What is Prolotherapy?

Prolotherapy is a natural and effective treatment for acute or chronic pain and arthritis. By injecting the degenerated or injured ligament/tendon with a mild irritant solution, a mild inflammatory response is triggered to give the body a second chance at healing. This healing cascade generates new, healthy, stronger tissue and has a significant impact on chronic, nagging pain. When function is restored pain tends to dissipate.

How is Prolotherapy different from physical therapy?

While these treatments pair very well together, physical therapy (PT) primarily concentrates on strengthening muscles and redistributing the load on the joint, and Prolotherapy strengthens and repairs ligaments. At the root of chronic pain is joint instability, which is caused by loose ligaments (the structures that hold joints together). It is not a muscle problem, though muscles become involved eventually to help stabilize the joint because the ligaments are too loose to do so. Loose ligaments cause destructive joint forces, resulting in symptoms like pain, bone spurs, swelling, and muscle spasms. Ultimately, the destructive joint forces cause cellular death and joint/cartilage/disc/labrum/meniscus degeneration. Prolotherapy is the only treatment for loose ligaments.

How is Prolotherapy different than an amniotic stem cell injection?

Amniotic stem cells are donor cells and have been freeze-dried, stored, and reconstituted prior to use. In the end, there are no live cells being injected but only high doses of growth factors. That being said, it can still be an effective treatment.

Additionally, stem cell treatments are touted as a one-shot wonder. Please understand that there are no shortcuts to treatment, especially something as serious as osteoarthritis. If someone tries to give you one, they are just plain ol’ wrong. Your joint is literally dying (think “necrosis” or “gangrene”). The reason that joint replacement has to happen in some cases is that the joint tissue is literally destroyed, and cartilage cells have drowned to death. It is very serious and can have devastating consequences. Without treating the joint comprehensively, long-term results are not likely and have not yet been shown effective in long-term studies. On the other hand, many studies have proven with thousands of patients over the decades that Prolotherapy is effective because of the more comprehensive injection technique. It is exactly the purpose of Prolotherapy.

How is Prolotherapy different than cortisone?

In short, cortisone accelerates joint damage whereas Prolotherapy protects and strengthens joint structures. Cortisone covers up pain signals and decreases inflammation. When you block pain, your body cannot tell you it hurts. This creates a vicious cycle of joint damage because you will not alter your activity level and end up doing additional damage to your joints because there isn’t a pain signal trying to warn you about further damage happening in the joint. There are many studies explaining the degenerative effects of cortisone, and most surgeons will even admit that during surgery, they can tell the difference between a joint that has received cortisone injections and one that has not. Prolotherapy aims to correct joint instability, thereby alleviating pain and destructive joint motion. Instability is progressive, meaning if left untreated, the instability gets worse! When the instability gets worse, so does the pain. Therefore, as you keep getting cortisone shots, it does not cure your pain—it simply covers it up while the joint damage accelerates.

How is Prolotherapy different than hyaluronic acid / Synvisc®?

Hylauronic acid injection is a temporary cushion that many people use to try and delay joint surgery. Prolotherapy, on the other hand, is a permanent way to avoid surgery altogether. By stabilizing and joint and correcting why it was breaking down in the first place, the cartilage can repair instead of die, which is what happens to cartilage cells when you have osteoarthritis- they die by drowning and hylauronic acid injections don’t do this.

Shouldn’t I do PRP or stem cells instead of Prolotherapy?

PRP and stem cells are types of regenerative injection therapy solutions, just like dextrose is. Not all patients need the more expensive PRP or stem cells, many are cured of their instability and pain with a dextrose solution. Based on the severity of your instability, functional goals, and other considerations, your provider will discuss with you the most appropriate solution for your individual case.

How do the treatments help nerve pain? I thought Prolotherapy was just for joint pain and arthritis?

Instability causes pain. When the ligaments are stretched and the joint is unstable, The nerves and surrounding tissues become irritated leading to constant pain.  Prolotherapy strengthens the joint and reduces the irritation on the nerves which decreases the pain.

Can I receive Prolotherapy if I’m taking medications?

Dr. Lisa will review your medication list during your New Patient consultation and advise if there is anything that should be discontinued, such as NSAIDs . In general, most medications that are unrelated to pain are fine to continue taking.


