If your joint or tendon pain has reached the point where you're researching injections, you've likely narrowed things down to a confusing shortlist: cortisone, hyaluronic acid ("gel shots"), prolotherapy, and PRP. The first two manage symptoms, the final two achieve something extraordinary: regenerative healing of the injured tissue. This post compares the two regenerative options head-to-head, because they're the ones patients most often ask us to choose between. We also dive into where Prolozone®, our ozone-enhanced version of prolotherapy, fits in.
The problem they're both trying to solve
Chronic joint and tendon pain usually isn't just "wear and tear." It's a stalled repair process: low-grade inflammation, weakened stabilizing ligaments, and tissue that heals poorly because ligaments, tendons and cartilage have limited blood supply. Cortisone temporarily quiets the inflammation effective immediately, but with a large caveat– repeated steroid injections may accelerate cartilage loss over time. Regenerative injections offer the opposite effect: short term discomfort for long term healing and pain reduction.
How prolotherapy works
Prolotherapy is the injection of a concentrated dextrose (sugar) solution, usually with a local anaesthetic, into a painful joint, ligament or tendon. The dextrose acts as a mild, deliberate irritant that restarts the stalled healing cycle — injury signal, then repair. Crucially, prolotherapy protocols usually treat the whole joint complex: the ligaments and tendons that stabilize the joint, not only the joint space. That matters when instability is part of your pain.
Prolotherapy has a large body of randomized-trial support, best established in knee osteoarthritis — including a University of Wisconsin RCT with benefits sustained at one year and a supportive systematic review and meta-analysis. It's also our most affordable regenerative option. We've written a fuller review of that research in Does Prolotherapy Work? What the Research Shows.
How PRP works
Platelet-rich plasma starts with your own blood. A small amount of blood is drawn and then spun in a centrifuge, which results in a concentrated layer of platelets. We inject that concentrate into the joint or tendon. Platelets are the body's first responders — they arrive loaded with growth factors that recruit repair cells and calm destructive inflammation. Where prolotherapy provokes your tissue into repairing by calling on repair signals, PRP is the direct delivery of concentrated repair signals.
PRP has the larger evidence base of the two for knee arthritis specifically. Multiple meta-analyses of randomized trials — including a 2024 pooled analysis in PLOS One and a meta-analysis of double-blinded randomized trials — have found PRP outperforms hyaluronic acid injections for pain and function, with benefits building over weeks and lasting 6–12 months or longer. Results depend meaningfully on preparation quality and injection accuracy, which is why our PRP is physician-performed with ultrasound guidance and prepared using high-end systems.
The practical comparison
The Mechanism. Prolotherapy stimulates your tissue's own repair response and treats the whole joint complex; PRP delivers concentrated growth factors from your blood, usually into the joint or tendon itself.
The Evidence. PRP: strongest for knee osteoarthritis — multiple meta-analyses of randomized trials, generally superior to gel shots. Prolotherapy: solid randomized-trial support for knee OA and promising smaller-trial support for chronic tendon and ligament pain.
Cost per course (our pricing). Prolotherapy/Prolozone: $270–$350 per site, typically 3–6 sessions — roughly $800–$2,100 for a full course. PRP: $950–$1,400 per session, often 1–3 sessions. Full details on our price list. Neither is OHIP-covered; many extended plans reimburse physician injections.
What treatment feels like. Both are office procedures, prolotherapy takes 30 minutes total, while PRP at least 60 minutes. Prolotherapy results in mild soreness for a day or two, while high concentration or PRP requires at least 5 days of full rest, up to 2 weeks of immobilization. PRP adds a blood draw; prolotherapy sessions are shorter but more numerous.
Timeline. Both build gradually — most patients notice change within 4–8 weeks, with continued gains over months as tissue remodels.
So which one?
There's no universal winner; there's a right fit per patient:
- Prolotherapy first tends to make sense when ligament laxity and instability contribute to the pain, when several sites need treatment, when budget favours lower per-session cost, or as a first regenerative step.
- PRP first tends to make sense for moderate joint arthritis where the joint surface itself is the main problem, for patients who prefer the option with the deepest knee-specific evidence, and when budget favours fewer, stronger sessions.
- Sequenced or combined is common in practice: many of our chronic joint patients do best with a prolotherapy series to stabilize the joint complex and PRP directed at the joint surface. This is exactly what a consultation is for.
Where Prolozone fits in
If prolotherapy is dextrose-based repair stimulation, Prolozone® is that same approach with medical ozone gas added to the injection. The reasoning: ligaments and tendons heal poorly in part because they have limited blood supply, and ozone is used to improve oxygen delivery and utilization in exactly those low-oxygen tissues. In practice, Prolozone is our default form of prolotherapy for most patients — you get the dextrose repair signal plus the oxygen support in one injection.
An honest note on evidence: the dextrose backbone of Prolozone carries the strongest trial support (the studies above). The ozone addition has a younger, growing literature — plausible mechanism, smaller studies — and we're straightforward about that distinction. For most joint and ligament pain we find the combination worth it; for a purely joint-surface arthritis problem, PRP's deeper knee-specific evidence may tip the balance.
One boundary that applies to all three: none of them regrows cartilage in a bone-on-bone joint. If your arthritis is end-stage, the right conversation may be surgical, and we'll say so — though regenerative injections are sometimes used successfully to delay a replacement.
Getting assessed in Toronto or Oakville
At Upper Room Clinic, all of these treatments are physician-performed, led by Dr. Biljana Kostovic, MD, with over 30 years in integrative and chronic pain medicine. An assessment covers your imaging, joint stability and goals, and ends with a specific recommendation — prolotherapy or Prolozone®, ultrasound-guided PRP, a sequence of both, or neither if the evidence doesn't support it for you. Eligible chronic pain patients can also ask about our OHIP-covered interventional pain program.
Weighing options specifically for knee arthritis? You may also want our comparison of Arthrosamid vs PRP for knee osteoarthritis — or book a discovery call to talk through your joint specifically.
