Ann Auburn, DO, Scott Benjamin, PT, DScPT, & Roy Bechtel, PT, PhD. Prolotherapy for Pelvic Ligament Pain: A Case Report. Journal of Prolotherapy. 2009;2:89-95.
Background Content: This case study examines the effect of the addition of Prolotherapy to manual therapy, and pelvic and trunk exercises, in a treatment regime for a patient with pelvic and chronic low back pain (CLBP) who had previously failed manual therapy and exercise alone and in combination. We hypothesized that with continued exercise and the combination of Prolotherapy and manual therapy, there would be better improvement than any single intervention to reduce pain and improve stability in the lumbar spine and pelvis.
Purpose: The purpose of our case study was twofold.
- If the tenderness in the above ligaments would be reduced using the combination of Prolotherapy, therapeutic exercise, and manual therapy.
- Whether our subject would show functional improvement after treatment.
Study Design: Single case study.
Methods: One subject, a 44 year-old male with a history of left L5-S1 laminectomy and ligamentous laxity in the pelvis and sacral ligaments, was assessed and treated by the primary author, using Prolotherapy and manual therapy. Therapeutic exercise was performed five days a week with an emphasis on the pelvic and deep trunk stabilizers.
Results: After Prolotherapy treatments, the patient demonstrated less tenderness, improved ligamentous stiffness, and displayed improved pelvic joint stability. Function also improved as measured by his ability to work, exercise, and perform home activities with less stiffness and pain than previously noted.
Conclusion: Patients with LBP may benefit from Prolotherapy to aid in reducing pelvic and lumbar instability in conjunction with manual therapy and exercise to improve dynamic pelvic stability.
It has been postulated that 80% of Americans will experience low back pain sometime in their lives.1 One estimate is that 40% of all visits to health care professionals are due to low back pain (LBP).2 Approximately 10-20% of these cases will become chronic, resulting in long-term pain and disability, making low back pain the largest cause of worker compensation claims in the US and Canada.3 Among industrial workers, the incidence is as much as 60% of all claims.4 When discussing LBP, one problem is to determine the origin of the pain, which in many cases is not known objectively.5 The origin of the CLBP (chronic low back pain) will help to determine whether or not the patient needs a multi-disciplinary approach,6 and whether or not there are some significant psychological factors that will either enhance or worsen the situation.7
There appears to be a growing consensus that a significant portion of CLBP cases have an element of segmental instability present.7-8 As defined by Panjabi,9 the intrinsic stabilizing system of the spine consists of three interrelated components:
- The passive stabilizing system, consisting of ligaments, intervertebral discs, and joint capsules.
- The myofascial system, consisting of muscles and fascia.
- The motor control processing system, consisting of the central and peripheral nervous systems.
A deficit in the motor control or myofascial systems can result in damage to the passive stabilizing system from poorly controlled segmental movements in the spine and pelvis.10 If the muscles become weak due to inhibition11 loads will be transferred to the disc and ligamentous structures and may lead to repetitive wear, causing a breakdown in this passive support system.12-13
Read the full article at the Journal of Prolotherapy.