Prolo Hawaii

Hawaii Center for Regenerative Medicine

The Hawaii Center for Regenerative Medicine is designed to provide our patients with advanced non-surgical pain relief to promote comprehensive, rapid and effective recovery.

ProloHawaii Offices

Dr. Smigel introduces to Hawaii the amazing, cutting-edge medical treatments for musculoskeletal problems such as acute and chronic sports injuries, accident injuries, cartilage tears, arthritis and nerve entrapments such as carpal tunnel syndrome. She treats patients with severe degeneration of the neck and low back including those who suffer with intractable pain despite spinal surgery

She offers traditional pain relief treatments and therapies, as well as state-of-the-art Regenerative Treatments, including Prolotherapy, Platelet Rich Plasma and Regenerative Cell Therapy. Dr. Liza Smigel is one of only a few Physiatrists nationally who is highly trained and experienced in these innovative, natural approaches to healing.

As a pioneer in Regenerative Medicine therapies, Dr. Smigel is well experienced in Prolotherapy, having been practicing this for 14 years. She was among the first physicians in the United States to experience first hand the miraculous effects of Neural Prolotherapy. She is considered to be the most experienced Neural Prolotherapist in the United States. She coordinates annual conferences on the Big Island and Chicago on Neural Prolotherapy, where approximately 100 International Doctors attend yearly.

She is also one of the pioneering physicians using Platelet Rich Plasma for orthopedic problems since its discovery a few decades ago. She is trained in Adipose and Bone Marrow Orthobiologic Therapy. She has discovered Dextrose Caudal Epidural for Treatment of Low back and lower extremity pain and will be published in the Archives of Physical Medicine and Rehabilitation. This coming October 2015. She continues to network with doctors around the world in Regenerative Medicine, which is now a global and rapidly growing field.

The Hawaii Center for Regenerative Medicine is proud to be the first Oahu Center for Advanced Regenerative Medicine Procedures. These procedures offer viable alternatives for patients with chronic pain who may be considering surgery.

Dr. Liza Smigel

Dr. Liza Smigel is Board Certified in Physical Medicine and Rehabilitation and highly trained in Interventional Pain Medicine. She has been in private practice in Hilo since 2002 and opened her practice in Oahu in 2009. After completing her PM&R residency at the University of Illinois, she completed a Musculoskeletal & Sports Arts Medicine Fellowship at the University of Texas-Houston. Dr. Smigel has been a faculty on the Hackett Hemwall Foundation trips to Honduras, Mexico and the Philippines, and at the Hackett Hemwall Patterson Foundation - University of Wisconsin Conferences. She has been faculty for the American Academy of Orthopedic Medicine in Peru, and faculty for Neural Prolotherapy Conferences all over the world including United States, Australia, Italy, New Zealand, Philippines and Mexico.

Dr. Liza Smigel uses ultrasound guidance to perform platelet rich plasma. She also uses fluoroscopic guidance to perform interventional spine injections in our Hilo office procedure suite for the care of patients with acute or chronic spine related conditions. We take great pride in combining cutting edge technology with compassionate care to give our patients an exceptional orthopedic medicine experience


prolotherapyProlotherapy is injecting dextrose or other irritant into the damaged area, it stimulates the tendon, ligament, joint, and cartilage, causing mild inflammation that triggers the healing cascade. As a result, new collagen begins to develop. As this collagen matures it begins to shrink and causes the tightening and strengthening of the tendons or ligaments of the damaged area.

neuralprolotherapyNeural Prolotherapy (NPT) is one of the newest exciting advances in Regenerative Medicine used to treat neuropathic pain in a variety of musculoskeletal injuries and various pain conditions. Neural Prolotherapy was developed and advanced by Dr. John Lyftogt from New Zealand. Neural Prolotherapy is the injection of a medical-grade sugar (either dextrose or mannitol or glycerol) just below the skin to promote healing of injured nerves and restoration of tissue function. This wonder therapy target specific receptors called TRPVI that are present in the sensory nerves. When TRPV1 is over activated, there is excessive release of neuropeptides called substance P and CGRP, which triggers the experience of pain, and with prolonged release of these neuropeptides, produces degeneration and disease. NPT works by down regulating TRPV1 release of the pain neuropeptides. Subcutaneous injection to deliver 5% dextrose leads to a complete freedom of pain within seconds of injection. The pain goes away almost immediately. The technique is simple, safe and very effective. There is cumulative effect with repeated treatments, and it may take 3- 6 treatment days before the patient is fully cured.


