Prolotherapy has focused on entheses as a key source of chronic low back pain, even without clear diagnosis of enthesopathy. Treatment has traditionally been guided by anatomic knowledge and careful palpation. This article integrates ultrasonographic diagnosis of fascial injury with examination findings taught in traditional prolotherapy technique. Thoracolumbar fascial anatomy and biotensegrity theory are used to explain patient presentation and response to treatment at these pathologic findings. Detailed case reports provide proof of concept for the 60-year history of prolotherapy in the treatment of chronic low back pain.