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Treatment for Chronic and Acute Soft Tissue Injuries: Prolotherapy and PRP

Dr David Hatton Prolotherapy

Prolotherapy is a treatment that has quickly become a primary option for pain management of chronic conditions such as arthritis, degenerative joint disease and ligament laxity. It is also being used to treat acute injuries to speed healing and reduce the occurrence of future onset arthritis. But what is prolotherapy and would it be a beneficial treatment for you?

There are scenarios when prolotherapy would not be the best treatment option and other avenues need to be explored. For most soft tissue injuries, prolotherapy will be beneficial but if there is a bone spur that is continuously causing damage, the benefits of prolotherapy will be offset. This is when the bone spur needs to be broken down with other methods such as Shockwave therapy before prolotherapy injections, to help repair the scarred and damaged tissue.


Prolotherapy is a regenerative injection treatment that is used to treat injured muscles, tendons, ligaments, and joints. When the solution is injected into the area of injury, a local healing response is triggered which results in the regeneration of the tissue. This regeneration occurs through fibroblast, growth hormone and nutrients being drawn to the area to start collagen production and the rebuilding of the damaged tissue, which is critical for long term support and benefit.

The most common solution used in prolotherapy in a mixture of dextrose, local anaesthetic, and vitamin b12. Other agents can be added to increase the benefit of the injections such as HGH (human growth hormone), if the injecting doctor believes it will be of added benefit.

Another type of injection that can be done is termed PRP (platelet rich plasma) injections. It acts in the same fashion as prolotherapy, but works at an accelerated rate due the high concentration of platelets. These platelets help to ramp up healing because they are an essential part to the healing cascade. When they are re-injected in a high concentration, they cause proliferation (rapid growth) of the damaged tissue, angiogenesis, and increased cellular migration.

What's the difference between prolotherapy and a Cortisone Shot?

If you are not in the medical field, these two injections would seem incredibly similar, but in reality they are incredibly different in their action. Cortisone injections act by relieving pain and inflammation in a specific area but they don't help in healing or regeneration. It is an injection that is made up of a corticosteroid medication and an anaesthetic, which for the most part, does a good job at reducing pain. It does not help to rebuild tissue but does come with a potential side effects of deterioration to the cartilage and tendons at the injection site. This is why there is often a limit to the number of injections that can be performed on any specific area in a year.

Prolotherapy injections are geared towards rebuilding tissue. They do help to manage and reduce pain but the main goal is long term healing and rebuilding. Instead of reducing inflammation, prolotherapy injections actually increase inflammation in the area which is how it causes the area to undergo the healing cycle.

How Many Injections Are Needed?

The exact number of injections will vary between each case depending on the area, severity of degeneration and the amount of stress put on the area during the healing process. For most, expect between two to six injections. These injections are spaced two to three weeks apart to gain optimal benefit. Many patients may need "booster shots" every so often after their treatment at less frequent intervals with the ultimate goal of not needing any further injections.

What To Expect After the Treatment

Immediately after the injections, the area is going to feel great. That is the local anaesthetic doing its job and allowing the injector to confirm they are in the correct area. This tends to wear off within four hours. This is where it tends to vary for each treatment. Expect the area the be tender for a couple of days post treatment. It will also feel full and stiff due to the volume of solution that is injected. Over the course of a week, most symptoms go away and the area begins to feel better, pain is reduced, and mobility is increased. These will continue to increase over the course of the treatment.

As always, this information is not intended to diagnose or provide any treatment plan, but is meant to educate and provide an insight into how prolotherapy works and why it has become a first line treatment for soft tissue injuries. If you have any questions, contact Dr. David at Helix Integrative Health either in person or send an email to drhatton@helixih.ca

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