Alternative to arthroscopic surgery

While the researchers may have concluded that, “arthroscopic SLAP repair provides a clinical and statistically significant improvement in shoulder outcomes” the statement that “a reliable return to the previous activity level is limited” does not show a completely efficient treatment, especially when a suitable alternative is available. Prolotherapy offers that alternative that allows people to return to previous activity level, an obvious desire for most shoulder pain patients.

In this video Prolotherapist, Ross Hauser MD, explains the use of Prolotherapy for SLAP tears:

1. Provencher MT, McCormick F, Dewing C, McIntire S, Solomon D. A prospective analysis of 179 type 2 superior labrum anterior and posterior repairs: outcomes and factors associated with success and failure. Am J Sports Med. 2013 Apr;41(4):880-6. doi: 10.1177/0363546513477363. Epub 2013 Mar 4.

Failure in one in four knees after five years

There are many reasons why doctors who practice Comprehensive Prolotherapy see so many meniscal patients. A recent article published in the Journal of Bone and Joint Surgery sheds some light into one of these reasons: poor surgical options for meniscal tears.  This article uses surgical terms to explain certain procedures –

• “Meniscal repair” refers to the surgical repair of the meniscal cartilage.
• “Meniscectomy” refers to partial or complete removal of the meniscus of the knee.

In short, doctors speculate that it is better to repair the meniscus than remove it. What a concept! Look at the research: “Meniscal repair offers the potential to avoid the long-term articular cartilage deterioration that has been shown to result after meniscectomy. Failure of the meniscal repair can occur several years postoperatively. Limited evidence on the long-term outcomes of meniscal repair exists.”

In light of this information, researchers sought to find out how patients did in the long term with a surgical repair of the meniscus as opposed to a removal of part or whole of the tissue: “A systematic review of the outcomes of meniscal repair at greater than five years postoperatively demonstrated very similar rates of meniscal failure (22.3% to 24.3%) for all techniques investigated.”¹

The surgical repair and the surgical removal scored about the same. A lot of failures. So the idea of repairing instead of removing seems to lose credibility in the long run.

As a side note, many readers comment that people who are against surgery do these studies. The reader should note the citations. This one is from The Journal of Bone & Joint Surgery. Almost every study we cite is surgeons writing for surgeons. Hardly anti-surgical groups!

In one recent study from the surgical journal The Journal of Arthroscopic and Related Surgery, the number of meniscectomies performed alarmed researchers. In fact it is concerning: “This study found that meniscectomy was performed in 65% of meniscus tears. This is concerning because studies have shown that, regardless of knee stability obtained after ACL reconstruction, meniscectomy accelerates degenerative joint changes.”²

So, even if the knee is stabilized, removing the meniscus causes osteoarthritis. These two studies should convince anyone that meniscal procedures should be examined carefully by the patient and that their expectations of what the procedure can an cannot do should be discussed with the doctor.

Comprehensive Prolotherapy for meniscal injuries

Now let’s look at two core concepts of Comprehensive Prolotherapy:

1. It is better to repair the meniscus than remove it in total or partially
2. The mensicus cartilage should be regrown after knee stabilization if a defect exists.

These are not new concepts – they go back more than 60 years to Dr. George Hackett who “invented” Prolotherapy.

Let’s look at the research:
“…Prolotherapy used on patients with MRI documented meniscal pathology including tears and degeneration, interviewed an average of 18 months after their last Prolotherapy treatment, was shown in this retrospective pilot study to improve patients’ quality of life. Most patients reported statistically significantly less pain and stiffness and major improvements in range of motion, crepitation of the knee, medication usage, walking ability, and exercise ability. The improvements with Prolotherapy met the expectations of the patients in over 96% of the knees to the point where surgery was not needed. Prolotherapy improved knee pain and function regardless of the type or location of the meniscal tear or degeneration. The improvements were so overwhelmingly positive that Hackett-Hemwall Prolotherapy should be considered as a first-line treatment for pain and disability caused by meniscal tears and degeneration…”³

Prolotherapy treats the entire area – injecting not only the torn meniscus, but also the surrounding weakened ligaments/tendons that most likely lead to the joint instability that lead to the tear in the first place. In the case of meniscus tears, sometimes a stronger proliferating solution is required,  PRP (platelet rich plasma) being one, or even possibly bone marrow stem cell injections, depending on the severity of the injury to regrow the cartilage tissue.

