If you
suffer from unresolved sacroiliac joint pain, Prolotherapy and Platelet Rich
Plasma Therapy may be the answer.
Researchers
writing in the medical journal Pain Physician examined conservative,
interventional, and/or surgical management options for managing sacroiliac
joint pain.
They noted:
“It is generally accepted that approximately 10% to 25% of patients with
persistent low back pain may have pain arising from the sacroiliac joints.”
What did
they find?
“The
evidence for cooled radiofrequency neurotomy in managing sacroiliac joint pain
is fair.
The
evidence for effectiveness of intraarticular steroid injections is poor.
The
evidence for periarticular injections of local anesthetic and steroid or
botulinum toxin is poor.
The
evidence for effectiveness of conventional radiofrequency neurotomy is poor.
The
evidence for pulsed radiofrequency is poor.” (1)
Why isn’t
prolotherapy and platelet rich plasma the standard in treatment of low back
pain?
There isn’t
a week that goes by when a patient who has experienced relief of chronic lower
back pain asks, “why did it take so long for me to find out about
prolotherapy?.” This is often followed
by, “I can’t believe prolotherapy was not the first treatment recommended for my
back – it was the only treatment that works.”
Most
patients that seek either prolotherapy and platelet rich plasma (PRP) treatment
of their lower back pain come to us as a last chance effort. They have tried
nearly every other treatment and have exhausted all possibilities –
chiropractic, acupuncture, epidurals, steroids, physical therapy, massage, and
a litany of medications such as anti-inflammatories, Lyrica, Neurontin,
anti-depressants, muscle relaxers, and others.
Some patients have also had surgeries on their back – fusions, laser
spine surgery, discectomy, and decompression.
Unfortunately, most patients who have chronic lower back pain sometimes
give up, and are told to “deal with it”, or end up on large amounts of opiates
like Oxy Contin.
So why
would prolotherapy and PRP work so well for this large subset of patients? Why would a patient who suffered each and
every day in pain for 20 or 30 years experience relief within a few months of
starting prolotherapy or PRP? The answer
is simple. The back is not just a disc
problem. The disc is a shock absorber
for vertebrae, and while this shock absorber can become defective, there are so
many other parts of the lower back and support structure for the lower back
that can cause pain.
“Intra-articular
prolotherapy provided significant relief of sacroiliac joint pain, and its
effects lasted longer than those of steroid injections. Further studies are
needed to confirm the safety of the procedure and to validate an appropriate
injection protocol.” (2)
“Ninety-one
percent (91.0%) of (Prolotherapy) patients reported reduction in level of pain;
84.8% of patients reported improvement in activities of daily living, and 84.3%
reported an improvement in ability to work.” (3)
Take, for
instance, the sacroiliac joint (or SI joint).
Not only can this joint become arthritic, but all of the ligament and
tendon structures that hold this joint together can become stressed, strained,
or torn but may appear normal on MRI (which is not very accurate at diagnosing
sacroliliac pain). Research published in
the medial journal Spine, states “ligament laxity in the sacroiliac joint is
the number one reason for sciatica, or pain radiating down the side of the leg,
and is one of the most common reasons for chronic low back pain.” (4)
Additionally,
most back pain patients have a functional leg length discrepancy / tilted
pelvis which further exacerbates sacroiliac joint pain. While epidurals, steroids, or surgery cannot
repair the damage that cause sacroiliac pain, prolotherapy and platelet rich
plasma (PRP) injections can!
If you have
the opportunity to examine and study the anatomy of the lower back and pelvis,
look at the ligament structure. The
ligaments that insert into the L4 and L5 vertebrae (which are the most common
to herniate in the lower back), actually are contiguous structures with the
sacroiliac joint, coccyx, and insert into the ischium (sit bones). Therefore, dysfunction in any part of this
ligament structure can impact what happens with the L4 and L5 disc and vertebrae. Just a tilt in the pelvis completely disrupts
the balance between the left and right sides of the back and contributes to
back and pelvic pain.
Now if you
are skeptical, and still think that prolotherapy and platelet rich plasma
injections to the lower back are without merit, realize not only has this
treatment withstood the test of time, with doctors practicing prolotherapy
dating back to the 1950s, but randomized medical studies have shown significant
success (greater than 85%) in patients with chronic lower back pain. In fact, in my home town of Philadelphia, PA,
the head orthopaedic spine surgeon, Abraham Myers, MD realized that the back
surgeries that he performed on his patients did not help, he decided instead to
treat his patients with prolotherapy. He
practiced prolotherapy for back pain until he was in his 80s, and had a
satisfying and successful career curing patients with chronic back pain.
Yes, many
insurance companies may not cover prolotherapy, and often patients are driving
or flying to our office to seek our expert treatment, but in the long run think
about how much time, aggravation, and wasting time on other procedures,
medications, and therapies you will spend, hoping for a cure, when prolotherapy
may be it. All it takes is a careful
history, physical examination of the back, pelvic tilt, feet, hips, reflexes
and strength in skilled and experienced hands to determine if someone has an
excellent chance at being cured of their back pain with prolotherapy and/or
platelet rich plasma.
- Hansen H, Manchikanti L, Simopoulos TT, et al. A systematic evaluation of the therapeutic effectiveness of sacroiliac joint interventions. Pain Physician. 2012 May;15(3):E247-78.
- Kim WM, Lee HG, Jeong CW, Kim CM, Yoon MH. A randomized controlled trial of intra-articular prolotherapy versus steroid injection for sacroiliac joint pain. J Altern Complement Med. 2010 Dec;16(12):1285-90.
- Hooper RA, Ding M.Retrospective case series on patients with chronic spinal pain treated with dextrose prolotherapy.J Altern Complement Med. 2004 Aug;10(4):670-4.
- Schwarzer AC, April CN, Bogduk N. The sacroiliac joint in chronic low back pain. Spine 1995;20:31-37
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