Man serving a tennis ballLateral epicondylosis (LE) is a common elbow injury. It’s usually referred to as “tennis elbow,” although it can be diagnosed in anyone with high repetition or gripping activities. Many non-surgical therapies have been tested for LE but none have been consistently effective. Animal studies suggest that using a combination of dextrose and an extract of cod liver oil may enlarge and strengthen ligament and tendon insertions. Clinicians at Trinity Health Systems in Ohio designed a study to measure the effect of a Prolotherapy solution on tennis elbow.

The Study Method

  • This was a randomized, double-blind controlled study. To control bias, physicians providing the treatments were blinded to the type of solution.
  • Twenty subjects, ages of 19 to 62 years, were enrolled. All subjects had elbow pain for at least 6 months and failed the following treatments: rest, NSAIDs, physical therapy, and 2 cortisone injections.
  • Subjects were randomized to receive either a saline injection or a Prolotherapy injection of 10% dextrose with an extract of cod liver oil. Injections were given at baseline, four weeks, and again at eight weeks.
  • Results were measured with resting elbow pain, grip strength, and isometric resistance strength.


  • The 10 Prolotherapy subjects showed significant improvements in pain and isometric strength scores. There was no improvement in control subjects.
  • At one year 60% of Prolotherapy subjects reported no pain or impact on daily activities as opposed to 10 % of control subjects with no pain and 80% of control subjects with pain interfering with daily activities. 20% of prolotherapy subjects reported mild pain with no impact on daily activities and 20% reported mild pain and disability with extreme grip and modest impact on daily living.
  • Grip strength improved for both groups but reached a plateau in the control group at 8 weeks, while it continued to improve for Prolotherapy subjects.
  • None of the Prolotherapy subjects reported using additional therapies. Four of 9 control subject used additional therapies.
  • There were no side effects reported in the prolotherapy group.

Why is this study important?

This study is the first of its kind to provide data for a safe but effective alternative therapy to traditional approaches that have shown little benefit for tennis elbow.

  • Although this study had a large effect size, results must be cautiously interpreted since it was a pilot study with a small sample size. However, results are encouraging for the effect of prolotherapy on tennis elbow.



Scarpone, M., Rabago, D. Zgierska, A., Arbogest, J. & Snell, E. (2008). The efficacy of prolotherapy for lateral epicondylosis: A pilot study. Clinical Journal of Sports Medicine, 18(3): 248-254.

Prolotherapy Improves Outcomes for Tennis Elbow
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