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What is Dextrose Prolotherapy?Dextrose prolotherapy is an injection-based treatment in which a hyperosmolar dextrose (glucose) solution is injected into ligaments, tendons, joints, or adjacent soft tissues with the intent to stimulate a local inflammatory response and promote tissue repair in chronic musculoskeletal conditions.The mechanism of action, which has been proposed for decades, is that it causes the induction of a mild, controlled inflammatory reaction, which is hypothesized to trigger healing and regeneration of connective tissue through the recruitment of growth factors and modulation of the inflammatory process. [1–2]&nbsp; Expanding Understanding of the MechanismMore recently, the exact mechanism of why dextrose-based solutions are beneficial has gone under deeper investigation around the world. To say that the whole story has been fully elucidated would not be an accurate statement.Different mechanisms are being proposed and discussed, which add more understanding to our current inflammatory model of understanding. One of the hypotheses that has been proposed is that dextrose injections can actually enhance cartilage growth through aggrecan synthesis and expression in musculoskeletal tissues, particularly chondrocytes. [7]This particular mechanism of action would fit well with some of the case reports across the literature, which suggest that osteoarthritic patients can actually achieve an increase in joint space following treatment. [8] Additionally, it would fit very well with a case study that performed arthroscopies (camera is placed into the joint) following treatment to assess for cartilage re-growth. [9]&nbsp; Research, Dosing, and Common UsesWe are committed to keeping you up to date on the latest prolotherapy research as we elucidate this treatment mechanism of action in real-time.Despite the push to further understand the MOA, Dextrose prolotherapy is commonly used for:Chronic tendinopathies Ligament injuries Osteoarthritis Other various musculoskeletal conditions Concentrations of dextrose used in clinical studies typically range from 10% to 25%, with higher concentrations often used for intra-articular structures, and lower concentrations for extra-articular structures.The injection protocol and frequency vary, but treatments are usually administered at intervals of 2–6 weeks over several sessions. Individuals typically average 4–6 treatments, with some above this number and some below. [3–6]&nbsp; Otten Medical’s Biotensegrity-Based ApproachAt Otten Medical, we have dedicated significant time to sampling various practices in their use of dextrose prolotherapy. What we have found is that achieving good patient outcomes is largely dependent on the method that is used.Since this is a proliferant solution and the goal with this specific regenerative treatment is to use a biotensegrity-based approach (addressing the joint as a whole), it is important that the physician uses a sufficient amount of concentrated solution and adresses a sufficient number of connective tissue structures.For instance, if we are specifically trying to address an MCL sprain in the knee, we take the approach that it’s unlikely the MCL was sprained in isolation. If the MCL has been sprained, using a biotensegrity-based approach tells us that it’s likely there are other connective tissue structures that have been weakened in the process.So even if other structures are non-painful, restoring biotensegrity, and therefore good biomechanics of the joint, may be dependent on addressing these structures also.