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Prolotherapy
Regenerative medicine for loose ligaments and lingering pain
Prolotherapy is an ultrasound-guided injection that signals your body to finish healing a stretched-out ligament or a worn tendon, so it can do its job again.
Here’s how we approach Prolotherapy at OASIS, starting with the diagnosis that tells us whether it’s the right treatment for you in the first place.
What is Prolotherapy?
If you sprained something years ago and it never quite felt right again, or a joint feels loose, keeps catching, or gives out long after it should have healed, the problem is often the same: a healing response that started but never finished. Prolotherapy is built for exactly that situation.
Prolotherapy is the controlled use of a mild irritant, usually a dilute dextrose solution (a.k.a. sugar water), that signals to the body that the healing response in a particular area was never finished, and prompts it to try again. The way I explain it to my patients: picture a road crew setting a ring of traffic cones around a pothole. The cones don't fix anything themselves. They flag the spot so the right crew comes to deal with it. Prolotherapy is the cones. It signals; your body does the repair.
For our patients, the procedure is about as natural and uneventful as medicine gets: We prepare a dilute solution of dextrose, ranging from 5 to 15 percent in sterile water, identify the exact site of injury, and under live ultrasound guidance, place the needle directly into the damaged area, injecting small amounts, usually half a milliliter to a milliliter at a time. The needle is very fine, about the diameter of a flu-shot needle, and most patients barely feel it. Local anesthesia often isn't needed at all, though it's available for anyone who's anxious about needles. Sometimes the injection is repeated up to three times over a few weeks, but more often it's titrated to effect: if you've already responded well after one or two, the series is done.
What conditions is Prolotherapy used for?
Prolotherapy really shines in conditions of ligament laxity. Ligaments are the tissues that hold bone to bone. They're meant to be strong and to allow only minimal movement. The ones you've probably heard of in sports, the ACL, MCL, and LCL, are all ligaments of the knee that keep it stable through its range of motion.
When a ligament becomes loose, whether from a single injury or from years of repeated sprains, it stops doing its job even if it's still fully intact. Think of a rubber band that's been overstretched: not torn, but no longer holding tension. Here is the part that matters most, and that most patients have never been told: ligament laxity does not show up on an MRI. The only way to prove it is a physical examination, and the most conclusive way of all is a physical exam performed under live ultrasound, where we can watch the ligament do, or fail to do its job in real time. Prolotherapy is very good at signaling the body to tighten those ligaments back up and restore their natural function.
A thumb ligament under live ultrasound, where we can see the liagment is intact, but lax. This allows the two bones, the thumb metacarpal and proximal phalanx, to move excessively relative to each other.
The other condition that responds well is tendinopathy, such as tennis elbow or jumper's knee. Tendons connect muscle to bone, and tendinopathy is the chronic breakdown of their normally uniform structure, leaving a tendon that's enlarged, weaker, and persistently painful. That cluster of findings is the body's own unsuccessful attempt to heal a chronic insult, and prolotherapy can serve as the boost that pushes an incomplete, stalled repair toward a more complete one. There are other uses, but these two are what I reach for prolotherapy to treat most often.
Where Prolotherapy shines
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Ligament laxity: a ligament that's intact but loose, like an overstretched rubber band, where stressing it reproduces your pain
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Tendinopathy: an intact but enlarged, disorganized, and/or weakened tendon (such as tennis elbow and jumper's knee)
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Chronic injuries lingering past the normal healing window (more on that below)
Where Prolotherapy is unlikely to help
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A fully transected ligament, where the two ends are no longer connected, and no amount of signaling will reattach them
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A full-thickness tendon tear, where the tissue is completely disrupted
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Large tears layered on top of tendinopathy, which often need a stronger healing mechanism, like PRP
How do we decide who's a candidate?
As with everything we offer, the non-negotiable foundation is an accurate diagnosis. For any treatment, the first job is to prove what we're actually treating, and that comes from a careful medical interview, a thorough physical examination, and the right use of ultrasound.
For ligament laxity, the proof is best obtained with a physical exam under direct ultrasound. There is nothing quite as conclusive as watching a ligament stretch on the screen as the two bones it's supposed to hold together run away from each other. When that laxity reproduces the exact pain you came in with, you're an excellent candidate for prolotherapy.
Tendinopathy is confirmed the same way: under ultrasound, we can see the tendon is enlarged, disorganized, and weakened rather than torn. That kind of intact-but-degraded tendon tends to respond well to prolotherapy.
What makes someone a less ideal candidate is the degree of damage. If the rubber band isn't merely loose, but fully cut through, no amount of prolotherapy can match what prompt surgical repair can do. Partial-thickness tears with laxity are a toss-up; in my experience, they can respond, and a good response often signals that PRP would do better still.
