Ozone therapy in musculoskeletal medicine: a comprehensive review

Background: why researchers are looking at ozone for musculoskeletal conditions

Musculoskeletal disorders - including osteoarthritis, tendon and joint injuries, chronic osteomyelitis, avascular necrosis, adhesive capsulitis and a range of chronic pain syndromes - are a major cause of disability worldwide, and conventional treatments do not always provide lasting relief. This has prompted interest in complementary options. Ozone therapy, usually delivered as an oxygen-ozone mixture, has been studied for its proposed effects on tissue oxygenation, oxidative-stress signalling and inflammation, and this review sets out to gather what is currently known about its use in orthopaedic and musculoskeletal medicine.

Study design: a narrative review of the existing literature

This is a comprehensive narrative literature review rather than a clinical trial or systematic review. The authors draw together published laboratory and clinical work to describe the proposed biological mechanisms of ozone therapy, the ways it is administered, and the musculoskeletal conditions in which it has been trialled. Because it is a narrative synthesis, it does not pool data statistically or apply the formal risk-of-bias assessment used in systematic reviews and meta-analyses.

Findings: reported effects across a range of conditions

The review describes ozone therapy as being explored across several orthopaedic conditions, including knee osteoarthritis, avascular necrosis, adhesive capsulitis, chronic osteomyelitis, tendinopathy, rheumatic disorders, fibromyalgia and chronic pain. At a biological level, the authors summarise proposed mechanisms such as improved tissue oxygenation, modulation of oxidative stress and anti-inflammatory and analgesic effects. Reported clinical outcomes centre on reduced pain and improved function in some conditions, though the authors note that the quality and consistency of the underlying evidence varies considerably from one indication to another.

What the authors concluded

The authors conclude that ozone therapy shows potential as an adjunct or alternative in musculoskeletal medicine, particularly for its anti-inflammatory and analgesic properties, but that it is not yet established practice. They call for further high-quality research with longer follow-up to clarify which conditions genuinely benefit, and for internationally agreed treatment guidelines and standardised protocols before ozone therapy can be more widely adopted.

Limitations of this study

As a narrative review, this paper does not statistically combine results or systematically grade the strength of the evidence, so its conclusions reflect the authors' interpretation of a varied body of work. The authors themselves highlight important gaps: relatively few direct comparisons between ozone therapy and other treatments, incomplete understanding of its mechanisms, uncertainty around safety and correct dosing, and inconsistent methods across the studies reviewed. The findings should therefore be read as a summary of an emerging area rather than confirmation that ozone therapy is effective for any specific musculoskeletal condition.