Prolotherapy
Instead of silencing the tendon - encouraging it to heal
Chronic tendon and ligament pain has a frustrating logic: the tissue has entered a state of failed healing. It is no longer acutely inflamed - which is why anti-inflammatory pills and rest achieve little - but it never finished repairing itself either.
Prolotherapy approaches this from a different direction. Instead of suppressing the pain, it deliberately stimulates a mild, controlled healing response in the damaged tissue - giving the tendon or ligament a reason, and a chance, to complete its repair.
At Team Clinic 360° in Herzliya, prolotherapy is performed under ultrasound guidance, so the solution reaches precisely the damaged fibers - not just the general area.
What is prolotherapy?
Prolotherapy ("proliferation therapy") is a series of injections of a concentrated dextrose (sugar) solution into damaged tendon, ligament or joint-capsule tissue. The solution acts as a mild local irritant: it triggers a short, contained inflammatory response - the body's natural first step of healing - followed by a repair phase in which new collagen is laid down and the tissue gradually strengthens.
In simple terms: the injection restarts a healing process that got stuck.
When is prolotherapy considered?
- Chronic tendinopathy - tennis elbow, golfer's elbow, patellar and Achilles tendon pain
- Chronic ligament pain and mild instability - ankle, knee, sacroiliac region
- Joint pain related to early osteoarthritis, in selected cases
- Pain that improved with rest but returns with every attempt to load the tissue
- Patients who had short-term relief from corticosteroid injections - and are looking for a longer-term answer
Evidence for dextrose prolotherapy is strongest in chronic tendinopathies such as lateral epicondylitis, where controlled studies have shown improvements in pain and function. It is not the right tool for every problem - which is exactly why the evaluation comes first.
Prolotherapy vs. cortisone - the key difference
A corticosteroid suppresses inflammation. That brings quick relief, but in degenerative tendon problems - where there is little true inflammation to suppress - the relief is temporary, and repeated steroid exposure can actually weaken the tendon.
Prolotherapy does the opposite: it works with the healing process rather than against it. The trade-off is patience - improvement builds gradually over weeks, as real tissue changes take place.
What does treatment look like?
- Clinical examination and diagnostic ultrasound to confirm the target tissue
- Skin cleansing and local anesthesia
- Ultrasound-guided injection of the dextrose solution into the damaged fibers - usually minutes
- A short course of treatments, typically several sessions spaced a few weeks apart
- Graded loading in between - the mechanical stimulus that guides the new tissue to organize properly
Mild soreness for a day or two after each session is expected - it is part of the intended healing response. We generally avoid anti-inflammatory medications around treatment days, precisely so as not to cancel the effect.
Our approach at Team Clinic 360°
Prolotherapy works when three things are true: the diagnosis is right, the needle is in the right place, and the plan around the injections - load management and graded strengthening - is real.
That is how we practice it: performed by Dr. Lior Shem Tov, specialist in anesthesiology and pain medicine, under ultrasound guidance, within a plan coordinated by Dr. Natalie Siegel - often alongside dry needling or physical therapy.
A tendon that never healed can still be given the chance
If your tendon pain has lasted months, returns with every load, and cortisone only bought you time - prolotherapy may be the mechanism-based next step.
To schedule an evaluation for prolotherapy - contact us by phone or WhatsApp.
Frequently asked questions
What is actually injected?
Most commonly a concentrated dextrose (sugar) solution with a local anesthetic - no steroids and no foreign substances. The dextrose acts as a mild, controlled stimulus for tissue repair.
How many treatments will I need?
A typical course is several sessions spaced a few weeks apart, tailored to the tissue and your response. Improvement usually builds gradually across the course rather than overnight.
Does it hurt?
The skin is numbed, and the injection itself is brief. Expect local soreness for a day or two afterwards - a sign the intended healing response has begun.
How is prolotherapy different from PRP?
Both aim to stimulate repair. PRP uses concentrated platelets from your own blood; prolotherapy uses a dextrose solution. They differ in cost and preparation, and the right choice depends on the tissue and the evidence for your specific problem - something we discuss openly at the evaluation.
Can I keep training during a course of prolotherapy?
Yes - in a managed way. Graded loading between sessions is actually part of the treatment. What we avoid is the boom-and-bust pattern of overloading the tendon and then resting completely.
Is prolotherapy safe?
Performed under ultrasound guidance by an experienced physician, it is considered a low-risk procedure. The main expected effect is temporary post-injection soreness.
Medical sources for further reading
The information on this page is intended as general background and does not replace personal medical advice.
The information on this page is general in nature and does not replace a personal medical diagnosis, consultation or treatment. Any treatment is tailored only after a medical evaluation, at the physician's discretion.