1. Nepple JJ, Dunn WR, Wright RW. Meniscal repair outcomes at greater than five years: a systematic literature review and meta-analysis. J Bone Joint Surg Am. 2012 Dec 19;94(24):2222-7. doi: 10.2106/JBJS.K.01584

2. Noyes FR, Barber-Westin SD. Treatment of meniscus tears during anterior cruciate ligament reconstruction. Arthroscopy. 2012 Jan;28(1):123-30. doi: 10.1016/j.arthro.2011.08.292. Epub 2011 Nov 9.

3. Hauser R, Phillips HJ, Maddela HS. The Case for Utilizing Prolotherapy as First-Line Treatment for Meniscal Pathology: A Retrospective Study Shows Prolotherapy is Effective in the Treatment of MRI-Documented Meniscal Tears and Degeneration. Journal of Prolotherapy. 2010;2(3):416-437.

Anxiety

• generalized anxiety, characterized by persistent worry;
• panic, or sudden, repeated attacks of fear;
• social anxiety, characterized by overwhelming anxiety in everyday social interactions;
• post-traumatic stress, or a repeated feeling of danger after a stressful event;
• obsessive-compulsive disorder, characterized by repeated thoughts or rituals that interfere with daily life.

They also evaluated health-related quality of life issues, ie fatigue, sleep habits, and work productivity. The results showed that 45% of the patients tested positive for at least one or more of these common anxiety disorders. Many of these were present in combination with depression. Patients with anxiety disorders also presented with more pain and worse quality of life issues.

Addressing the cause of chronic pain

In many of these cases, researchers pointed out that patients may not necessarily need treatment for the anxiety as they may just have the symptoms related to the disorder, although they did predict that one in five patients may have an anxiety disorder. This research shows that the source of anxiety is chronic pain. The standard treatment of pain medications was not working so it’s clear that an effective treatment of the chronic pain is warranted. Prolotherapy is a treatment that addresses chronic joint and back pain, attacking the origin of pain that is ligament and tendon injury or laxity. Patients who choose Prolotherapy no longer have to cope with pain, or the byproducts that come with it. They find a permanent cure, ceasing the anxiety, depression, fatigue, sleeplessness and decreased productivity that accompany chronic pain.

Questions? Contact us for more information.

1. Kroenke K, Outcalt S, et al. Association between anxiety, health-related quality of life and functional impairment in primary care patients with chronic pain. General Hospital Psychiatry. 2013.

Knee osteoarthritis treatments: short-term results

This short-term relief is the problem with some treatments like hyaluronic acid. They are designed in general to delay the inevitable – total knee replacement. Listen to what German researchers just published:

“Osteoarthritis of the knee is a degenerative joint disease with progressive degradation of articular cartilage and subchondral bone. Symptoms may include joint pain, tenderness, stiffness, locking and joint effusion depending on the stage of the disease. In an effort to delay major surgery, patients with knee osteoarthritis are offered a variety of nonsurgical modalities, such as weight loss, exercise, physiotherapy, bracing, orthoses, nonsteroidal anti-inflammatory drugs (NSAIDs) and intra-articular viscosupplementation or corticosteroid injection. In general, the goals of these therapeutic options are to decrease pain and improve function. Some of these modalities may also have a disease-modifying effect by altering the mechanical environment of the knee. Chondroprotective substances, such as lucosamine, chondroitin sulphate and hyaluronic acid are safe and provide short-term symptomatic relief while the therapeutic effects remain uncertain.”¹

Again we read that there are many options with unproven long-term effectiveness, but with an ability to delay the surgery. At least we agree that delaying surgery is a good goal. Preventing it is even better.

Knee osteoarthritis treatments: long-term results

In research published in the Journal of Prolotherapy, we identified many of the problems with the above listed stopgap treatments and why we do not employ their use in our practice.