&nbsp; The Broader Perspective Makes a DifferenceThis is why we strongly consider supporting role structures as well as downstream and upstream joints.In addition to this, reversing the degenerative cascade to a regenerative one typically takes a little persistence. Therefore, we employ this perspective in each case.These overall differences in philosophy typically make treatment much more successful in our experience. And these differences can often give that case which “has tried it all” the elusive answers that they’ve been looking for. Article written and composed by:Dr. Drew Otten NMDFounder and Medical Director of Otten Medical PLLC REFERENCES1. &nbsp; &nbsp; Distel, L. M., &amp; Best, T. M. (2011). Prolotherapy: A clinical review of its role in treating chronic musculoskeletal pain. PM&amp;R: The Journal of Injury, Function, and Rehabilitation, 3(6 Suppl 1), S78–S81. <a href="https://doi.org/10.1016/j.pmrj.2011.04.003" data-mce-href="https://doi.org/10.1016/j.pmrj.2011.04.003">https://doi.org/10.1016/j.pmrj.2011.04.003</a>&nbsp;2. &nbsp; &nbsp; Jensen, K. T., Rabago, D. P., Best, T. M., Patterson, J. J., &amp; Vanderby, R. (2008). Early inflammatory response of knee ligaments to prolotherapy in a rat model. Journal of Orthopaedic Research, 26(6), 816–823. <a href="https://doi.org/10.1002/jor.20600" data-mce-href="https://doi.org/10.1002/jor.20600">https://doi.org/10.1002/jor.20600</a>&nbsp;3. &nbsp; &nbsp; Ciftci, Y. G. D., Tuncay, F., Kocak, F. A., &amp; Okcu, M. (2023). Is low-dose dextrose prolotherapy as effective as high-dose dextrose prolotherapy in the treatment of lateral epicondylitis? A double-blind, ultrasound guided, randomized controlled study. Archives of Physical Medicine and Rehabilitation, 104(2), 179–187. &nbsp;<a href="https://doi.org/10.1016/j.apmr.2022.09.017" data-mce-href="https://doi.org/10.1016/j.apmr.2022.09.017">https://doi.org/10.1016/j.apmr.2022.09.017</a>&nbsp;4. &nbsp; &nbsp; Teymouri, A., Birang, N., Fakheri, M., &amp; Nasiri, A. (2025). Comparison of the efficacy of ultrasound-guided dextrose 25% hypertonic prolotherapy and intra-articular normal saline injection on pain, functional limitation, and range of motion in patients with knee osteoarthritis: A randomized controlled trial. BMC Musculoskeletal Disorders, 26(1), 313. <a href="https://doi.org/10.1186/s12891-025-08580-5" data-mce-href="https://doi.org/10.1186/s12891-025-08580-5">https://doi.org/10.1186/s12891-025-08580-5</a>&nbsp;5. &nbsp; &nbsp; A comparative analysis of prolotherapy efficacy in patients with knee osteoarthritis across varied dextrose concentrations. (n.d.). <a href="https://pubmed.ncbi.nlm.nih.gov/37540383/" data-mce-href="https://pubmed.ncbi.nlm.nih.gov/37540383/">https://pubmed.ncbi.nlm.nih.gov/37540383/</a>&nbsp;6. &nbsp; &nbsp; Open Medical Publishing. (n.d.). A comprehensive update of prolotherapy in the management of osteoarthritis of the knee. Orthopedic Reviews. <a href="https://orthopedicreviews.openmedicalpublishing.org/article/33921-a-comprehensive-update-of-prolotherapy-in-the-management-of-osteoarthritis-of-the-knee" data-mce-href="https://orthopedicreviews.openmedicalpublishing.org/article/33921-a-comprehensive-update-of-prolotherapy-in-the-management-of-osteoarthritis-of-the-knee">https://orthopedicreviews.openmedicalpublishing.org/article/33921-a-comprehensive-update-of-prolotherapy-in-the-management-of-osteoarthritis-of-the-knee</a>&nbsp;7. &nbsp; &nbsp; Wu, T. J., Fong, Y. C., Lin, C. Y., Huang, Y. L., &amp; Tang, C. H. (2018). Glucose enhances aggrecan expression in chondrocytes via the PKCα/p38-miR-141-3p signaling pathway. Journal of Cellular Physiology, 233(9), 6878–6887. <a href="https://doi.org/10.1002/jcp.2645" data-mce-href="https://doi.org/10.1002/jcp.2645">https://doi.org/10.1002/jcp.2645</a>&nbsp;8. &nbsp; &nbsp; Caring Medical. (2024, September 21). Prolotherapy knee cartilage regeneration: Standard clinical x-ray studies document cartilage regeneration in five degenerated knees. <a href="https://caringmedical.com/about/prolotherapy-results/cartilage-regeneration-knees/" data-mce-href="https://caringmedical.com/about/prolotherapy-results/cartilage-regeneration-knees/">https://caringmedical.com/about/prolotherapy-results/cartilage-regeneration-knees/</a>&nbsp;9. &nbsp; &nbsp; Rabago, D., Mundt, M., Zgierska, A., Grettie, J., &amp; Kijowski, R. (2016). Hypertonic dextrose injection (prolotherapy) for knee osteoarthritis: Results of a single-arm uncontrolled study with 1-year follow-up. PM&amp;R, 8(7), 652–662. <a href="https://pubmed.ncbi.nlm.nih.gov/27058744/" data-mce-href="https://pubmed.ncbi.nlm.nih.gov/27058744/">https://pubmed.ncbi.nlm.nih.gov/27058744/</a>&nbsp;

