Prolotherapy is a type of regenerative medicine that uses injections that can help repair and rebuild weak and degenerating ligaments and joints, and ease chronic pain in connective tissue disorders such as Ehlers-Danlos syndrome (EDS). It is generally recommended when other treatments have failed.

EDS is a group of genetic disorders characterized by the abnormal synthesis of collagen, the most abundant type of extracellular matrix proteins. The symptoms of EDS include skin hyper-extensibility (extremely “stretchy” skin), joint hypermobility (joints have a large range of movement), tissue fragility (skin that is easily injured), chronic pain, and joint dislocations.

What is prolotherapy?

Prolotherapy is a safe and effective orthopedic procedure that involves injecting a solution containing dextrose (sugar), glycerin, lidocaine/procaine (phenolic compounds), or even growth factors or factors stimulating the production of growth factors in order to strengthen joints tendons, ligaments, or other tissues, and effectively eliminate pain.

The progress in tissue growth after prolotherapy is generally monitored with high-resolution ultrasound and MRI.

The benefits of prolotherapy can be long-lasting and the treatment can prevent the need for surgery to fix weakened or hypermobile and painful joints. It also can reduce the need for pain medications.

Types of prolotherapy

There are three types of prolotherapy. These are summarized below.

Growth factor injection prolotherapy

Growth factor injection prolotherapy consists of injecting a growth factor that supports the growth of specific types of cells such as the fibroblasts at the site of injection.

Growth factor stimulation prolotherapy

Growth factor stimulation prolotherapy consists of injecting solutions containing substances like low-concentration dextrose, which will induce cells to produce growth factors such as connective tissue growth factor (CTGF) and basic fibroblast growth factor (bFGF). These growth factors help with the growth and migration of various cell types, such as fibroblasts, to the site of the injection. These cells then secrete extracellular matrix proteins, including collagen, and strengthen the joints, ligaments, or other tissues, where the growth factor has been injected.

Inflammatory prolotherapy

Inflammatory prolotherapy consists of injecting solutions containing higher concentrations of dextrose, phenolic substances like lidocaine or procaine, and sodium morrhuate. These solutions cause low-grade inflammation at the site of injection that would induce migration of immune cells and fibroblasts to the site, thereby stimulating the buildup of connective tissue and restoring the joint.

Other details

The safety and effectiveness of prolotherapy have not been tested in clinical trials for the treatment of EDS patients specifically. However, several case studies have shown that the treatment is safe and effective in this group of patients.


Last updated: Jan. 7, 2020


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