Here is what we published: “although steroid injections and nonsteroidal anti-inflammatory drugs (NSAIDs) have been shown to be effective in decreasing inflammation and pain of ligament injuries for up to six to eight weeks, the histological, biochemical, and biomechanical properties of ligament healing are inhibited. For this reason, their use is cautioned in athletes (and patients) who have ligament injuries. As such, NSAIDs are no longer recommended for chronic soft tissue (ligament) injuries, and for acute ligament injuries should be used for the shortest period of time, if used at all. Regenerative medicine techniques, such as Prolotherapy, have been shown in case series and clinical studies, to resolve ligament injuries of the spine and peripheral joints.”²

The long-term success of Prolotherapy is not a new phenomenon. Our friend and colleague K. Dean Reeves, M.D., published back in 2000 his long-term successes. “Prolotherapy injection with 10% dextrose resulted in clinically and statistically significant improvements in knee osteoarthritis — ACL laxity, when present in these osteoarthritic patients, improved.”³ Here Dr. Reeves confirms what Prolotherapy doctors need to do: treat the whole knee. Despite the belief that osteoarthritis treatment should be targeted at the cartilage only – Dr. Reeves says that knee osteoarthritis improves when you treat the ACL.

We recently published an article Ligament Injury’s Effect of Cartilage Breakdown – which describes the very dominating influence of ligaments on knee cartilage Our newest research “Ligament Injury and Healing: A Review of Current Clinical Diagnostics and Therapeutics” also supports the view the long-term consequence of non-healed ligament injury is osteoarthritis.⁴

So is it any wonder why the treatments mentioned above including hyaluronic acid do not last? The situation of osteoarthritis can only be remedied when the problem of ligament laxity is addressed. None of those above treatments address this problem. Comprehensive Prolotherapy does.

1. Diehl P, Gerdesmeyer L, Schauwecker J, Kreuz PC, Gollwitzer H, Tischer T. Conservative therapy of osteoarthritis. Orthopade. 2013 Feb 1. [Epub ahead of print]
2. Hauser RA, Dolan EE. Ligament injury and healing: an overview of current clinical concepts. Journal of Prolotherapy. 2011;3(4):836-846.
3. Reeves KD, Hassanein K.Altern Ther Health Med. 2000 Mar;6(2):68-74, 77-80. Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity.
4. Hauser RA., et al. Ligament Injury and Healing: A Review of Current Clinical Diagnostics
and Therapeutics. The Open Rehabilitation Journal, 2013, 6, 1-20

Diagnosing fibromyalgia

This study examined 326 patients with three months of persistent pain following a whiplash injury. Fibromyalgia is typically diagnosed when widespread pain is persistent for three months and there is tenderness in 11 of 18 specific locations. Ten of these locations are located in the neck and shoulder girdle. In the patient with whiplash injury, most of the tender points tend to be in this area, leading some to believe that the fibromyalgia diagnosis is more related to localized injury in the neck and shoulder region, rather than a widespread condition.

The whiplash patients in this study almost always had a greater proportion of neck/shoulder tender points to distal tender points. When this study compared whiplash injury patients to other non-whiplash fibromyalgia patients seeking treatment, they found that the whiplash patients had the same amount of neck and shoulder girdle tender points but less distal tender points.  As these patients completed a three-week treatment program, 63% saw the fibromyalgia diagnosis disappear, as their condition no longer met the diagnosing criteria. In summary, the diagnosis of fibromyalgia following whiplash is controversial because of the location of the tender points, indicating a localized injury rather than widespread condition, and the disappearance of some of these tender points after treatment, ruling out the fibromyalgia diagnosis.

Treatment for fibromyalgia related to whiplash injury

Seeing that most tender points following whiplash tend to be located in the neck and shoulder girdle indicate cervical instability caused from the trauma of the whiplash. The most effective treatment for cervical instability, or any joint instability, is Prolotherapy. Prolotherapy is an injection technique that stimulates a mild inflammation in the injured area. This inflammation mimics the body’s natural healing process, so it can be said that Prolotherapy stimulates healing. Therefore any fibromyalgia resulting from whiplash has a high chance of being cured with Prolotherapy. While the diagnosis may be controversial, the pain is real and patients suffering from symptoms of whiplash injury are looking for a cure. Prolotherapy could be the cure for many of these patients.

For more on Prolotherapy, contact us or follow us on Facebook.

1. Robinson JP, Theodore BR, Wilson HD, Waldo PG, Turk DC. Determination of fibromyalgia syndrome following whiplash injuries: methodologic issues. Pain. 2011 June; 152(6): 1311–1316.

