What Is Prolotherapy? A San Francisco Doctor's Guide to Healing Joint Pain Without Surgery
By Dr. Smriti Singh, DO, MPH · Updated October 2026
You work out. You eat well. You do the things that are supposed to keep you healthy and yet your knee still aches after a hike, your shoulder still catches when you reach overhead, or your lower back still talks to you every time you sit down for a long day of meetings.
You've tried the workout modifications. The foam rolling. Maybe even a round of physical therapy or a cortisone shot that helped for a few weeks and then wore off. You're not injured, exactly. You're just... stuck.
If that sounds familiar, you may be a good candidate for a conversation about prolotherapy as a non-surgical injection therapy that's been used for decades to treat chronic joint and ligament pain, and one of the core services we offer at Trailhead Wellness Medicine here in San Francisco.
What Does Prolotherapy Treat?
Prolotherapy is most often used for pain in:
Knees, including knee osteoarthritis
Neck or mid-back pain (cervical and thoracic pain)
Low back and sacroiliac (SI) joint
Shoulders and rotator cuff tendon pain and tears
Elbows (tennis elbow and golfer’s elbow)
Ankles, achilles tendon, and plantar fasciitis
What Is Prolotherapy?
Prolotherapy (short for "proliferation therapy") is a series of injections designed to stimulate the body's own natural repair process in an area of chronic pain, most often a joint, tendon, or ligament that's become weakened or unstable over time from overuse, past injury, or simple wear and tear.
Unlike a cortisone shot, which is designed to calm inflammation temporarily, prolotherapy works differently: it introduces a mild irritant solution (typically a dextrose, or sugar-water, solution) directly into the injured tissue. This is thought to trigger a localized healing response, encouraging the body to lay down new, stronger connective tissue at the site of the injection.
It's important to know that prolotherapy is not the same as PRP (platelet-rich plasma) therapy, which is a different regenerative treatment that uses a patient's own blood components. At Trailhead, we perform prolotherapy and we want our patients to understand exactly what they're receiving and how it works.
Who Tends to Seek This Out
Our prolotherapy patients are usually people who:
Are active, or want to be, but keep getting sidelined by the same nagging joint or ligament pain
Have tried physical therapy, rest, or over-the-counter approaches without lasting relief
Want to explore options before considering surgery
Are drawn to a more hands-on, non-medication, approach to their health rather than a one-and-done fix
Value understanding why their body hurts, not just masking the symptom
What to Expect
Every prolotherapy plan at Trailhead starts with a real conversation, not a script. Dr. Smriti Singh is an emergency medicine physician who founded Trailhead Wellness Medicine and evaluates the joint or area in question, talks through your history and goals, and builds a plan around what's actually going on in your body. As an osteopathic physician, Dr. Singh also uses hands-on osteopathic manipulative treatment (OMT) before and after injections to improve how the joint moves and support healing.
From there, prolotherapy is typically done as a series of injections spaced a few weeks apart, often packaged as a three-session series over the course of a few months. Most patients tolerate the injections well, though some soreness at the injection site for a few days afterward is common similar to how a muscle feels after a hard workout.
Because prolotherapy works with your body's own repair process, it isn't an overnight fix. It's a gradual approach, and results vary from person to person depending on the joint involved, how long the issue has been present, and your overall health.
Why San Francisco Professionals Choose Trailhead
Trailhead was built for people who want more than a rushed ten-minute appointment. As a cash-pay, concierge medical practice, we're not working around insurance restrictions or a packed waiting room we're working around your schedule and your goals, with direct access to your physician.
Dr. Singh's background in emergency medicine means she's spent her career making fast, careful assessments of what's actually wrong and that same instinct shapes how she approaches long-term, preventive care now. Whether you're dealing with an old running injury, a shoulder that's never quite been the same since a ski trip, or knees that ache more than they used to, the goal is the same: understand what's happening and build a real plan around it, together.
Frequently Asked Questions
Is prolotherapy painful? Most patients describe the injections as a brief pinch or pressure, followed by mild soreness for a day or two, comparable to post-workout muscle soreness. Most patients have tolerated the injections very well and report it is less painful than anticipated!
How many sessions will I need? This varies by patient and by joint, but prolotherapy is typically done as a series (often 3-6 sessions) spaced 4-6 weeks apart, since the treatment relies on your body's own healing process over time.
Does insurance cover prolotherapy? Trailhead is a cash-pay practice, and prolotherapy is offered as a self-pay service. We're happy to walk you through pricing and packages during a consultation.
Is prolotherapy right for everyone? Not necessarily it depends on the joint, the underlying cause of pain, and your overall health history. That's exactly what the initial consultation is for.
Will prolotherapy get rid of my pain permanently? Every body responds differently, and we can't promise a specific outcome. What we can promise is an honest evaluation, a plan built around your goals, and a physician who will tell you clearly whether this approach makes sense for you.
Curious If Prolotherapy Is Right for You?
You don't need to have it all figured out before reaching out. Come talk with us. We'll take a real look at what's going on, answer your questions honestly, and help you figure out whether prolotherapy, or something else is the right next step.
Book a consultation with Trailhead Wellness Medicine
This article is for general educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Individual results vary. Please consult with a qualified physician to determine whether prolotherapy is appropriate for your specific condition.
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