Prolotherapy for low back pain

Ross Hauser, MDRoss Hauser, MD

The first step in determining if prolotherapy for low back pain can be an effective treatment for the patient is to determine ligament laxity or instability in the lower back by physical examination. The examination involves maneuvering the patient into various stretched positions. If weak ligaments exist, the stressor maneuver will cause pain. Do this simple test at home: Lie flat on your back and lift your legs together as straight and as high as you can, then lower your legs. If it is more painful to lower your legs than to raise them, laxity in tile lumbosacral ligaments is likely. During physical examination by a physician, laxity can be “tested” by palpating various ligaments with the thumb to elicit tenderness. A positive “jump sign” indicates ligament laxity.

Prolotherapy for low back pain

Low back pain is one of the easiest conditions to treat with Prolotherapy. Ninety-five percent of low back pain is located in a 6-by-4 inch area, the weakest link in the vertebral-pelvis complex. At the end of the spine, four structures connect in a very small space which happens to be the 6-by-4 inch area. The fifth lumbar vertebrae connects with the base of the sacrum This is held together by the lumbosacral ligaments. The sacrum is connected on its sides to the ilium and iliac crest. This is held together by the sacroiliac ligaments. The lumbar vertebrae is held to the iliac crest and ilium by the iliolumbar ligaments. This is typically the area treated with Prolotherapy for chronic low back pain.

Please see our article for more information about failed treatments for lumbar disc herniation.

Sacroiliac Ligaments

The diagnosis of ligament laxity in the lower back can be made relatively easily. Typical referral pain patterns are elicited-the sacroiliac ligaments refer pain down the posterior thigh and the lateral foot, the sacrotuberous and sacrospinous ligaments refer pain to the heel. The iliolumbar ligament refers pain into the groin or vagina. Iliolumbar ligament sprain should be considered for any unexplained vaginal, testicular, or groin pain.

The most common cause of unresolved chronic low back pain is injury to the sacroiliac ligaments which typically occurs from bending over and twisting with the knees in a locked, extended position. This maneuver stretches the sacroiliac ligaments, placing them in a vulnerable position.

How effective is prolotherapy for low back pain? In one of his original papers, George S. Hackett, M.D., noted 82 percent of people treated for posterior sacroiliac ligament relaxation considered themselves cured and remained so 12 years later.

Ross Hauser, MD demonstrates Hackett-Hemwall dextrose Prolotherapy to the low back. This is a more comprehensive approach to get permanent back pain relief and is an alternative to spinal fusion, laminectomy, chronic chiropractic adjustments or unsuccessful physical therapy exercises.


In research published in the Journal of Prolotherapy a research team including myself investigated the outcomes of patients undergoing Prolotherapy low back pain.

We looked at One hundred forty-five patients, who had been in pain an average of four years and ten months, were treated quarterly with Prolotherapy. This included a group of 55 patients who were told by their medical doctor(s) that there were no other treatment options for their pain and a subset of 26 patients who were told by their doctor(s) that surgery was their only option. Patients were contacted an average of 12 months following their last Prolotherapy session and asked questions regarding their levels of pain, physical and psychological symptoms and activities of daily living, before and after their last Prolotherapy treatment.

In these 145 low backs, pain levels decreased from 5.6 to 2.7 after Prolotherapy; 89% experienced more than 50% pain relief with Prolotherapy; more than 80% showed improvements in walking and exercise ability, anxiety, depression and overall disability; 75% percent were able to completely stop taking pain medications. The decrease in pain reached statistical significance at the p

In this retrospective study on the use of Hackett-Hemwall dextrose Prolotherapy, patients who presented with over four years of unresolved low back pain were shown to improve their pain, stiffness, range of motion, and quality of life measures even 12 months subsequent to their last Prolotherapy session. This pilot study shows that Prolotherapy is a treatment that should be considered and further studied for people suffering with unresolved low back pain.

Free access to this Prolotherapy research on back pain article can be found at the Journal of Prolotherapy.

More Prolotherapy research citations can be found on this page on our site Prolotherapy research. To learn more about Prolotherapy and if it is the right treatment for your hip pain, please read our article Prolotherapy information for patients.