By Dr. Zack Allen, ND

Dr. Zack Allen, ND

Joint pain is a common occurrence, and our active Kaua‘i community of surfers, dancers, hikers, gym rats, gardeners, landscapers and weekend warriors is certainly no exception. As we age, even those of us that aren’t avid sports enthusiasts will often encounter the painful effects of osteoarthritis caused by motor vehicle accidents, job related injuries, active hobbies and mishaps that occur while playing with and caring for our lively, at times wild Kaua‘i keiki.

What Causes Joint Pain?

Joints receive a poor blood supply, which limits the delivery of oxygen, glucose and other nutrients to ligaments, tendons and cartilage. Aging decreases both circulation and oxygen utilization. When trauma occurs, swelling and inflammation further compromise circulation to the joint. These factors slow down healing time as ligaments and other joint structures become weak and painful.

Why Are Ligaments Important? 

Ligaments connect and surround all our joints. They hold the bones together and protect the joint by limiting its range of movement. They also have a large number of nerve endings so that if they are stretched, pain may result. Over time, ligaments lose elasticity as they overstretch, due to the effort of holding our bodies in upright posture, along with the effects of daily wear and tear and occasional trauma.

What is Prolotherapy?

Prolotherapy, or proliferative therapy, is the injection of a solution, commonly procaine/dextrose, to stimulate the growth of new cells to heal painful areas. Ligaments are the most common sites for injection although muscles, tendons and cartilage may also be treated.

Procaine, an anesthetic, is combined with dextrose and injected prior to the addition of ozone gas. This reduces discomfort by numbing the injured area and also resets neurons by repolarizing cell membranes that have been altered by trauma.

In addition to delivering healing substances, the needles used in prolotherapy mechanically stimulate any weak and injured areas. When treating the attachment sites of ligaments and tendons, the prolotherapist touches the bone gently with the needle.  When scar tissue is present, the needle loosens it and breaks it up. This prepares the area to better absorb the dextrose and ozone that stimulate the growth of strong and resilient connective tissue. Healthy new tissue then replaces the scar tissue and the ligaments and tendons become more firmly attached to the bone.

Dextrose Prolotherapy

Dextrose is commonly used in prolotherapy because of its high safety profile and potential therapeutic effect in a variety of conditions. It has been used since the 1950s, has been widely studied and its effects have been proven over many decades of use.  It is also a cost-effective way to prime the joint for future regenerative therapies, such as platelet rich plasma (PRP) and stem cell injections.

Dextrose is a mild irritant to the ligaments. This stimulates a localized inflammatory response that leads to strengthening and healing of the joint. When injected into or around joints, dextrose hyper polarizes nerves by opening potassium channels, thus decreasing transmission in nociceptive pain fibers. In plain terms, dextrose reduces the sensitivity of the nerves around an injured joint and lessens pain during the healing process. Post injection soreness lasts two to five days.

Dextrose is also known to provide essential nourishment to ligaments and to the mitochondria. This provides energy and chemical resources to the immune system so that it can effectively benefit from the inflammatory cascade that restores the joint structures to optimal strength, shape and function.


Injecting ozone gas in and around joints promotes healing in a number of ways.

Ozone is effective because it replenishes oxygen to the joint that results from poor blood supply. It also limits and controls the inflammation the body uses in its efforts to heal the joint. An excellent antiseptic, ozone also helps to eradicate infections that may contribute to joint pain.

When a joint is injured, it sends out biochemical and neurological signals that draw in stem cells and blast cells. These cells can only repair the damage when they have adequate oxygen. This oxygen is provided by the ozone.

Ozone is a relatively unstable molecule made up of three oxygen atoms. When injected, the third oxygen atom detaches and becomes available to re-oxygenate depleted tissues, leaving behind the more stable O2. Clusters greater than three also occur when the ozone gas is formed. The larger clusters are even more unstable, all providing oxygen as the molecules stabilize. Single oxygen atoms readily bind to lipids and amino acids, forming peroxides, which allow the oxygen to enter the cells and produce the energy necessary to repair the joint. For ozone therapy, typically, one-to-tree percent is formed into oxygen clusters of three or more (ozone), as the rest remain as O2, the original form that comes from the medical grade oxygen tank.

Actively Heal Your Joint Pain

Everyone is likely to experience  joint pain at some point. Minor sprains and strains may heal on their own or respond well to physical therapy and joint manipulation. More severe injuries may require surgery. For moderate joint trauma and arthritis, prolotherapy provides a third option.

Prolotherapy is unique in that it targets weak and painful ligaments that are difficult to treat effectively with other modalities. It provides an effective treatment option in cases that are too severe for body work alone and not severe enough to require surgery.

  • Zack Allen, ND practices at the Natural Health Clinic in Līhu‘e and is currently available by appointment. Visit for more information.


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