How would you diagnose me without an MRI?

An MRI is typically not needed in order to treat you for Prolotherapy. They typically are used to justify surgery and don’t focus on the ligaments in the same way that Dr. Lisa does with palpation, physical exam and history taking. Occasionally, there are times that an MRI may be warranted and would be ordered if deemed necessary to rule out significant conditions or obtain additional information that would increase your chance for better results.

Do I need to bring in my X-rays, MRIs, and old records?

If you do have imaging results, please bring a copy of the written report (actual CD images are not necessary). It is not necessary to have an MRI or other tests prior to your appointment, unless you have been otherwise instructed to do so by your medical provider. Results of recent lab work, done within the last six months,would be beneficial to bring to your visit.

Should I eat before my appointment?

Yes, you must eat before receiving Prolotherapy. Please eat a good-sized breakfast with protein before coming in for a morning appointment and eat a good-sized lunch with protein before coming in for an afternoon appointment.

How long is the visit?

The average new patient visit is approximately 60-90 minutes. For follow up Prolotherapy treatments, the visit duration is approximately 45 minutes.

Will I get Prolotherapy on the first visit?

Typically, the first visit is used for intake, physical exam and assessment of whether you are a good candidate for Prolotherapy. You will likely be given a pre-prolotherapy treatment plan in order to set you and your body up for a successful experience.

What forms of payment are accepted?

Dr. Lisa accepts cash, Visa, MasterCard, Discover, and American Express. Check out our Prolotherapy prices and billing policies.

Is Harbor Regenerative Natural Medicine and Dr. Lisa part of any insurance networks?

While Dr. Lisa is not a part of any insurance networks, she will provide you with detailed invoice that can be submitted to a private, non-HMO insurance company for possible reimbursement at the “out of network” rate. The invoice will reflect that you paid in full and reimbursement should be sent directly to the primary/patient. Invoices can NOT be submitted to government-based insurance plans such as Medicare, Medicaid, Tricare, or to HMO plans. Prolotherapy services are not billable to insurance and you will need to check with your insurance company to see if any services are covered.

If you have a Health Savings Account (HSA) or Flexible Spending Account (FSA), these are great payment options for regenerative medicine treatments.



Is this just to help postpone surgery?

Not necessarily! Prolotherapy is the preferred alternative to surgery, eliminating the need for surgery in most cases. Many patients have been told they need joint replacements, the dreaded “bone on bone” and are currently walking, jogging, playing tennis and golfing on a regular basis without surgery! Bone on bone, is not likely the cause of your pain, it is ligament laxity that typically causes it.

What happens if I don’t get complete relief after the first treatment?

Don’t get discouraged! Just because you do not notice immediate relief, does not mean nothing is happening. It takes time for your body to heal, and each treatment builds on the one prior. Think of it as building a house; you have to build the foundation first. It may not look like much progress, but without the foundation, you can’t build the house. The first treatment is the foundation, the base for all of your other treatments and the first step toward curing your pain! This is why it is so important for you to stay on your treatment schedule.

Why does the Prolotherapy series take more than one treatment?

Ligaments have a poor blood, and nutrient supply, because of this, they are slow to heal.  Prolotherapy causes inflammation at the ligaments, which initiates the healing cascade in the area. This inflammation tells the body there is tissue damage, and the body begins to send the additional nutrients and healing cells that are needed to not only tighten and strengthen the ligaments but help them regenerate as well.

Follow up is crucial with Prolotherapy, and this is when it matters most to work with an office that does Prolotherapy full time. When it comes to exercise, I make specific recommendations on what type of exercises, when you are allowed to graduate from cycling to jogging to running, etc. I work with you on specific supplements or other healing aids that can help boost or speed your response to Prolotherapy.

The Prolotherapy treatment series is a 50/50 deal. We are a team and it takes us both to succeed. I will give you the most comprehensive treatment techniques during your visit and recommend a home care plan and/or adjunctive treatment plan for you to work on after treatment. Whether your goal is to be able to play with your kids or grand kids, hike Mt. Rainer, run a marathon, return to work full-time, avoid a career-compromising surgery, enjoy retirement, or stop your pain medication dependency, I want to help you succeed!