Examination by a prolotherapist emphasizes precise diagnosis. This involves a careful history, awareness of ligament referral patterns, physical examination, efforts at manually reproducing the patient’s pain, and often the injection of a local anesthetic at the site of the painful structure so that immediate relief in pain confirms it as the source of the problem. Any diagnostic studies such as scans or X rays are considered supplementary and secondary to diagnosis by physical examination. Precise and accurate diagnosis which is capable of localizing the source of pain to ligaments and tendons results in a greater chance of successful treatment.  As a non-surgical treatment modality, prolotherapy is relatively inexpensive and requires minimal to no downtime from usual activities of daily living. It also shares none of the usual list of general potential complications associated with surgery.  Prolotherapy does not disturb, remove or weaken existing non-pathologically-involved structures in the painful region, nor does it ever accelerate the degenerative arthritic process.  Prolotherapy is an effective treatment for chronic pain because it is able to specifically and permanently strengthen tissue and reverse ligament laxity and tendon strain, the number one causes of chronic joint and other musculoskeletal disturbances.9  Beyond relieving pain, the ligament tightening effect of prolotherapy stabilizes the commonly seen hyper-mobility in affected joints, thus literally slowing down or arresting the actual cause of the degenerative arthritis process. It is this abnormal motion and friction, relieved by prolotherapy, that causes the wearing down of joint cartilage and reactive bone spur formation that brings on the pain and progression of the common form of osteoarthritis.