Prolotherapy

Prolotherapy is a time-tested regenerative treatment that stimulates your body’s natural healing response in ligaments and tendons. Using carefully formulated dextrose-based solutions, prolotherapy creates a controlled healing stimulus that may help strengthen lax ligaments and improve joint stability.

At Palm Beach Regenerative, Dr. Ghattas often combines prolotherapy with advanced interventional orthobiologics for comprehensive care of joint instability and chronic ligament conditions.

The term “prolotherapy” comes from “proliferant therapy” – stimulating the proliferation of cells involved in tissue repair.

1. Preparation
   Dextrose-based solution (typically 12.5-25% dextrose) is prepared. Local anesthetic may be mixed with the solution for comfort.
2. Precision Injection
   Using palpation or ultrasound guidance, Dr. Ghattas injects the solution into weakened ligaments, tendons, or around joints. This solution creates a mild, controlled inflammatory response that:
   • Stimulates your body’s healing cascade
   • Promotes collagen production by fibroblasts
   • Strengthens tissue with new structural proteins
   • Improves joint stability through tighter ligaments
3. Series Approach
   Unlike cortisone (which suppresses inflammation), prolotherapy intentionally creates inflammation to jumpstart healing. Typically requires multiple treatments spaced 2-4 weeks apart for optimal results.

Joint Instability:

• Sacroiliac joint instability
• Chronic ankle sprains/laxity
• Knee instability from ligament laxity
• Shoulder instability
• Finger/thumb joint laxity

Ligament Conditions:

• Partial ligament tears
• Chronic ligament sprains
• Ligament laxity from overuse
• Post-injury ligament weakness

Tendon/Insertion Issues:

• Chronic tendinopathy
• Tennis/golfer’s elbow
• Plantar fasciitis
• Achilles tendinopathy

Chronic Pain Conditions:

• Sacroiliac joint dysfunction
• Chronic low back pain from ligament laxity
• Chronic neck pain from whiplash
• Headaches from cervical instability

Mechanism of Action:
Unlike orthobiologics (which deliver cells or growth factors), prolotherapy works by creating controlled inflammation that stimulates your body’s own repair mechanisms.

Cost-Effective:
Prolotherapy is generally less expensive than advanced interventional orthobiologics, making it accessible for conditions that may respond to this approach.

Series Approach:
Typically requires multiple treatments (4-8 sessions) spaced 2-4 weeks apart for optimal results. Progressive improvement builds over the series.

Combination Potential:
Often combined with orthobiologics:

• Prolotherapy for ligament tightening
• PRP/BMC for cartilage or tendon support
• Comprehensive approach for complex conditions

Pre-Procedure:

• Evaluation of joint instability or ligament laxity
• Physical examination to identify specific structures
• Discussion of treatment series and timeline

Treatment (30-45 minutes):

• Treatment area cleansed
• Multiple small injections to ligament and tendon attachments
• May use ultrasound guidance for specific structures
• Local anesthetic may be mixed with prolotherapy solution

Total Time: Approximately 1 hour per session

Immediate (Day 0-3):

• Post-treatment soreness is expected and part of healing
• Mild swelling at injection sites
• Ice and rest as directed
• Avoid anti-inflammatory medications (they suppress desired response)

Between Treatments (Week 2-4):

• Soreness resolves
• Gradual strengthening of treated structures
• Continue normal activities as tolerated
• Next treatment scheduled

Treatment Series (2-6 months):

• Typically 4-8 treatments total
• Spaced 2-4 weeks apart
• Progressive improvement over series
• Final assessment 6-8 weeks after last treatment

Long-Term:

• Maintained improvement in many cases
• Lifestyle modifications may be needed
• Occasional maintenance treatments for some patients

Many patients with ligament laxity or joint instability report:

• Improved joint stability
• Reduced pain from instability
• Enhanced function and confidence in joint
• Decreased frequency of “giving way” episodes

Important Factors:

• Severity of instability
• Chronicity of condition
• Number of treatments completed
• Adherence to rehabilitation
• Underlying joint health

Realistic Expectations:

• Prolotherapy supports healing but cannot reverse advanced arthritis
• Some conditions require surgical stabilization
• Results build progressively over treatment series
• Not all patients achieve complete symptom resolution

May be appropriate when:

• You have joint instability or ligament laxity
• Conservative care (bracing, therapy) hasn’t provided lasting improvement
• You have chronic tendon or ligament conditions
• You want to strengthen supporting structures around joints
• Cost is a factor and you have condition that may respond

May be combined with:

• Interventional orthobiologics (PRP, BMC) for comprehensive approach
• Physical therapy for strengthening
• Corrective exercises and ergonomic modifications

May NOT be best choice when:

• You have complete ligament rupture (may require surgical repair)
• You have severe arthritis as primary problem
• You cannot commit to treatment series
• You need immediate pain relief

• Evidence-based protocols
• Can be enhanced with ultrasound guidance
• Often combined with orthobiologics for comprehensive care
• Fellowship-trained physician
• Part of complete treatment approach
• Systematic outcome tracking

Most insurance plans do not cover prolotherapy. We provide:

• Affordable option compared to advanced biologics
• Transparent pricing
• Superbills for possible reimbursement
• HSA/FSA eligible
• Treatment series pricing available