There are currently no treatment guidelines or protocol for prolotherapy. It is most commonly used for patients with back pain caused by chronic ligament and tendon sprains and strains. Some physicians do use prolotherapy as a first-line therapy.

It is important to note that approximately 90% of people with acute back pain get better with standard conservative (nonsurgical) treatments within 6 to 8 weeks and do not require additional treatment.

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Candidates for prolotherapy might include patients with back pain who:

  • Take medication on the recommendation of their physician (aspirin, ibuprofen, oral steroids) for ligament, tendon, or joint problems
  • Have ligament, tendon, or joint pain or weakness/instability lasting over 6 weeks
  • Get only temporary relief from manual or physical therapy
  • Have had surgery with no back pain relief
  • Experience joint pain that is worse with exercise and better with rest

Relative contraindications for prolotherapy include:

  • Unclear diagnosis of the location of the injury (sprains, strains, and weakened ligament do not show up on diagnostic imaging studies)
  • Lack of training by the selected physician on the solutions used and how to perform the prolotherapy injections
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