Quick answer
Dextrose prolotherapy is an injection approach sometimes used for persistent tendinopathy. A small randomised trial in mid-portion Achilles tendinosis found faster symptom improvement when prolotherapy was combined with eccentric loading, but long-term scores were similar and the evidence base remains limited.
Article
What prolotherapy involves
Prolotherapy commonly uses hypertonic dextrose injected around selected painful or abnormal tendon regions. Ultrasound guidance can help localise anatomy and avoid relying on surface landmarks alone.
What the Achilles evidence shows
The best-known Achilles randomised trial included only 43 participants. Combined eccentric loading plus prolotherapy improved symptoms more rapidly than exercise alone at some time points, but long-term VISA-A outcomes were similar. This is a signal of possible benefit, not definitive proof.
Why rehabilitation still matters
Even when an injection is selected, the tendon still needs graded mechanical loading. Prolotherapy may therefore be framed as a possible adjunct for selected persistent cases after diagnosis and rehabilitation have been reviewed, rather than as a stand-alone “regenerative cure”.
Key points
- Evidence is much smaller than for exercise-based rehabilitation.
- Avoid claiming that dextrose has been proven to regenerate the human Achilles tendon.
- Ultrasound guidance improves anatomical targeting but does not itself prove treatment efficacy.
Frequently Asked Questions
Is prolotherapy proven to heal Achilles tendinopathy?
No. Limited studies suggest possible symptom benefit, but the evidence is not strong enough to promise tendon regeneration or cure.
Should I stop rehabilitation after an injection?
Usually no. Loading progression remains central, although the immediate post-procedure plan should be individualised.