Cortisone Injection Alternatives

As a sports medicine specialist, I see many athletes on the examination table with “hot” inflammation in a joint that is hindering their ability to play their game. In the past, this athlete would have gone to another specialist with the hope of receiving a cortisone injection. Cortisone, they believed, would have them flying off the off the table with an expectation to be back at the game or training immediately. The problem that the medical community and athletes soon found out was that too much of a good thing – cortisone – can lead to a quicker end of the athlete’s ability to participate in sports. For sports medicine specialists, an alternative to cortisone is just as important as being able to administer a cortisone injection. For some specialists that alternative is Prolotherapy.


Cortisone is a naturally occurring steroid in the human body. In the late 1940′s and 1950′s researchers developed ways to produce it synthetically and make it available on a grand scale. Hailed as a miracle drug, it was widely prescribed by physicians for a large array of inflammatory problems and for the athlete, it was considered the gold standard for chronic inflammation, and THE way to get them back on the field as fast as possible.

Cortisone became too much of a good thing

The rampant, nearly unchecked use of cortisone, started to show its consequences to patients. Physicians and researchers started to issue warnings on the overuse of cortisone injections. As far back as 1969 Researcher Rodney Sweetnam writing in the Journal of Bone and Joint Surgery reported that not only were surgeons noting that prolonged usage of corticosteroids lead to the development of severe vertebral osteoporosis but also ruptured tendons in athletes. Later research points to cortisone accelerating cartilage degeneration in joints.

Cortisone Alternatives

Athletes have learned through research and their own personal experience that repeated cortisone injections will lead to arthritis, joint degeneration, and other unwanted side-effects. Athletes also want to be healed and returned to to their game as strong as before if possible. This is where the use of Prolotherapy can help reduce inflammation, reduce pain, and as opposed to cortisone, rebuild damaged tissue and strengthen the athletic joint. And Prolotherapy has been proven in studies to do this without the negatives of cortisone.

Chronic injuries in athletes are mostly caused by wear and tear on the connective tissues of the joints. Mainly, the ligaments, which connects bones to bones, and tendons which hold muscles to bones. It is these soft tissues that are the main culprit in joint inflammation, and the ones that receive cortisone injections.

Prolotherapy is a series of injections of simple dextrose (sugar) that stimulates the body to send the cells necessary to repair and strengthen damaged ligaments and tendons. Prolotherapy introduces dextrose into the area so that a mild, controlled inflammation occurs through irritation of the soft tissue. The immune system recognizes this irritation as an injury and is jump started into sending a new wave of immune cell building blocks to heal the wound.

Studies have shown that Prolotherapy can stimulate a 50% increase in mass and a 200 – 400% increase in ligament strength.

Platelet Rich Plasma Therapy has become very popular. Physicians who do not do traditional Prolotherapy are now offering PRP. Unfortunately, these untrained doctors are injecting the platelets in a way that is often painful, debilitating for weeks, and can leave hematomas (collections of clotted blood) in the area injected. We believe that PRP is best delivered by a physician already experienced and well versed in Prolotherapy.

Platelet alpha granules contain potent growth factors necessary to begin tissue repair and regeneration at the wound site. Concentrated autologous platelets contain large reservoirs of growth factors that have the potential to greatly accelerate the normal healing process, naturally. The use of concentrated growth factors is considered by many to be a “new frontier” of clinical therapy

Prolotherapy and Platelet Rich Plasma Therapy can be practiced differently from office to office. We use ultrasound guidance for the injections so that we can watch the needle and solution be placed into the target area. Studies show that with blind injections, there is a high incidence of missing the targeted area or joint.

At our clinic, Darrow Sports and Wellness Institute, we don’t like to offer cortisone but sometimes, in extreme chronic injury, cortisone, used one time is a very good diagnostic test to see where the pain generator is, and at the same time quiet the pain. The next step is to use Prolotherapy to rejuvenate the tissue and end the pain. Prolotherapy treatments for the athlete are typically given once a week over a 4 – 6 week period.

Interested in Prolotherapy? To learn more about Dr. Darrow, PRP Therapy, and Prolotherapy, callus at 310-231-7000.

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About Marc Darrow MD, JD

Marc Darrow, MD, JD, is one of the leading physicians practicing Stem Cell Therapy, Platelet Rich Plasma Therapy, and Prolotherapy. Email with questions about this article to