Regenerative injection therapy · London
Prolotherapy - London.
A series of hypertonic dextrose injections for chronic ligament, tendon and joint pain. The evidence is mixed but honest, the cost is modest, and it is a reasonable step once conservative care has run its course.
What prolotherapy is
A short, targeted injection meant to nudge tissue to remodel.
Prolotherapy is a regenerative injection therapy. A hypertonic dextrose solution, typically 12.5% to 25%, is injected into painful ligaments, tendon insertions or joints. The proposed mechanism is a brief, controlled inflammatory stimulus that promotes local healing and collagen remodelling.
It is delivered as a series, usually three to six sessions two to six weeks apart. It uses only sugar and water, no blood or tissue harvest, which makes it the simplest and cheapest of the injection therapies. It is not a cure. It is a reasonable trial once conservative treatment has failed.
When it is offered
Indications with the strongest case.
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Chronic ligament laxity or instability
Recurrent joint instability where ligaments have failed to tighten after injury, physio and time.
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Tendinopathy failing conservative care
Achilles, patellar, common extensor and gluteal tendinopathies still symptomatic after loading programmes.
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Mild to moderate knee osteoarthritis
Kellgren-Lawrence grade 2-3 knees with pain out of keeping with imaging, where injection therapy is being considered.
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Sacroiliac joint dysfunction
Chronic SIJ pain confirmed on examination or diagnostic block, particularly with a laxity pattern.
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Chronic non-specific low back pain
Longstanding axial back pain where facet or ligamentous pain generators are suspected.
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Plantar fasciitis
Persistent heel pain unresponsive to stretching, orthoses and prior injection therapy.
The evidence, honestly
A modest effect where it works, and no promises.
Cochrane and other systematic reviews of prolotherapy are mixed. There is a modest effect for chronic low back pain and for knee osteoarthritis, with several positive randomised trials in tendinopathies. The trials are small and heterogenous, and blinding is difficult.
NICE does not routinely recommend prolotherapy, and it is not offered on the NHS for most indications. A fair use of the treatment is as a trial after conservative care has failed, with the intent to reassess after two or three sessions and to stop if nothing has changed.
The procedure
A short day-case injection, repeated in a planned series.
A typical course is three to six sessions at two to six week intervals. Injections are placed under palpation for superficial structures or under ultrasound guidance for deeper joints and tendons. The clinician cleans the site, infiltrates a small amount of local anaesthetic, then injects the dextrose solution at one or several points into the target tissue. Each session takes twenty to thirty minutes. Patients go home the same day and return to normal activity within one to two days once the injection-site soreness has settled.
Indicative pricing
What private prolotherapy costs in London.
| Service | Indicative range | Duration | Recovery |
|---|---|---|---|
| Prolotherapy - single session | £250-£450 | 20-30 min | Same day home |
| Typical course of 3-6 sessions | £850-£2,400 | 20-30 min ea | 2-6 week intervals |
| Ultrasound-guided prolotherapy | £350-£550 | 30-40 min | Same day home |
| Consultation only | £180-£350 | 30-45 min | Same visit |
Prices vary by clinic, by whether the session is ultrasound-guided, and by the number of sites injected. A course of three to six sessions typically lands between £850 and £2,400.
Where it is offered in London
A small set of pain and MSK clinics do most of the volume.
Named London providers include the London Pain Clinic, the Regenerative Clinic in Marylebone, HCA Wellington Pain Service and the London Sports Injury Clinic. It is also offered by BIMM-registered musculoskeletal physicians and by a smaller group of MSK physiotherapists trained in injection therapy. We match you to a clinician who does the specific joint or tendon in question at reasonable volume.
Safety and recovery
A low-risk injection with a predictable ache afterwards.
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Well tolerated overall
Dextrose is a simple sugar solution. There are no significant systemic effects and no steroid-related tissue thinning.
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Transient injection-site pain
A predictable ache or stiffness at the injected site for 24-48 hours is expected, and is thought to reflect the intended inflammatory response.
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Rare infection
As with any injection, deep infection is possible but rare when done under aseptic technique. Red, hot, spreading pain or fever needs same-day review.
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Bruising and small bleeding
Small bruises at the needle site are common and settle within a week.
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No guarantee of benefit
A meaningful proportion of patients report no useful improvement. A fair plan is to reassess after two or three sessions and stop if there is no signal.
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Not for acute red flags
New neurological loss, unexplained weight loss, night pain or fever needs a diagnosis first, not an injection.
Compared with PRP, BMAC and Lipogems
The cheapest of the orthobiologic options, and the least effective in head-to-head trials.
Prolotherapy is the simplest and lowest-cost injection option. Direct comparisons with platelet-rich plasma tend to favour PRP for tendon and knee OA endpoints. BMAC and Lipogems offer a stronger biological rationale for cartilage-related pain. Prolotherapy remains a fair first step, particularly for patients who cannot justify the cost of biologic therapies, or as a bridge while a longer plan is considered. Related pages: BMAC, Lipogems, PRF, ultrasound-guided knee HA, back pain injections, arthritis, back pain.
FAQs
The questions patients ask before booking.
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What is prolotherapy and how is it meant to work?
Prolotherapy is a regenerative injection therapy in which a hypertonic dextrose solution, typically 12.5% to 25%, is injected into painful ligaments, tendon insertions or joints. The theoretical mechanism is a brief, controlled inflammatory stimulus that recruits healing cells and encourages collagen remodelling. The evidence for this mechanism in humans is limited, and the clinical effect is thought to depend on both the injectate and the precise placement.
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How strong is the evidence for prolotherapy?
Honestly, mixed. Cochrane and other systematic reviews show a modest effect for chronic low back pain and for knee osteoarthritis. Small randomised trials in lateral epicondylitis, Achilles and plantar fasciitis are positive but heterogenous. NICE does not routinely recommend prolotherapy, and it is not offered on the NHS for most indications. It is reasonable as an option after conservative treatment has failed, provided expectations are set carefully.
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How many sessions will I need and how often?
A typical course is three to six sessions, spaced two to six weeks apart. Some clinicians reassess after two or three and stop if there is no benefit. A minority of patients have longer courses or occasional maintenance injections. If nothing has changed after three well-placed sessions, further injections are unlikely to help.
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What does a prolotherapy session actually involve?
The site is cleaned, a small amount of local anaesthetic is placed, and the dextrose solution is injected at one or several points into the target ligament, tendon or joint. It can be done under palpation or, for deeper structures, under ultrasound guidance. Most sessions take twenty to thirty minutes. You are sore for a day or two, then return to normal activity.
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How much does private prolotherapy cost in London?
Indicative ranges are £250 to £450 per session, and £850 to £2,400 for a typical course of three to six. Ultrasound-guided sessions sit at the upper end. Consultation is usually charged separately at £180 to £350. Prolotherapy is the least expensive of the orthobiologic injection options, which is part of its appeal.
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How does prolotherapy compare with PRP, BMAC and Lipogems?
Prolotherapy is the cheapest and simplest of the injection options and uses no blood or fat harvest. In head-to-head trials, PRP tends to outperform dextrose prolotherapy for tendon and knee indications, and BMAC and Lipogems have more biological rationale for cartilage-related pain. Prolotherapy remains a reasonable first step where cost is a factor or where biologic options are not available.
Speak to us
Tell us about the pain, and we will tell you whether prolotherapy is a fair next step.
A short, confidential enquiry. We reply within one working day with a shortlist of clinicians, indicative fees and an honest read on whether prolotherapy or another injection therapy is the better use of your time and money.