PT on the Net Research

Prolotherapy and Exercise


What do you know about Prolotherapy, primarily for chronic back pain. How to train during the months of prolotherapy? I have read conflicting information on exercise during the months of prolotherapy treatments.


First of all let's identify what Prolotherapy is. Prolothereapy (which is short for Proliferation therapy), is a procedure that consists of a series of 1 to 10 (or more) injections of a simple substance, quite often times dextrose (sugar water), into the dysfunctional/pain causing joint. The purpose of this injection is to cause inflammation, thereby encouraging the healing process to take place. This is why it is deemed "Proliferation" therapy because it "proliferates" (causes growth) new tissue. Research has shown Prolothereapy to be useful for spinal and joint injuries, carpal tunnel syndrome, fibromyalgia, and even TMJ. Recovery times have varied from person to person, injury to injury; taking a little as a few days to several months.

As far as exercising during Prolotherapy sessions, the only professional who can ethically make that decision is the client's physician who is overseeing the treatments. However, if the "green" light has been given for exercise to begin, here are a few common sense ideas things to keep in mind:

  1. Remember, the treatment itself is MEANT TO CAUSE PAIN AND INFLAMMATION! Pain and inflammation causes muscle tightness which goes hand in hand with muscle inhibition. This may make certain forms of exercise completely inappropriate from a kinetic standpoint until the treatments have concluded!
  2. Know the exact location and severity of the injury (by staying in close contact with your client's physician). This will help you determine what exercises may be contraindicated.
  3. The physician can also determine the speed at which the client seems to be healing. There seem to be no absolutes to the speed of recovery from person to person. Interestingly, research has show that some Prolothereapy patients experience the absence of pain following only 1 treatment, yet it has been determined that this is now where near enough time for actual "proliferation" to even take place! I.E. the pain is gone, yet the weakness remains, suggesting an obvious red flag to the fitness professional!
  4. Be sure to take into account the following: Your clients current level of health, dedication to their fitness goals, perceived exertion, and pain threshold.

In conclusion, the professional and ethical constant remains the same: Follow the supervising physicians orders. Once exercise clearance is granted (whether it be during or after treatment), take a common sense approach as with any chronic conditions, adhering to the principals of biomechanics, and the kinetic chain. I highly recommend following the systematic approach outlined within the NASM's programs. For a complete understanding of this, take time to read Mike Clark¹s article series titled "Essentials of Integrated Training".

Here are a couple of physicians whom currently practice Prolotherapy you may want to contact for more specific info:

Thank you for your concern and interest!