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Prolotherapy and Disc Problems
Richard I. Gracer, M.D.
While disc problems cause
back pain and are often responsible for
sciatica (leg
pain), ligaments that are strained or lax are the most common cause.
When you bend over the
sacroiliac joints (SIJ) must loosen and release the
pelvis to allow for the necessary movement. The only structures that hold these
bones together are very strong ligaments. If one twists to pick something off
the floor while they are bent forward, the SIJ can get caught at an awkward
angle, causing severe and immediate pain and muscle spasm. Usually the pain
passes in a few days as the SIJ can return to its usual position. Often,
however, it stays misaligned and can cause ongoing, chronic back problems. After
a while, the ligaments that hold the joints in place can become lax and
overstretched, much as a rubberband that has been holding too many pencils. When
this happens, one's back can "go out" frequently or there can be a chronic ache
that gets worse with sitting or standing, but better with walking a short
distance or constantly changing positions.
When one has sciatica, they usually think that a disc pinching a nerve in the
back causes it. The spinal nerves run from the spinal cord area down the legs
and pressure at their origins can cause symptoms further down their length. This
is called
referred pain. While this is true, ligaments also refer pain to the
buttock and leg pain in specific patterns that were worked out by Kelgren in the
1930's. He took medical student "volunteers" and injected them with concentrated
salt solution into specific ligaments. He then recorded exactly where they felt
pain. We use these patterns today to help decide which ligaments are involved.
Ligaments are sensitive to pressure and tension. When they are strained or lax
they send painful stimuli to the brain and one experiences pain or even a
numb-like sensation called nulliness. When one changes positions or gets up to
walk this ongoing stimulation is relieved and the pain goes away. When the
physician examines a patient with this type of problem, she or he finds that the
ligaments themselves are tender to touch.
The treatment is to correct the misalignment with
manipulation performed by an
osteopathic physician,
chiropractor, physician, or
physical therapist well
trained in this type of work. There is often immediate relief of pain, although
if the problems are longstanding it may take time for the ligaments to heal.
Many research studies have shown the value of this type of intervention. I feel
that if manipulation is going to work, it will help early and if there is no
change after two or three treatments, something else, such as an injection of
cortisone with lidocaine in the area of the painful ligaments needs to be done.
Another important aspect of care is to maintain the corrected position with
specific exercises. Nutritional supplements such as vitamin C, many of the B's,
and
glucosamine sulfate are also important for helping the ligaments to heal.
Following a low carbohydrate diet decreases insulin levels, allowing the cells
to produce more anti-inflammatory prostaglandins.
Although these conservative measures should be tried first, it is very common
for the ligaments to get too lax for them to be effective. If they fail to
relieve the problem the next treatment is to induce a mild
Inflammation in the
ligaments by injecting a concentrated sugar and lidocaine solution onto the
ligaments themselves. This effects healing that results in stronger and less
sensitive ligaments that will not allow abnormal movement and are not as
sensitive to pain. This is called Proliferative Therapy. A series of injections
is given at intervals of one to two weeks. There are two double blind controlled
research studies one in the Lancet (1987) and the other in The Journal of Spinal
Disorders (1993) that show that this treatment is effective about 80 percent of
the time.
Most physicians are not familiar with many of the concepts that I have outlined
in this article. If you have suffered with
chronic
low back
pain that has not
responded to the usual treatment of exercise and medication, perhaps you explore
some of them.
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