Proliferative Injections

"An injection with dextrose, which acts as an irritant, and lidocaine, an anesthetic, can strengthen ligaments. This is called a proliferative injection. By increasing blood supply, it brings nutrients to the injured ligament and new connective tissue is formed."                                                                                                                                                                                                                                                                                                                                                                          Dr. Irène Minkowsky

Proliferative Injections

What are Proliferative Injections?

Ligaments hold bones and joints together. Tendons attach muscles to bone, near joints.

When ligaments are injured from trauma, improper exercise or poor posture, they become overstretched, lax, inflamed and even torn.

Bones may become misaligned which stretch the ligaments even more.

These ligaments have nerve endings and we feel pain.

An adequate exercise program and manipulation aim at bone alignment; however, if the ligament remains stretched, the correction is only temporary and misalignment can reoccur.

A proliferative injection with dextrose which acts as an irritant and lidocaine, an anesthetic, can strengthen ligaments. This creates an increased blood supply and nutrients to the injured ligament and new connective tissue is formed from fibroblasts.

Several strengthening injections are required, a week or two apart. The total number of injections depends on the area of injury.


  • Shoulder, 2-4
  • Tendinitis of the elbow 2-4
  • Cervical strain 4-6
  • Lumbosacral, iliolumbar, sacroiliac strain 6-8
  • Sacrotuberous, sacrospinous ligaments 4-6
  • Piriformis 4-6
  • Foot, hand 4


Manipulation pre injection is helpful to restore proper alignment. There is no sedation needed. Use of a local skin analgesic spray numbs the area.

Daily home exercises are taught. Touch up injections may be required for residual pain spots.
Ice and anti inflammatories should be avoided during the injection series. Tylenol ( acetaminophen) and heat can be used instead.

How the solution works:

The solution induces an inflammatory response. This mimics an early injury repair sequence.

Polypeptide fibroblast growth factor stimulates a proliferative response and acceleration of wound repair. An inflammatory exudate occurs at 24 – 48 hours. Proliferation of fibroblasts occurs at 3-7 days. New collagen dense fibrous tissue occurs at 8 weeks. It was observed that ligament or tendon mass increases through fibroblast hyperplasia and an increase in collagen fiber diameter.

It is as if a good scar is formed. The strengthening process continues 4-6 months, even 12 months, after the injections are completed.

To encourage normal pliability of the fresh scar and for proper proliferation of the new collagen in a parallel direction, specific stretching exercises are important. Walking which varies ligament stress is necessary during injections. If ligaments heal in a shortened position, they are susceptible to reinjury.

In the spine, passive elastic tissues, namely lumbosacral fascia, apophyseal joint capsule, posterior longitudinal ligament and the annulus fibrosus of the disc provide static posterior support and contain, as we know, nerve endings which produce back pain from abnormal mechanical stress. Sacroiliac ligaments are powerful. However, if injured they cannot absorb the forces of the long lever of the spine in stressful bending or torsion movements.

When fascial and ligament support tissues function normally, the intervertebral disc is less exposed to external forces. Facet contact contributes to stabilization during flexion motion via interspinous ligaments. If they are overstretched, or infiltrated with fat, there is a problem.

The goal of the procedure in the spine is to normalize biomechanics of a segment of the supporting connective tissue at the intraligamentous, fascial and facet capsule level.1234

1Klein, R.G., et al. A randomized, double blind trial of dextrose-glycerine-phenol injections for chronic low back pain. Journal of Spinal Disorders, 1993; 6: 23- 33.

2DeLong, W.B., Klein, R.G. Ligamentous injections for low back pain. Surgical Rounds for Orthopedics, 1989.

3Hackett GS. Ligament and tendon relaxation treated by prolotherapy. 3rd ed. Springfield, Charles C. Thomas. 1958.

4Kenneth D. Reeves, Hypertonic dextrose injection (prolotherapy) in the treatment of symptomatic knee osteoarthritis: a systematic review and meta-analysis. Sci Rep April 07: 7: 45879 2017.

Schedule Your Consultation Today

(415) 776-4644

Don’t let chronic pain and musculoskeletal injuries affect your quality of life. Schedule a consultation at the Physicians' Back Institute today. Drs. Irène and Robert Minkowsky have healed thousands of patients. Dr. Irène Minkowsky has been using proliferative injections as part of her treatment for over 30 years. Let the doctors at the Physicians’ Back Institute find a way to treat your problem and get you back to your physical and active lifestyle. We are proud to serve the San Francisco Bay Area.