"In chronic nonspecific low-back pain, significant and sustained reductions in pain and disability occur with ligament injections, irrespective of the solution injected or the concurrent use of exercises," write author Michael J. Yelland, FRACGP, FAFMM, from the University of Queensland in Brisbane, Australia, and colleagues.

Prolotherapy describes a procedure for strengthening lax ligaments by injecting proliferating agents/sclerosing solutions directly into torn or stretched ligaments or into a joint or adjacent structures to create scar tissue in an effort to stabilize a joint. Agents used with prolotherapy have included zinc sulfate, psyllium seed oil, potassium hydroxide, combinations of dextrose, glycerine and phenol, or dextrose alone. "Proliferatives" act to promote tissue repair or growth by prompting release of growth factors, such as cytokines, or increasing the effectiveness of existing circulating growth factors.

Prolotherapy may involve a single injection or a series of injections, often diluted with a local anesthetic. Prolotherapy is also known as “regenerative injection therapy (RIT)”, “non-surgical tendon, ligament and joint reconstruction”, or “growth factor stimulation injection therapy.”

There is conflicting evidence regarding the efficacy of prolotherapy injections for patients with chronic low-back pain. When used alone, prolotherapy is not an effective treatment for chronic low-back pain. When combined with spinal manipulation, exercise, and other co-interventions, prolotherapy may improve chronic low-back pain and disability.