Problem 1: The saline used in many medical procedures actually damages articular cartilage.
“Normal saline, the most commonly used irrigation fluid, may have an inhibitory effect on proteoglycan metabolism in articular cartilage. Additional studies are required to assess the potential damage to cartilage from normal saline in the clinical setting.”1
This  medical research paper was published in December 2012. Interestingly ,way back in 1991, similar concerns were noted: “[It is suggested] that meniscal damage may occur as a direct result of using normal saline for irrigation during knee arthroscopy.”2

Problem 2: Loss of knee fluid
Remarkably, about twenty years later, one paper noted: “The short-term recovery period post-arthroscopic meniscectomy is characterized by pain and impaired function most likely related to the irrigation of synovial fluid from the knee intraoperatively. Consequently, along with removal of harmful debris, the irrigation fluid dilutes the hyaluronic acid layer covering the joint tissues. Hyaluronic acid contributes to the homeostasis of the joint environment and is an important component of synovial fluid and cartilage matrix.Hence, the instillation of hyaluronic acid after the procedure may relieve symptom. “3

In concept, replacing hyaluronic acid makes sense. If the surgery is causing loss of natural hyaluronic acid, then replacing it after surgery should help. For some it reduced pain ,but  it did NOT improve knee function for all. As a side note – which patients were excluded from the study? “Patients with ligamentous injuries or severe chondral damage were excluded.”3 These patients are those who seemingly would benefit the most from Comprehensive Prolotherapy.

Problem 3: Lack of comprehensive treatment
Why do Prolotherapists see so many patients for Comprehensive Prolotherapy following knee procedures ? The above study is somewhat reflective of knee procedures. The procedure is going in to fix a specific problem, for instance a meniscal tear. Regardless of the surrounding damage, only the meniscal tear is being addressed. In Comprehensive Prolotherapy, the meniscus, the articular cartilage, the ligaments, and the tendons are ALL addressed.

“The Hackett-Hemwall technique of dextrose Prolotherapy used on patients with MRI documented meniscal pathology including tears and degeneration, interviewed an average of 18 months after their last Prolotherapy treatment, was shown in this retrospective pilot study to improve patients’ quality of life. Most patients reported statistically significantly less pain and stiffness and major improvements in range of motion, crepitation of the knee, medication usage, walking ability, and exercise ability. The improvements with Prolotherapy met the expectations of the patients in over 96% of the knees to the point where surgery was not needed. Prolotherapy improved knee pain and function regardless of the type or location of the meniscal tear or degeneration. The improvements were so overwhelmingly positive that Hackett-Hemwall Prolotherapy should be considered as a first-line treatment for pain and disability caused by meniscal tears and degeneration. If these results are confirmed by further studies under more controlled circumstances, with larger patient populations, and with MRI confirmation, surely Hackett-Hemwall Prolotherapy will become a first-line treatment for meniscal tears and degeneration.”4

In our opinion, the best approach to treating meniscus tears is to stimulate meniscus repair with Prolotherapy. Prolotherapy heals the meniscus because it stimulates fibroblastic growth of new, stronger meniscus tissue, thereby repairing the area. In simple terms, Prolotherapy stimulates the body to repair painful areas. It does so by inducing a mild inflammatory reaction in the weakened ligaments, tendons, and cartilage. Since the body heals by inflammation, Prolotherapy stimulates healing.

1. Gulihar A, Bryson DJ, Taylor GJ. Effect of Different Irrigation Fluids on Human Articular Cartilage: An In Vitro Study. Arthroscopy. 2012 Dec 19. pii: S0749-8063(12)01654-4. doi: 10.1016/j.arthro.2012.07.013. [Epub ahead of print]
2. Mah ET, Lee WK, Southwood RT, Carbone A, Leppard PJ. Effects of irrigation fluid on human menisci: an experimental comparison of water, normal saline, and glycine. Effects of irrigation fluid on human menisci: an experimental comparison of water, normal saline, and glycine. Arthroscopy. 1991;7(1):24-32.
3 . Thein R, Haviv B, Kidron A, Bronak S. Intra-articular injection of hyaluronic acid following arthroscopic partial meniscectomy of the knee. Orthopedics. 2010 Oct 11;33(10):724. doi: 10.3928/01477447-20100826-11.
4. Hauser R, Phillips HJ, Maddela HS. The Case for Utilizing Prolotherapy as First-Line Treatment for Meniscal Pathology: A Retrospective Study Shows Prolotherapy is Effective in the Treatment of MRI-Documented Meniscal Tears and Degeneration. Journal of Prolotherapy. 2010;2(3):416-437.

