Prolozone Therapy

Joint Pain? Don’t Replace It, Fix it with Prolozone Therapy

Stephen Smith, M.D. is an Integrative Functional Medicine physician with over 40+ years of experience in the medical field. Hear his talk about Prolozone Therapy.

What is Prolozone Therapy?

Many painful joints can be repaired using prolozone therapy. The primary reason for pain in joints is damage to connective tissue within the joint. As we age our repair processes slow as well. When wear and tear exceed repair the cartilage and other connective tissue within the joint is more susceptible to injury and slower to heal. There is a remedy for this – prolozone therapy.

Prolozone is an injection technique used to heal joints and ligaments. The healthcare provider injects a local anesthetic and medications into the joint that stimulates healing. The provider removes the syringe, leaving the needle in place, and then injects a small amount of oxygen in the form of ozone into the joint through the same needle. The ozone gas stimulates the local circulation and the cells in the joint to start repairing themselves. Because ozone is a gas, it disperses easily throughout the joint stimulating all the tissues and causes a widespread healing response.

You may often see results rather quickly due to the anti-inflammatory effect of prolozone therapy, this is especially true for back pain, where the results are seen within less than 24 hours. However, in major joints like the knee, it takes time for new connective tissue to grow. It takes about six weeks of cartilage growth to see the full effect of prolozone therapy in patients that have extensive cartilage damage. Prolozone is an effective therapy for reducing pain in most major joints and back pain.

Our ligaments and joints deteriorate with age, overuse, and overload due to obesity. As ligaments age, they lose elasticity and start to pull away from the periosteum (lining of the bone), and this space is filled with new bone resulting in bone spurs and general deterioration of the joint over time. Ligaments have a poor blood supply, which further deteriorates with aging when injured they’re slow to heal or heal incompletely. This is one of the reasons why so many people undergo knee replacement surgery because their torn ligaments and cartilage just can’t heal. Prolozone therapy allows ligaments and cartilage to heal by supplying the needed oxygen to start the healing process. It can reduce pain and inflammation in the joint fairly quickly.

This article by Dr. Shallenberger explains the history, mechanism, indications and patient results from prolozone.

Back Pain and Prolozone

Prolozone is often most effective for the treatment of chronic back pain. Cuban studies showed 80% of back pain patients treated with prolozone had improvement. Prolozone has been effective in quickly relieving back pain even in patients with a long history of back pain. Unlike epidural injections which are given directly in the lining of the spinal cord, prolozone treatments are given in the facet joints, which are off to the side, eliminating most of the risk of the side effects associated with epidural type injections.

The Procedure Benefits

  • In-office procedure
  • No downtime
  • Triggers the body’s innate healing system
  • Can delay or eliminate the need for joint replacement therapy
  • Low-risk procedure
  • Minimal discomfort
  • Rapid results

The practitioner preps the skin with iodine or another disinfectant. Then, he or she injects a needle with local anesthetic along with nutrients into the joint space. He or she then removes the syringe, leaving the needle in place and attaches another syringe containing the ozone to the needle. Then, he or she removes the needle and applies bandages. All procedure usually takes less than 10 minutes. We recommend repeating the procedure on a bi-weekly basis for about six to eight weeks.

While there is sometimes immediate pain relief with the procedure, most of the results come after four to six weeks after the ligaments and cartilage have had some time to heal. The procedure works extremely well for knee and shoulder pain but can work in other joint spaces, as well. Of course, the earlier the intervention the better the results are. However, even fairly severely damaged joints may benefit from Prolozone therapy, but the results may take more time because more tissue repair is required to relieve the symptoms. A study done for the treatment of back pain demonstrated an 80% success rate.

Results can be improved by combining prolotherapy with PEMF (pulse electrical magnetic force) therapy. PEMF will also increase blood flow in the joint and raise the temperature of the tissue around the joint to improve circulation and reduce pain. We include PEMF therapy as part of our prolotherapy protocol. Prolozone is sometimes done as a single treatment to relieve pain or a series of treatment to repair a major joint such as a knee or shoulder.

How does the procedure work?

As we age our rate of tissue repairs slows, but not the rate of break down. Prolozone therapy increases the rate of repair and provides oxygen, so the joints can repair themselves. There is also an anti-inflammatory effect of ozone which reduces inflammation in the joint, which is why most patients see immediate improvement with the first treatment. My experience with knee and other joint injuries has taught me that it takes about 6 weeks for a joint to repair in a young healthy person. This is also the case with prolozone therapy, which is why we recommend three to four treatments two weeks apart.