One more thing that decides candidacy: timing. For most people, an injury the body was capable of healing on its own would have done so within about six to eight weeks. That's a general rule, and it varies by body part, but if your injury is lingering past the two-month mark, it's a hint that the body's own healing response gave up before it finished. That's exactly where prolotherapy earns its place. We tend not to use it on fresh, acute injuries, because if your body is going to fix something on its own, there's no reason to add a needle and its small risks to a problem that was already getting better.
Finally, prolotherapy depends a great deal on your underlying health, the same as most regenerative medicine. If you smoke, or have uncontrolled diabetes, the results suffer. If you're otherwise healthy and simply ran into some bad luck, you'll likely do well. Your specific conditions are reviewed in the consultation and folded into an honest risk-and-benefit conversation built around you.
So candidacy isn't a simple yes or no. It rests on three things: the right diagnosis, the degree of the injury, and the state of your overall health. The consultation isn't there to sort you into a yes pile or a no pile — it's there to find out what's actually causing your pain, and what it will take to get you the result you deserve. That's what sets us apart from other offices offering these injections: we don't just perform a procedure, we help you take full ownership of your health and optimize you for the best possible outcome.
How does Prolotherapy compare to the alternatives?
Most people with a chronic musculoskeletal injury have already been handed some version of the same menu: surgery, a cortisone shot, or try physical therapy while waiting for a denied MRI. Some are also shopping for other regenerative options. Here's how prolotherapy sits against each.
Surgery, we've mostly covered. The rule of thumb: surgery is the right call for full-thickness tears and complete ruptures of ligaments and tendons. Anything less substantial than that is where prolotherapy can reasonably be considered first.
Cortisone deserves a closer look, because it's what most patients have already been offered. Cortisone is the everyday word for a corticosteroid injection, a class of drug that mimics the body's own steroids and acts as an extremely powerful anti-inflammatory. On the surface, that sounds ideal: switch off inflammation, switch off the pain. The problem is that inflammation is how your body repairs damaged tissue. So when you carpet-bomb an area of injury with cortisone, you're essentially telling the body to stop what it's doing and attempt no further healing. What you get in exchange is temporary pain relief on top of weakened or incomplete healing, leaving a structure that's more prone to reinjury. In a way, cortisone is a deal with the devil. If your only goal is short-term relief and you're not concerned about the underlying structure over the long run, it can be okay. But in an era where prolotherapy and regenerative medicine exist, I can't recommend it first-line for most conditions anymore. The fact that the insurance-based world still treats it as first-line tells you everything you need to know about their priorities (hint: it's not delivering the best care for you).
Then there's the rest of the regenerative menu: an alphabet soup that includes PRP (platelet-rich plasma), BMAC (bone marrow aspirate concentrate), and MFAT (microfragmented adipose tissue), some of which we offer now and some of which we'll offer later. The way I place prolotherapy on that menu is as the appetizer. Think of it as the soup or salad: if you respond well to it, that's a pretty good sign the main course will do even more for you. It's a broad generalization, but it's the simplest, honest way to say it.
Here's the same comparison in one place:
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Ready for an answer?
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Request a consultation with Dr. Kiok to find out if you're a candidate for Prolotherapy.
What does treatment look like?
Prolotherapy is tiny-volume injections of dilute sugar water into a ligament or tendon under ultrasound guidance. It's about as safe, natural, and boring as a procedure gets. Sometimes a series of up to three injections, spaced a month or two apart, is needed for the fullest effect. The needle is teeny, about the diameter of the one used for a flu shot, and the injection is often done without any local anesthetic simply because so little is felt. Patients are routinely surprised by how worked up they got over how little they feel. Local anesthetic, like lidocaine, is always available for anyone squeamish about needles, with one caveat: it means two needle sticks instead of one, the lidocaine first and the prolotherapy after.
Recovery is gentle. We ask you not to stress the ligament or tendon in unusual ways — no strenuous exercise, jumping, or impact sports — until we've confirmed its stabilizing function is restored. Short of that, life goes on as normal: you can move, walk, drive, and work.
The timeline does run long, and it's worth setting expectations honestly. The series can stretch over several months, sometimes requiring up to three injections to get the maximal effect. Many patients feel pain relief within the first few weeks, but structural function usually isn't restored until at least the two-to-three-month mark. We're playing the long game here. We typically understand what your maximal effect looks like around six months, though improvement has been shown to continue, incrementally, anywhere from six months out to three years.