What is Dextrose Prolotherapy?

As my learning has evolved, there started to develop one scientific mechansim that stood out above all of the rest that I wanted everyone to understand, that is Heart and Brain Coherence. There was a lot of information out there, as well as books, and speakers. Some of which take a lot of time to digest. So what I did was write a short two page article which could break down the basics and give someone a snapshot of this integral concept, without tying them up for hours if not days of research. So that is what you have here.&nbsp; For as far back as society can remember, we’ve always associated the heart with feelings of love and joy. With the development of modern science though, this association was quickly cast away as a fallacy that holds no real association. Upon discoveries in the field of neuroanatomy, such as various neurotransmitters and hormones, science began associating feelings of elation, love, and gratitude strictly with the brain. The brain became the manufacturing center of all forms of subjective human experience. This was and is the general understanding for most people still to this day.What is not as well known are the discoveries that have been made in the field of neurocardiology that flip a lot of this understanding on its head. According to the Heart Math Institute, researchers have discovered that the heart has an extensive network of nerve cells within it, also termed the ‘heart-brain’. It is made up of ganglia, neurotransmitters, proteins, and supporting cells, the same cells as what make up the brain. According to their research, “the heart-brain’s neural circuitry enables it to act independently of the cranial brain to learn, remember, make decisions and even feel and sense” (<a data-mce-href="https://www.heartmath.org/research/science-of-the-heart/heart-brain-communication/" href="https://www.heartmath.org/research/science-of-the-heart/heart-brain-communication/">HeartMath Institute</a>). With all of these discoveries, the previous paradigm in which the brain was solely responsible for directing the function of the heart through hormonal and neuronal communication has been completely shifted. We now understand that the heart and brain are in a constant dialogue where the heart influences the brain and the brain influences the heart through a variety of different communicating mechanisms (<a data-mce-href="https://www.heartmath.org/research/science-of-the-heart/heart-brain-communication/" href="https://www.heartmath.org/research/science-of-the-heart/heart-brain-communication/">Heart Math Institute</a>).Born out of all of this was a very important concept, that of Brain-Heart coherence. The researchers studying all of these concepts have proposed that the rhythmic pulsations emitted by the heart can transmit emotional information into the collective electromagnetic field, which can influence that of other people (<a data-mce-href="https://www.heartmath.org/research/science-of-the-heart/energetic-communication/" href="https://www.heartmath.org/research/science-of-the-heart/energetic-communication/">HeartMath Institute</a>). What we now know is that when the heart is in coherence with the brain, it emits a much more coherent electromagnetic signal into the collective field, but when these two organs are not in coherence, the heart demonstrates patterns that are irregular and erratic (<a data-mce-href="https://www.youtube.com/watch?v=QdneZ4fIIHE" href="https://www.youtube.com/watch?v=QdneZ4fIIHE">HeartMath Institute</a>). What influences these states of coherence and incoherence are the emotional states that we enter into. Negative emotions such as anger, frustration, and anxiety cause incoherent heart rhythm patterns while “positive emotions send a very different signal throughout our body. When we experience uplifting emotions such as appreciation, joy, care, and love; our heart rhythm pattern becomes highly ordered, looking like a smooth, harmonious wave (<a data-mce-href="https://www.heartmath.org/research/science-of-the-heart/energetic-communication/" href="https://www.heartmath.org/research/science-of-the-heart/energetic-communication/">HeartMath Institute</a>).What is more interesting that makes these findings even more potent for all of us is that the nerve cells within the heart emit a massive electromagnetic field. There are other organs in the body that emit an electromagnetic field such as the brain, but by comparison the field emitted by the heart is 60 times greater in amplitude and 100 times greater in strength than the field emitted by the brain. In addition, this field can be detected up to 3 feet away from the body (<a data-mce-href="https://www.heartmath.org/research/science-of-the-heart/energetic-communication/" href="https://www.heartmath.org/research/science-of-the-heart/energetic-communication/">HeartMath Institute</a>).We’ve all had those moments when someone we have a particular affinity for walks into a room we are in and it feels as if a wave of peace and calm comes over you just because of the presence of that person. The opposite I’m sure is true as well, when someone’s presence makes you feel anxiety levels rise just by being around them. Now we know that these effects may not be simply the psychological effect that this person has on us. Since they are emitting a certain signal into the field that we can sense, we are literally picking up on their own emotional intelligence being emitted into our surroundings. Along with all of this information about the details of brain and heart coherence, these researchers have discovered that we have the ability to self-regulate our coherence independent of our surroundings. It helps tremendously to be around people who are also trying to self-regulate into a coherent state but it is not necessary (<a data-mce-href="https://www.heartmath.org/research/science-of-the-heart/energetic-communication/" href="https://www.heartmath.org/research/science-of-the-heart/energetic-communication/">HeartMath Institute</a>). We can choose to be in a coherent state regardless of our surroundings. And what is most important is that staying in this state of coherence promotes massive health benefits because we are learning to direct our physiological response toward optimal function even if a stressful situation comes along. We are keeping our bodies in a parasympathetic state that is actually quite distinct from a traditional relaxed state. In this state, your body stays alert and ready to function at a high capacity. In so doing, we avoid the need to initiate the stress response. Everybody already knows how stress in excessive amounts can wreak havoc on our bodies and organ systems in many different ways. But when we avoid this pathway and instead and self-regulate into a coherent state, “our physiological systems function more efficiently, we experience greater emotional stability, and we also have increased mental clarity and improved cognitive function. Simply stated, our body and brain work better, we feel better, and we perform better” (<a data-mce-href="https://www.heartmath.org/science/" href="https://www.heartmath.org/science/">HeartMath Institute</a>). The question then ensues, if everyone understood this science and was trained to self regulate into coherent states during stressful situations, how much illness could be prevented? How much different would our world look like as a whole? I suspect we'd be pleasantly surprised! If this research interests you in anyway, I encourage you to check out the HeartMath Institute website. I am attaching a few direct hyperlinks right here that have applicable information, but their whole website is a wealth of knowledge and worth checking out (<a data-mce-href="https://www.youtube.com/watch?v=kIy-zwnaHJM" href="https://www.youtube.com/watch?v=kIy-zwnaHJM">Resources</a>, <a data-mce-href="https://www.heartmath.org/resources/heartmath-tools/quick-coherence-technique-for-adults/" href="https://www.heartmath.org/resources/heartmath-tools/quick-coherence-technique-for-adults/">Resources</a>). At a later date I will share a social media page here to my personal platforms which I have been running for quite a while with the goal of making these concepts easier to understand with a dialed in focus on brainwaves and spirituality.

Dr. Drew Otten, NMD

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What is Dextrose Prolotherapy?

BRAIN AND HEART COHERENCE