Dextrose prolotherapy as an adjunct to exercise and manual therapy in iliotibial band syndrome: assessment of pain relief and functional improvement

Iliotibial band syndrome (ITBS) is a common cause of lateral knee pain, particularly in physically active individuals, and symptoms may persist despite conservative treatment. Dextrose prolotherapy is a regenerative injection-based treatment used for chronic musculoskeletal pain; however, evidence regarding its effectiveness in ITBS is limited. This study aimed to evaluate the effects of dextrose prolotherapy added to exercise and manual therapy on pain and functional outcomes in patients with ITBS. This retrospective cohort study included 103 patients diagnosed with ITBS. Patients were divided into a control group receiving exercise and manual therapy alone ( n = 52) and a prolotherapy group receiving dextrose prolotherapy in addition to exercise and manual therapy ( n = 51). Pain intensity was assessed using the 0–10 Numeric Rating Scale (NRS), and functional status was evaluated using the Lower Extremity Functional Scale (LEFS) at baseline, week 6, month 1, month 3, and month 6. Changes over time were analyzed using mixed-design repeated measures ANOVA, with linear mixed-effects models used as sensitivity analyses. No statistically significant between-group differences were observed in the measured baseline demographic and clinical characteristics. Both groups showed significant improvements in NRS and LEFS scores over time. Significant group × time interactions were observed for both NRS (F = 29.236, p < 0.001) and LEFS (F = 35.494, p < 0.001), indicating greater improvement in the prolotherapy group. At month 6, the prolotherapy group had lower NRS scores and higher LEFS scores than the control group. Sensitivity analyses confirmed these findings. No serious adverse events were reported; transient mild post-injection pain occurred in nine patients. Dextrose prolotherapy added to exercise and manual therapy was associated with greater improvements in pain and function in patients with iliotibial band syndrome. These findings suggest a possible adjunctive benefit, but prospective randomized controlled trials are needed to confirm the results.