The cost of a course of treatment is approximately $270/ per treatment of one area on the first visit including the office visit for a major joint such as the knee, shoulder, or back. Fees for joint injection range from $77 for small joints to $122 for large joints plus the office fee.


After the initial 6 week period, the joint is usually fine for several months, but prolozone does not stop the wear and tear process, so every 3 or 4 months you may need a booster treatment to keep the joint pain free.

Frequently Asked Questions:

Is the procedure painful?

There can be some discomfort if the joint is inflamed, but generally, there is minimal discomfort with the procedure. On a scale of 1 to 10, 1.5. When the local anesthetic is introduced into the joint there is often some minor discomfort lasting a few seconds. When the ozone is introduced into the joint, there is usually no discomfort, but the joint feels full for about 30 minutes. You may experience some minor soreness in the joint for about 24 hours after the procedure, especially the first treatment since there is often some inflammation present. However, we have many patients tell us they felt no discomfort whatsoever.

Will I be able to drive or walk after the procedure?

Yes, your joint will feel a bit numb and full after the procedure, but you can resume normal activity after the procedure. Generally, people feel relief right away due to the anti-inflammatory effect of the treatment and the local anesthesia use.

What is in the injection?

The first injection contains a local anesthetic (procaine), Methyl B12 (the active form of B12), ketorolac (a strong anti-inflammatory medication), trace minerals. These ingredients help reduce inflammation in the joint and provide key ingredients to aid the rebuilding of the joint. The second syringe contains moderate strength ozone gas. The ozone quickly converts into oxygen and releases energy into the joint space. This energy release is key to the effectiveness of prolozone. Studies have shown that if oxygen is used instead of ozone, the procedure does not work. The energy jump starts the healing process.

Have you had the procedure done on yourself?

Yes, I have had multiple treatments to both knees, both shoulders, lumbar, thoracic, and cervical spine. The results have been great in all areas treated, especially the thoracic and cervical spine areas, where the pain was gone with the first treatment. I had a tear in the labrum of both shoulders. The labrum is the ring of cartilage around the edge of the shoulder joint causing an impingement syndrome in my shoulders. I was unable to throw a baseball or swim without a sharp pain in my shoulder. All the pain in my shoulder has completely resolved with treatment. I can now swim pain-free. My low back is pain-free as are my knees.

I have been told there is no cartilage left in my shoulder and that I am bone on bone. Will prolozone work for me?

Maybe, prolozone is not 100% successful. A study in back pain patients reported a success rate of 80%.

I have been told I need a joint replacement will prolozone work in this situation?

It depends on the degree of damage in the joint, but we have seen results with fairly severe joint damage. If there is severe joint damage it takes more time for the joint to heal and the pain relief may not be complete. However, we have patients with bone on bone diagnosis that are seeing a reduction in their joint pain.

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Prolozone Therapy Reviews


I Had Pain In Both Knees...

I had pain in both knees. My left knee was so painful that I could barely place any weight on it and walked with a limp. The pain impacted every aspect of my life and woke me up many times during the night. Started prolozone therapy with Dr. Smith and after a short time, my right knee was totally pain-free. Pain in my left was much improved, but still present. I continued four more treatments in the left knee. Now, my left knee was also pain-free. I'm now able to work on my feet for 10 hours a day without pain.

David B
West Richland, WA

I Had Back Pain For Years...

I had back pain for many years. It was gone within hours by the first treatment. I came back for a second session weeks later thinking I needed another one. My pain was gine, so I was told wait until it starts herting again and hen come back for the second session.

Deborah S

My Back Was So Stiff...

My back was so stiff that I was stooped over when I walked, but after just one treatment of prolozone my low back pain was about 60% better. I was able t to work in the yard and even do some shoveling work. After three treatments I was almost completely normal. Simply amazing.

T Longley
Patterson, WA

Back Pain For 37 Years...

I have had back pain for 37 years. I had three prolozone treatments on my back each two weeks apart and now I am pain free for the first time in many years.

J Chan
Kennewick, WA

Shoulder Pain Is Gone...

I had pain in right shoulder for many years. It was quite painful to raise it past 90 degrees, which made writing on a blackboard very painful, which was big problem for as I am a teacher. The whole area was quite tender even to the lighter touch. I had a total of three prolozone treatments, but after the second treatment there was marked improvement and after three treatments, I was completely pain free.

L Gragg
Pasco, WA