Prolotherapy chiropractic guidelines

Ross Hauser, MDRoss Hauser, MD

In this article Ross Hauser, MD explains Prolotherapy chiropractic guidelines for back and neck pain.

Cervical radiculopathy, though a serious and disabling painful condition, can often be treated conservatively. At times, Prolotherapy, nerve blocks, chiropractic, osteopathy or physical therapy alone can resolve the condition, sometimes a combination of approaches will be needed. While the person is getting treated, close monitoring by the clinicians is necessary to ensure the condition is resolving. With proper care non-operative treatment of cervical radiculopathy is not only effective but recommended.

Someone who has chronic pain due to joints or vertebrae being too lax (Ligament laxity) caused by too much high velocity manipulation by chiropractor is someone we call suffering from Over-Manipulation Syndrome (OMS).

Overmanipulation Syndrome

A female patient states that she found out about Prolotherapy because her chiropractor said her sacroiliac joint was hypermobile. She then researched this on the internet and came across Prolotherapy as a treatment for hypermobile joints. Her history was interesting in that she originally saw the chiropractor for headaches, then she started getting low back manipulation. She said that she must have had 120 manipulations of her sacroiliac joints over the course of the last 4 or 5 years. Prior to seeing a chiropractor, she had no low back pain. Her diagnosis as far as I am concerned is Over-Manipulation Syndrome.

Another female patient did have low back pain for which she saw a chiropractor, actually about eight chiropractors in total. She found out about Prolotherapy because a friend of hers had a similar problem so she came in for an evaluation. She could just tweak her pelvis a little and you could hear an audible pop in her sacroiliac joint. She was massively hypermobile in her sacroiliac joint. Her extremities had no hypermobility. She stated she felt she had over a hundred manipulations of her sacroiliac joints. I concluded that she had Over-manipulation Syndrome.

The majority of cases that I see for hypermobility have had excessive chiropractor manipulation. I do not doubt the effectiveness of a short course of manipulation to relieve tension or pain, but to see someone over and over again when they are hypermobile is, in my opinion, ridiculous. To me, if after 10 visits or so if the person’s joints are not staying in place after manipulation then the cause is obviously ligament injury or weakness and the treatment of choice, in my opinion, is Prolotherapy, not continued manipulation.

Prolotherapy chiropractic guidelines

  1. A chiropractor who spends little time with a patient and just manipulates them is a manipulator and not a chiropractor.
  2. A chiropractor in the true sense of the word is a ‘family physician’. They may choose to just treat pain but they can treat a whole lot more.
  3. I get treated once in awhile for a sports injury and Marion gets treated more regularly. Marion is in front of the computer for 6 hours a day and as such has a forward head posture. She gets chiropractic care about once every eight weeks, but she goes to chiropractors who do not use manipulation as their primary tool.
  4. When a manipulation is needed these chiropractors spend the time to relax the muscles so a very gentle manipulation can be done that is very specific. Most of the time is spent on stretching muscles and using modalities such as cold laser to relax muscles and help rebalance the body at specific points. If you want care by a chiropractor, go to a chiropractor, not a manipulator.

A good chiropractor is worth their weight in gold. Someone who is honest and caring, but also very skilled. Ideally one should go to a chiropractor who can help you with your overall health.

For acute pain that may have caused moderate damage, most can be resolved by a good chiropractor in five visits. If you are on your twentieth visit for an acute muscular-type injury by a chiropractor, it is almost 100% predictable that the pain will not resolve with that treatment (There are special cases, of course). Most likely you will need Prolotherapy, because there has been ligament damage (either initially or because of the excessive manipulation).

Manipulation can stretch ligaments and cause hypermobility. Even one manipulation can cause hypermobility. Manipulation is using a super-physiologic force to push a bone into a certain direction that it is not going on its own. Chiropractors who don’t relax the muscles ahead of time have to use an extraordinary force to move the bone the certain way. It is easy to understand how during this ‘movement’ that ligaments can get sheared and ultimately produce hypermobility. The hypermobility would need Prolotherapy to resolve.