In a recently published article in the American Journal of Bone and Joint Surgery, researchers examined the effect that obesity has on patients managed for symptomatic lumbar disc herniation. They studied a group of patients who underwent back surgery and a group of patients who had more conservative non-surgical treatments. Both groups showed significantly less improvement as it related to problems of obesity.¹

In another article, spinal surgeons said that a component of failed spinal surgery was obesity. Amazingly enough this two-year-old research was the first to examine obesity’s role in recurrent disc herniation. A study should have been performed to see what took so long to make an obvious connection: “Obesity was a strong and independent predictor of recurrent (disc herniation) after lumbar microdiscectomy. Surgeons should incorporate weight loss counseling into their preoperative discussions with patients.”²

There is even suggestion that elevated cholesterol levels and triglycerides have a role: “patients with symptomatic herniated lumbar disc showed statistically significant higher triglyceride concentration  and total cholesterol concentration. Serum lipid levels may be a risk factor for [symptomatic disc herniation]. An enhanced understanding of these factors holds the promise of new approaches to the prevention and management.”³

Again, this all comes down to lifestyle choices to accelerate healing or make healing more difficult. We discuss the lifestyle choices in regards to healing at length in our article on the relationship between obesity and healing.

Addressing obesity and back pain

It should be obvious that if you have joint deterioration, a change in lifestyle in addition to any treatment will be beneficial.

“new models of care and strategies to train community health-care workers and primary health-care practitioners to detect and initiate the management of patients with musculoskeletal disorders at an earlier stage are required. There is also a need for prevention strategies with campaigns to educate and raise awareness among the entire population. Lifestyle interventions such as maintaining an ideal body weight to prevent obesity, regular exercises, avoidance of smoking and alcohol abuse, intake of a balanced diet and nutrients to include adequate calcium and vitamin D, modification of the work environment and avoidance of certain repetitive activities will prevent or ameliorate disorders such as osteoarthritis, osteoporosis, rheumatoid arthritis, gout and musculoskeletal pain syndromes including low back pain and work-related pain syndromes. These prevention strategies also contribute to reducing the prevalence and outcome of diseases such as hypertension, cardiovascular diseases, diabetes and respiratory diseases.”⁴

The most successful Prolotherapy offices are those that promote healthy lifestyles along with Prolotherapy to achieve the most efficient healing. To inquire more, contact us here.

1. Rihn JA, Kurd M, Hilibrand AS, Lurie J, Zhao W, Albert T, Weinstein J. The Influence of Obesity on the Outcome of Treatment of Lumbar Disc Herniation:  Analysis of the Spine Patient Outcomes Research Trial (SPORT). J Bone Joint Surg Am. 2012 Nov 28. doi: 10.2106/JBJS.K.01558. [Epub ahead of print]
2. Meredith DS, Huang RC, Nguyen J, Lyman S. Obesity increases the risk of recurrent herniated nucleus pulposus after lumbar microdiscectomy. Spine J. 2010 Jul;10(7):575-80. Epub 2010 Mar 27.
3. Longo UG, Denaro L, Spiezia F, et al. Symptomatic disc herniation and serum lipid levels. Eur Spine J. 2011 Oct;20(10):1658-62. Epub 2011 Mar 9.
4. Mody GM, Brooks PM. Improving musculoskeletal health: global issues. Best Pract Res Clin Rheumatol. 2012 Apr;26(2):237-49.

• 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.¹

Lumbar disc herniation treatment: treating the whole patient

It is always important to realize the significance of a patient’s anxiety, depression and overall disability as a human being and not treat them as a “spine.” Researchers in the Journal of Orthopedic Science also looked at these factors in trying to predict which patients with lumbar back pain would be “disabled” by the pain.

Here is what they said: “Lumbar disc herniation may influence patients’ daily activities and social interactions; however, no predictive models of disability could be found for patients with lumbar disc herniation. We aimed to explore predictive factors for disability in patients with lumbar disc herniation.”

