article image

Prolotherapy and Prolozone Can Improve Ligaments and Tendons

Pain is a universal experience shared by humans and animals alike. As we age, our bodies are prone to degeneration and damage from acute or repetitive traumas. We are all familiar with the term arthritis, which refers to degeneration of the joints, starting in the cartilage. But what about the ligaments and tendons surrounding and stabilizing the joints? Tendinitis, an acute injury with inflammation in a tendon or ligament, and tendinosis, a chronic condition of connective tissue that hasn’t healed, are common causes of pain and laxity in joints. These poorly healing injuries are not as well recognized by the medical profession and can be challenging to treat. If you’ve ever had tennis elbow, plantar fasciitis, cruciate ligament tears, or a sprained ankle, you know how painful these conditions are and how slow they can be to heal.


Prolotherapy, or proliferative therapy, is a way of strengthening and healing loose connective tissue structures.

Ligaments and tendons do not have a good blood supply, and when they are damaged, they can be stuck in a nonhealing, stretched, or lax state (tendinosis), making the tissue prone to further injury and slow to heal on its own.

Prolotherapy uses a solution that is injected into the tendons and ligaments where they attach to bone (the tendino-osseous junction) and causes inflammation that kick-starts the healing process. 

This low-grade inflammation activates fibroblasts in the area, releases growth factors, and results in the synthesis of precursors to mature collagen, reinforcing the connective tissue. 

Prolotherapy solutions can vary, but most veterinarians use a mixture of 50 percdnt dextrose, Vitamin B12, and either lidocaine or procaine local anesthetic. 

The poor circulation in the tendons and ligaments also decreases with age, and edema and inflammation from trauma/injury cause decreased oxygen utilization in these tissues, inhibiting healing and leading to further degradation of the structures. 

Injury also causes lactic acid production leading to a build up of free-radicals, necrotic (dying) tissue, and contributes to chronic pain. 


While prolotherapy alone can do wonders to help heal the tendons and ligaments, enriching the oxygen environment in these tissues can speed healing and relieve pain better. 

This is where ozone therapy comes in. Ozone (O3) can be generated in a medical setting and administered in a variety of ways to patients with the result of super-oxygenating tissues. When ozone gas is injected into areas that have received prolotherapy solution, there is stimulation of oxygen utilization that enhances cellular functions and speeds up healing and repair of tissues. This combination of prolotherapy with ozone has been dubbed prolozone.

The gas injected into prolotherapy sites expands through the tissues, dissecting along tissue planes and spreading the healing effect over a larger area. 


What kind of injuries or conditions might benefit from Prolotherapy and Prolozone? Most acute or chronic ligamentous injuries including damaged anterior cruciate ligaments, luxating patellas, hip dysplasia, and spinal or joint instabilities. 

In order to minimize stress and maximize comfort, the treatments are generally done with the animal companion sedated and take five to 10 minutes to administer. In some cases with a very cooperative patient, or if there is a health issue precluding sedation, the treatments can be done while the animal is fully awake. Patients may be more sore for a couple days after the treatment (the inflammatory phase), though often feel better right away and through the next few weeks as the treated tissue moves into the healing phase. The area is treated monthly until the desired comfort and stability is achieved, usually anywhere from two to six treatments. 

Not all tendon and ligament injuries are amenable to these types of treatments, but they are certainly worth investigating as an alternative to surgery or chronic pain medications. 

Not only have I seen great results in my veterinary patients, I’ve experienced successful prolotherapy treatments on my own knees. I am happy to have found this healing modality that works in people and animal companions, alike. 

Dr. Kirsten Williams offers prolotherapy and prolozone through Creature Comfort Holistic Veterinary Center in Oakland. An Oakland native who grew up in the Bay Area, she has a veterinary medicine degree from UC Davis. She is certified in veterinary acupuncture, has studied Chinese herbal therapy, and underwent additional training in prolotherapy for pets. She lives in Oakland with her husband, two children, a dog, and a snake. She also practices Aikido several times a week.

Are you a San Francisco Bay Area veterinarian who would like to write an article for the Ask Dr. Dog column, which is authored by guest veterinarians practicing in the Bay Area? Bay Woof is accepting submissions. Send email to

Main article photo by: X-Ray Gvolk-CC