Even one manipulation can cause hypermobility which leads to chronic pain. Stated again for emphasis.

A good percentage of chronic pain patients have had excessive manipulation. It may be that the cause of their chronic pain is not the ‘original’ injury but the injury to ligaments caused by excessive manipulation.

Preventative manipulation has a role, but it is very limited. A person who has no chronic pain and has had almost no pain their whole life does not need monthly preventative manipulations, in my opinion. The person who is always getting pain and that pain can be relieved by chiropractic care could benefit from preventative chiropractic care. I would qualify the latter by saying the care can include some manipulation, but again if this is the sole modality used, then the person should call themselves a manipulator not a chiropractor. Ultimately the person will get manipulated out of a lot of money.

I should explain some about hypermobility. Hypermobility occurs when a ligament is stretched and then can no longer perform its function to stabilize a joint or vertebral segment. The body then recruits muscle to do it with resultant chronic muscle spasms produced in the patient. I believe the cause of the majority of chronic muscle spasms in people is due to ligament injury beneath the muscles. Prolotherapy to strengthen these ligaments relieves the chronic pain by providing stability back in that area. The ligaments strengthen and tighten and thus there is no more need for the muscles to spasm. The musculature relaxes and the person gets their range of motion back.

Prolotherapy is given to cure a person of their chronic pain. It takes typically 3 to 6 visits. It can be used for acute or chronic pain. Most people with acute injuries need two visits.

C1 – C2 Treatment

Question: I have been having severe neck pain for over four years. My atlas (first cervical vertebra) in my neck goes “out” to where you can feel a round hard surface in the neck. I get very bad headaches which leads to nausea, and I end up in the hospital with morphine shots to control the pain. I have also been seeing a chiropractor for many years, three times a week for my neck pain. This relives the pain, but the joints slips out again within 24 hrs. Have you ever seen a patient or heard of someone having this problem and by being treated with Prolotherapy have success?

Answer: Yes, over the years I have seen people who have these types of symptoms with the atlas. Many respond very well with Prolotherapy. Just make sure you go to a Prolotherapy doctor who has experience treating C1 and C2 vertebra.


Question: I was in a head-on car accident 20 years ago. I have been going to a chiropractor for about 10 years at intervals of every 3 months and now I am down to every 7-14 days. I had severe head trauma with my neck. My C1 and C2’s are the ones that lock up and crack in the mornings. I am now at the point now I have heavy pressure in my right eye and also pain between my shoulder  blades. I need your help please. Will Prolotherapy work for me?

Answer: Whiplash injuries cause the ligaments, muscles and tendons to stretch too much. This leads to laxity in the vertebral joints which the person feels as the neck locking up and cracking. Cracking in any joint typically means the joint is unstable and has ligament laxity. If it was determined you were a good candidate for Prolotherapy, you would most likely need your whole neck treated and part of your upper thoracic area.

Bulging Discs

Question: Prolotherapy works on my back and hip but my neck is still a challenge. However I get relief from my neck pain for about 3-8 weeks so it is worth it for me to get the tune ups. I have 2 bulging discs. Whenever I go to the chiropractor it gives me immediate relief for 2 days and then the pain returns with a vengeance! It even feels like a bone is protruding in my neck. I am trying very hard not to use chiropractic care anymore but sometimes I can’t turn my neck without it. Neurosurgeon told me I am not a candidate for surgery because I don’t have symptoms of nerve damage.

Answer: Your case is typical of the cases that recur. Your continued manipulation in your neck is most likely the reason you are not getting cured with the Prolotherapy. You should also look at the ways you ‘hold’ your neck or activities you are doing that could be breaking down the tissue that is being repaired with Prolotherapy. Do you have a forward head posture? Do you sit at the computer for 8 hours per day? There is a reason you are not getting cured of your neck pain with Prolotherapy. I have given you several. You may want to get an evaluation by a 2nd Prolotherapy doctor!

More Prolotherapy research citations can be found on this page on our site Prolotherapy research. To learn more about Prolotherapy chiropractic guidelines, please read our article Prolotherapy information for patients

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