Low Back Pain and Sacroiliac (SI) Pain

Ross Hauser, MDRoss Hauser, MD

Prolotherapy treatments consist of injections that stimulates the repair of connective tissues such as tendons and ligaments by causing a mild inflammatory response which initiates an immune response. This mimics what the body does naturally to heal soft tissue injuries.

Prolotherapy is effective in SI pain because we have found it fairly rare for sacroiliac pain to be caused by a pinched nerve or by a slipped or herniated disc. Much more common is a ligament injury which caused ligament laxity or ‘looseness.”

Research published in the medial journal Spine, (A. Schwarzer, 1995) 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.”

Our clinical experience has been that if we treat back pain with Prolotherapy, administering injections into the  lumbar and SI ligament attachments that exhibit tenderness, the pain and referred pain diminishes, even when MRI’s showed disc abnormalities. The injections are not given near the discs yet the back pain is completely healed.

Ligaments and the SI Joint

Ligaments connect bones to each other, like the vertebrae to each other and the sacrum to the pelvis. The sacrum is the part of the spine below the fifth and last lumbar vertebrae and above the coccyx. The uppermost portion of our pelvis is called the ilium. The area that connects these structures is called the sacroiliac joint (SI): sacro from the sacrum, iliac from the ilium. There is an expansive mesh of ligaments that make up this sacroiliac joint which is frequently injured. A problem here can affect the groin, pubis, hips and lower lumbar areas as well.

A Success Story: From one of the Caring Medical staff – Joe the male nurse

One of my own injuries that was successfully treated with Prolotherapy perfectly illustrates the point made in the above paragraph. I have been one of Dr. Hauser’s nurses for nearly six years and have had several areas treated. My worst injury began as a left hamstring injury incurred from increasing my pace on a training run. The original point of injury was where the hamstring attaches to the ischial tuberosity (IT), the bottom most part of the pelvis, the bone you sit down on.

As with most people, I tried rest, heat, stretching, not stretching, nothing seemed to help. Even me, a person with access to a great Prolotherapy doctor, put off the injection treatment to see if I could heal it on my own.

Can you blame me? Nurses don’t like shots either. The problem was my IT hurt on my left so while driving I leaned on my right. After a month of doing this, can you guess what happened? That’s right; the pain was now traveling up into my left SI joint, and was beginning to affect my sleep. The abnormal motion of sitting just on my right buttock caused an imbalance in my SI joint. Because I was educated in the mechanics of the pelvic ligaments, I knew that if left unchecked, my IT and SI problem could eventually cause a problem in my lumbar ligaments. So two months after my original injury, it was time to get up on the Prolotherapy table and take my medicine!

 

After the soreness from the treatment wore off in a few days, I estimated my pain as 40% less. I needed three more treatments spaced about four weeks apart to completely resolve my problem.

We’ve seen many diagnoses for back pain and oftentimes patients ask how Prolotherapy can help with their specific back condition. Whether it’s a pinched nerve, sciatica pain or spinal stenosis, Prolotherapy helps by addressing the root cause of the issue – ligament laxity. Most back pain conditions result from a degenerative cascade that occurs along the spine.

Degenerative Cascade and Prolotherapy

Degenerative Cascade.

Ligament Instability

The degenerative cascade explains the origin of degenerative disc disease, bone overgrowth and spinal stenosis. In other words, disc issues arise with increasing instability of the spinal structure. As can be seen from the illustration, instability of the spine is a part of the degenerative cascade. If the instability isn’t treated, the end result will be the overgrowth of bone and the potential for various pinched nerves (spinal stenosis).

Ligament Laxity

Instability in the lower back, neck or thoracic spine occurs because various ligaments become torn, weakened or stretched. As the ligaments weaken they lose the ability to hold their specific vertebrae in place. As the vertebrae move excessively much force is placed on the intervertebral disc and facet joints. As excess movement occurs and force increases the discs and facet joints start to deteriorate at an accelerated rate. The body tries to stabilize the spine by muscle spasms. When this doesn’t work the body overgrows bone that leads to pinched nerves via spinal stenosis, facet syndrome, or multilevel spondylosis (osteoarthritis).

Prolotherapy Halts the Degenerative Cascade

While surgery is an option once a person reaches the pinched nerve stage, Prolotherapy often is all that is needed. Prolotherapy is an injection technique that created a mild inflammatory response mimicking the body’s natural response to soft tissue injury. The inflammation draws in healing factors that regenerate cartilage leading to stabilization of the spine through strengthened ligaments. When a person has the burning pain down the leg or arm in a certain position (like walking or with the neck extended), Prolotherapy can diminish the pain by affecting the ligament laxity and thus the stability of the vertebral segments one to the other. Once the stabilized vertebral segments move in unison, the instability stops and along with it the degenerative cascade and the chronic pain.

In the ideal situation, the person would receive Prolotherapy early in the degenerative cascade. If spinal pain is not relieved within a few weeks of therapy, exercise, rest or osteopathic/chiropractic work then Prolotherapy should be considered. The earlier a client comes in for Prolotherapy, generally the fewer treatments are needed. Typically Prolotherapy is given every three to five weeks and generally three to six visits are needed. . For more information on Prolotherapy for your specific back condition, give us a call at 708-848-7789 or email us at drhauser@caringmedical.com.