Dextrose Prolotherapy

What is Dextrose Prolotherapy?

Proliferate + Therapy = Prolotherapy. Prolotherapy is an injection therapy recommended for healing dysfunctional tendons/ligaments and reducing joint pain and damage caused by osteoarthritis. Joints, ligaments, and tendons don’t have a good blood supply, so they need help to heal and proliferate (grow stronger).

Dextrose is a sugar that, when injected in/around dysfunctional tissues, acts to signal the attention of your body’s immune system to heal and strengthen the area.


Modern prolotherapy was developed in the 1920s and has been shown in studies to strengthen the areas of your body that need more support without surgery. This style of treatment triggers your body’s natural healing response and is as old as medicine itself, dating back to ancient Egypt. This low-invasion treatment causes your body to make tendons and ligaments get thicker and tighter, and some studies show cartilage in mild to moderate osteoarthritis growing thicker, providing a better gliding surface. OA pain is reduced in most cases.

Sometimes pain levels increase during the first few days after prolotherapy. This is normal and preferable to better outcomes. Triggering the immune response in the tissues is what gives rise to healing. These irritated tissues will heal and hurt much less in the long run. The doctor will prepare you on what to expect with your individualized treatment.

What can be successfully treated with Dextrose Prolotherapy?

Areas: Knee, shoulder, hip, ankle, elbow, wrist, hand, sacroiliac joint, and some low back connective tissues, muscle-tendon junctions, some nerves in limbs, skull, and low back.

Conditions: Osteoarthritis, partial tendon tears, rotator cuff problems, ligament laxity, Ehlers-Danlos and other hypermobility syndromes, some types of chronic low back pain, and sacroiliitis, trigger points (knots), tennis elbow, golfer’s elbow, certain types of headaches including tension and occipital neuralgia.

Exclusions: These must be managed/controlled before embarking on treatment: diabetes, autoimmune conditions, rheumatism, severe/traumatic injuries, poor wound healing from any other condition, thrombocytopenia (low platelets), leukemia, or other active cancers. Joint replacements cannot be injected directly, but areas around them can. Severe osteoarthritis may not respond to prolotherapy at all. The doctor will determine your eligibility individually during evaluation.

Alterations: Important factors that can alter but won't eliminate treatment: allergies to anesthetics, allergies to iodine or chlorhexidine, allergies to dexamethasone (minuscule amount, only in a single diagnostic injection).

How is Dextrose Prolotherapy done in the clinic?

The doctor will diagnose the problem first or confirm diagnoses from other providers with their included documentation/imaging.

Imaging will be ordered and reviewed as needed, usually an ultrasound exam in the office and/or x-rays. Sometimes MRI is necessary.

The Prolotherapy treatment path looks a bit like this, but your individual plan may differ. Underlined words indicate insurance billing as appropriate:

Appt 1 (40 min): Initial evaluation to diagnose clinically using history, physical exam, and any imaging. Basic dietary, movement, and supplement plans will be given to aid in healing systemically.

Appt 2 (30 min): Diagnostic injection of anesthetic to verify pain generator, often done with ultrasound guidance. You will keep a pain diary during this time to support diagnostic value.

 Appt 3 (20 min): Follow up in 1-2 weeks to confirm treatment target. Plan Dextrose Prolotherapy injection series. It can be virtual or in person.

Appt 4 (30 min): 1st Dextrose Prolotherapy treatment. Begin physical therapy for 6 weeks. Recommend working with Dr. Max on mobilization, home exercises, and Graston/Guasha to stimulate tissue rebuilding.

Appt 5 (20 min): Follow up at 2 weeks after the first Dextrose Prolotherapy treatment. It can be virtual or in person.

Appt 6 through last injection appt (30 min): Remaining Dextrose Prolotherapy injections, spaced 4 to 6 weeks apart from each other. Anywhere from 3 to 8 injections are needed depending on severity.

Program follow-up (30 min): Scheduled 6 months after first Dextrose Prolotherapy injection. Go over any future maintenance plans and check in to make sure the program was satisfactory and troubleshoot as needed. It can be virtual or in person.

How much does Dextrose Prolotherapy cost? Can I use my insurance?

The evaluation, diagnostic injection, and follow-ups are all billable to most insurances, based on the provider’s credentialing. These may also be cash-pay as needed by un/underinsured patients. Ultrasound evaluation is a separate significant e/m code and thus a distinct cash charge. Pricing for work done with other providers is based on their credentialing/rates. PA is suggested for diagnostic injection codes.

The prolotherapy treatment series itself is always cash.

Single area injection: $200.00

Add-ons we may want to incorporate:


SP: Ligaplex I: $90.00 - 90 count.

sig: 2 caps 3x/day through program duration to support healing/strengthening

Mt. Peak: MSK Injury Formula: $51.12

x2 bottles of #90

sig: 2 caps 1-2 times per day through program duration

Verdant Leaf CBD topical: $40.00

sig: massage into joints/muscles daily (unbroken skin only), not to be used less than 48 hours after injections