Platelet Rich Plasma stimulates bone, muscle and soft tissue healing. It is another treatment option in the event of a failed cortisone injection, or other therapies. Sports injuries, arthritic joints (knee, shoulder, hips, ankle, foot), tennis elbow, rotator cuff tears, low back pain, plantar fasciitis and all may be effectively treated with PRP. To prepare Platelet Rich Plasma, a small amount of blood is taken from the patient. The blood is then placed in a centrifuge, which spins and automatically creates the PRP, which increases the concentration of platelets and growth factors to 500%. It is a natural approach to healing ligament, tendon and joint injuries. The procedure is less aggressive and less expensive than surgery. It allows your body to heal itself using its own natural resource, your blood. PRP will heal tissue with minimal or no scarring and prevent further degeneration of the tissues. Recovery time from PRP is minimal, with quicker return to work and exercise.

Research and clinical data show that PRP injections are safe with minimal risk of adverse reaction or complication. Studies have shown that cortisone injections may actually weaken tissue. Cortisone shots may provide temporary relief and stop inflammation, but may not provide long term healing. Thus, pain may reoccur within months. PRP is delivered to the tissue in its inactivated form. The collagen in connective tissue activates the platelets, which then release their cytokines and growth factors. These chemical messengers signal genes to augment the healing stage and activate local regenerative cells. This causes regenerative cells, which migrate, from the local blood and bone marrow to the treatment site. The regenerative cells then become cartilage, ligament, and tendon or muscle cells as needed at the injury site. At the same time, the cytokines and growth factors downgrade the local inflammation. They mitigate the internal war between the bad proteins, which slowly chew up the joint cartilage in severe osteoarthritis and the good proteins, which stop this degeneration. Without this help, in a typical knee with osteoarthritis, it takes approximately five years from symptom onset to knee replacement, necessary when the cartilage is gone and the knee joint is bone on bone. The desired end result of PRP therapy is functional repair of an injured tendon, muscle or joint cartilage allowing it to bear greater mechanical stress during activity without pain. Patients can see a significant improvement in symptoms. This may eliminate the need for more aggressive treatments such as long-term medication or surgery, as well as remarkable return of function.

The use of PRP has expanded across many medical fields. PRP has been used in cardiovascular surgery; neurosurgery; ophthalmology; urology; ear, nose and throat surgery and cosmetic surgery. The procedure can be done in a doctor's office in thirty to sixty minutes and, some athletes have reported being back to their game as quickly as two days after the procedure, although three to ten days of downtime and six weeks away from rigorous training is more common.

While responses to treatment will vary, most people will require from one to three treatments. There is no limit to the number of treatments you can have, if the treatments are spaced appropriately.

Orthobiologic Therapy

Through Orthobiologic Therapy, a patient can take advantage of the body’s ability to heal itself by using the healthy regenerative cells that can be found throughout the body. Laboratory and clinical research have shown that it is possible to use regenerative cells to restore and repair damaged or aging cells and effectively regenerate tissue in the body. Additionally, Orthobiologic Therapy allows patients to receive orthopedic care on an outpatient basis. It is designed for patients with low back pain due to disc degeneration and joint pain due to osteoarthritis in the hip, knee, shoulder, etc.

While Orthobiologic Therapy has been used for decades to treat a variety of diseases, their application in orthopedic and sports-related procedures is relatively new. Dr. Smigel has currently completed training for this modality and will be providing it to the Hawaii community.

We take great pride in combining cutting edge technology with compassionate care to give our patients an exceptional orthopedic medicine experience.

Insurance companies do not currently cover these cutting edge treatments, and payment is due in full at time of visit
For more information about regenerative medicine, please check Call 808 933 3444 to set an appointment.

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