Prolotherapy may also be paired with a formal physical therapy program. If a ligament has been lax for long enough that you've developed compensating habits, like a subtle change in how you walk, we may enroll you with our concierge physical therapist during the treatment course to unlearn those patterns, take pressure off the stretched ligament, and restore natural movement. We may also recommend physical therapy alongside the injections when there are several sites of laxity and the overall picture is more involved than a single isolated injury.
The process, step by step:
Step 1: Consultation and diagnosis
Interview, exam, and in-office ultrasound confirm the real source of the pain. Remember, ligament laxity is proven by a physical exam under ultrasound, not by MRI. One hour with Dr. Kiok, $500, credited toward your plan if you proceed
Step 2: The injection
Dilute dextrose injection placed down to the millimeter under live ultrasound. A flu-shot-sized needle; usually no anesthetic needed. Most patients barely feel it.
Step 3: The series
Titrated to effect: up to three injections spaced a week to a month apart, stopping early if you've already responded well.
Step 4: Recovery
Keep using the area normally (walk, drive, work); avoid strenuous loading until stabilizing function returns. Optional concierge rehab to unlearn compensating movement habits.
Step 5: Follow-up
Pain relief often within the first weeks; structural function by two to three months; maximal effect read around six months, with incremental gains possible out to three years.
What are the risks?
Any time a needle goes anywhere in the body, there's a risk of infection, no matter how carefully we prep, and a chance of touching something we shouldn't, whether a nerve or a blood vessel. The way we minimize that is by doing the entire procedure under live ultrasound guidance. We can prove the needle went exactly where we said it would and that it touched nothing it wasn't supposed to. Ultrasound guidance is the top-end standard of care for delivering accurate injections to soft-tissue injuries. As for infection, we take our precautions and carefully screen your health history for anything that would compromise your ability to fight off everyday germs. It's impossible to make any environment 100 percent sterile, so we still rely on your own immune system for the few organisms in the air and on the skin.
So you know what to watch for: signs of infection include fever, chills, body aches, and warmth, redness, bleeding, or swelling at the site. If a nerve is irritated, you'd notice numbness, tingling, burning, and pain along that nerve's path, and possibly some weakness if it supplies a muscle.
Worth putting in perspective: this risk profile is actually far more favorable than the standard blind cortisone injection that many offices still give for everyday aches and pains. Those are done without ultrasound, with a larger needle, and with cortisone, which switches off the inflammatory response right where it's injected, and with it, your ability to fight off any infection that reaches that area. Cortisone also carries a long list of side effects of its own, ranging from localized fat necrosis and skin atrophy to systemic ones like worsening diabetes and, in rare cases, agitation and psychosis. Those serious effects are uncommon, but the point stands: what's already done routinely out there is riskier than prolotherapy, and done with a bigger needle and far less precision.
How much does it cost?
Every injury is different, so the cost of a prolotherapy plan depends on your diagnosis: how many sites need treatment, and whether we recommend pairing the injections with a structured rehabilitation program. We'll walk you through the specifics in your consultation once we know exactly what we're treating.
For simple, isolated ligament issues, prolotherapy is often the most cost-effective regenerative option. Think of it as a sneak peek at your body's regenerative capacity: if you have a partial response, that's a good sign a stronger option like PRP would do even more, and you can decide to go further whenever you're ready.
The path there starts with a consultation: one hour with Dr. Kiok for $500, which is credited toward your treatment plan if you proceed.
Is it covered by insurance?
No, Prolotherapy is not covered by insurance.
It's worth understanding why we're comfortable with that: An insurance company's job is to keep its own costs down, not to find what's best for you. We don't take insurance because we don't believe a coverage desk should shape your care. Treatment plans are decided in person, between you and Dr. Kiok, and carried out on a timeline that fits your goals; no delays, no denials. We don't invite an insurer into the exam room, so we don't weigh their opinion on your care. No exceptions.
Learn more about why regenerative medicine isn't covered by insurance.
How can I find out if Prolotherapy is right for me?
Prolotherapy’s success depends entirely on having the right diagnosis. At OASIS, we reach that diagnosis through the foundations of good medicine:
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A thorough medical interview, where we listen in detail to your symptoms, what aggravates and relieves them, and anything that might point to, or rule out, the real problem
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An intensive physical examination, with particular attention to laxity at the site of injury (only possible through ultrasound, not MRI or X-ray)
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Live musculoskeletal ultrasound, performed in our office
If you want to find out whether prolotherapy, or any regenerative medicine, is the right path for you, it all starts with a good diagnosis, and a good diagnosis starts with a consultation with us.
You'll leave knowing what's actually causing your pain and what it will take to get you the result you deserve.