other books on the subject can be found on the website. You may also click here to read summaries of research on Prolotherapy.