Will Your Radiculopathy Respond to Prolotherapy: Five Key Factors to Know

Ross Hauser, MDRoss Hauser, MD

My Own Story

Lumbar and cervical radiculopathy are some of the most painful conditions ever experienced. What most folks don’t know is that most pains down the arm and legs (referral pain) stemming from the back and neck  respectively can be easily and effectively treated with Prolotherapy. I personally had suffered from severe cervical radiculopathy and had my condition resolved with Prolotherapy. As you may have guessed pretty much every day I evaluate cases of radiculopathy from locally to those that travel across the country to see me. When I evaluate radiculopathy cases below are some of the points I will use to determine if the radiculopathy will respond to Prolotherapy. I hope they are helpful to you!

1. Is your radiculopathy constant or intermittent?

Intermittent radiculopathy generally responds very well to Prolotherapy. Back pain with intermittent leg pain typically means that the nerve is getting “pinched” due to lumbar instability. One or two vertebral segments have too much movement due an underlying ligament injury in the area. The best treatment to stabilize an unstable vertebral segment is Prolotherapy. Generally within three to six visits the low back or neck pain and subsequent leg pain often resolves completely.

Cervical Spine MRI

Constant radiculopathy, however, can also resolve with Prolotherapy. I am a prime example of this. Please see my neck MRI In January, 2010 after a vigorous swim I started to get severe upper back pain near my scapula which over the next few days progressed to severe, knife-like pain in my hand, which was my worst pain, ranking a 100 on a scale of 0-10. I received an MRI at this time because I thought I had blown a disc. As you can see from the scan and the report, all I had was tremendous Osteoarthritis. Nerves were blocked or crunched all over the place. Interestingly enough, when I was 15 years old, my dad and I were rear-ended in our vehicle and both of us suffered terrible whiplash injuries, with subsequent neck arthritis. I was definitely not a surgical candidate, so I received some chiropractic care, physiotherapy, and medications to get me through the day, but ultimately what healed me was Prolotherapy. Please read more about my case and the comprehensive approach to cervical radiculopathy in the Journal of Prolotherapy.

When someone has constant severe leg or arm pain (always 10 out of 10) this typically means that the radiculopathy is structural in the sense that the patient either has a herniated disc or bone spur hitting the nerve. If the case does not quickly respond to Prolotherapy, then surgery may be needed. Sometimes the only course of action is surgery, especially if the patient experiences numbness and loss of muscle strength. However, take these words with caution, because I myself had true numbness and lost my muscle strength in my brachioradialis muscle, but still resolved my condition without surgery and I am now basically 100%. On very rare occasions I’ll get a slight tingling in my hand, but again it rarely occurs and as most of you know, I recently ran 60 miles and had no neck or arm pain.

2. Do you have clicking in your back?

It is not normal for low backs and pelvic bones (sacroiliac bones) to shift and move and thus click. A person who needs constant high velocity manipulation, either by osteopathic or chiropractic physicians or self-manipulation, has spinal instability and needs Prolotherapy. Any clicking or popping sound in the neck or lower back is completely abnormal. Low back pain associated with referral pain down the leg or neck pain with referral pain down the arm, is a sure sign that the Prolotherapy is needed to strengthen the weakened area(s). By stabilizing the spine, Prolotherapy should get rid of the low back and neck pain and subsequent referral/radicular pains down the extremities.

3. True numbness or numbiness?

Most people with the diagnosis of cervical radiculopathy or lumbar radiculopathy state they have a numb feeling but can feel everything. This is what I call numbiness! Numbiness is a numb type feeling but when sensation is tested everything is completely fine! Numbiness is commonly found with ligament injuries. If you have some neck or low back with referral pain down the extremity combined with a numbiness there is a good chance that your radiculopathy will respond to Prolotherapy.

In 2008, I had true numbness in my hand. There was a small section on the posterior (dorsal) part of my hand that was numb. If you touched it I could feel it. This is true numbness. When someone has true numbness, meaning that the area of their leg or arm is truly numb this is typically a finding that the person has a true radiculopathy where by a nerve is getting injured. This is more likely the person will need something in addition to Prolotherapy. It doesn’t totally preclude Prolotherapy but it might be an indication that Prolotherapy may not totally resolve the pain. There are times where a person has severe arthritis causing a true radiculopathy whereby the persons nerve roots are getting pinched and serious or some other therapy, besides Prolotherapy are needed.

4. Can you find a comfortable position?

If a patient can find a comfortable position where the pain becomes nominal, this is a good indication that Prolotherapy will be effective. In general, this means that the radiculopathy is intermittent in nature. Let’s be honest. A bone spur directly pressing on the nerve or a herniated disc depositing inflammatory contents all over the nerve is going to cause constant severe pain. It will not be positional. The pain is typically excruciating and constant! When pain comes and goes, this tells us that the pain is positional. For instance the patient lies down and the pain drastically lessens or lying on the side reduces the pain. In such a case, typically Prolotherapy will be a great treatment option and the person should make a complete recovery. A normal person with radiculopathy will require 3-6 Prolotherapy visits and will typically see complete resolution of the issue.

5. Extremity pain and pain intensity.

If pain occurs primarily in the back or neck and not in the leg or arm, then Prolotherapy is likely to be successful at eliminating the pain. Structural radiculopathy, however, results in much more severe extremity pain, compared to the neck or back pain. Let’s go over this again. If your pain is 80-90% in the low back or neck and only 10-20% in the extremity, then there is a great chance Prolotherapy is going to get rid of your radicular symptoms. Conversely if 80-90% of your symptoms stem from your hand or foot, then surgery or some other therapy besides Prolotherapy may be required.

A patient with a pain level of 6 or under (on a scale of 0 to 10, with 10 being the worst pain ever experienced and 0 being no pain), will most likely experience symptom relief with Prolotherapy regardless of its origin. The pain of a nerve irritation or pinch is excruciating – like a 100 on a scale of 0 to 10. If your pain is almost exclusively in the hand or foot and it is a 90 on a scale of 0 to 10, then by all means go to the orthopedic surgeon and get it checked out. If you are not a surgical candidate or desire a second opinion, then see a Prolotherapy doctor.

Realize most Prolotherapy physicians see plenty of true radiculopathy cases resolve with Prolotherapy. Hopefully these guidelines will help you make a better decision.

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