So they went looking for those quality of life aspects that would predict “disability” in these patients. They found that “the most influential factor affecting the disability level was the pain level, followed by the fatigue level, and depression level. The depression level was directly affected by the fatigue level and the pain level. The fatigue level was directly affected by the pain level, and the pain level was directly affected by age and previous surgery.”²

Low back pain: quality of life

Prolotherapy doctors do not need statistical analysis to see that a patient’s quality of life is severely suppressed by continuing lower back pain, especially after a failed surgery. Nor do children of aging parents, wives or husbands of a spouse in pain, or parents of a young athlete. Chronic pain causes chronic anguish and varying levels of depression, anxiety, and despair.

Writing in the medical journal Pain Medicine researchers, not surprisingly, noted that when low back pain was not resolved – patients had catastrophizing thoughts, state anxiety, anger, and depressive symptoms. Mostly a lot of anger, especially after failed back surgery.³

This is the challenge that faces many Prolotherapy doctors. A patient that visits a Prolotherapy doctor can express the symptoms of anger, depression, fatigue and exhaustion from their pain. The Prolotherapy doctor was not the first choice but the fifth, sixth, seventh choice and only after a failed regiment of pain-killers, epidurals, spiraling back pain, and failed surgical expectations. These patients are of course very skeptical of the medical profession on all levels.

Can Prolotherapy heal all these patients? No. If the pain source is not being generated by ligament and tendon weakness and instability, then the realistic goals of Prolotherapy should be immediately discussed with the patient. Can Prolotherapy help many of these patients? In our experience YES!

This is supported by other independent Prolotherapy research that found that pain and disability problems significantly improved after Prolotherapy treatment.⁴ See our article Faster Treatment for Back Pain for supportive research.
1. Hauser RA, Hauser MA. Dextrose Prolotherapy for unresolved low back pain: a retrospective case series study. Journal of Prolotherapy. 2009;1:145-155.

2. Chen HN, Tsai YF. A predictive model for disability in patients with lumbar disc herniation. J Orthop Sci. 2013 Jan 24. [Epub ahead of print]

3. Moix J, Kovacs FM, Martín A, Plana MN, Royuela A; Spanish Back Pain Research Network. Catastrophizing, state anxiety, anger, and depressive symptoms do not correlate with disability when variations of trait anxiety are taken into account. a study of chronic low back pain patients treated in Spanish pain units [NCT00360802]. Pain Med. 2011 Jul;12(7):1008-17. doi: 10.1111/j.1526-4637.2011.01155.x. Epub 2011 Jun 13.

4. Kim WM, Lee HG, Jeong CW, Kim CM, Yoon MH. A randomized controlled trial of intra-articular prolotherapy versus steroid injection for sacroiliac joint pain. J Altern Complement Med. 2010 Dec;16(12):1285-90. doi: 10.1089/acm.2010.0031.

In more research, doctors suggest that even if you do not lose weight, even moderate physical activity will help low back pain. Here are the highlights of their research:¹

1. If you have a big belly, even if you are pain free now, you are at high risk for developing low back pain.
2. If you have no physical activity you are at high risk factor for low back pain.
3. If you are obese with no physical activity – you are at very high risk for low back pain or more severe back pain.

Exercise suggestions revolving around the core

Prolotherapists routinely see patients who try to relieve their low back pain with high intensity workouts. Often the patients are doing more harm than good. Low back pain patients must remember that they need exercise that brings circulation and muscle building to the low back area, but they should be cautious to engage in accelerated or extreme activities.

“Compared to general exercise, core stability exercise is more effective in decreasing pain and may improve physical function in patients with chronic low back pain in the short term. However, no significant long-term differences in pain severity were observed between patients who engaged in core stability exercise versus those who engaged in general exercise.”²

This should not surprise anyone. Patients with low back pain have weakened and stressed ligaments. This causes instability and low back pain. What is not mentioned in the above research is the likely cause for the core exercises not showing a very clear advantage: overuse.

On occasion a Prolotherapist will see a patient return two months after completing a successful comprehensive Prolotherapy treatment, complaining of worsening low back pain. Typically the patient will reveal that they felt so good that they begin to engage in extreme activity without a slow, gradual buildup.

The main movements that injure newly healed lumbar ligaments are ones that involve flexing at the waist and twisting to the side. The lower back, for most people, does not have enough flexibility and strength to perform motions, especially fast ones that involve both flexing and twisting. The sacroiliac ligaments, in particular, are fine if you twist with a straight back or flex forward without twisting. Once you flex and twist, it puts such a great torque on the lower back.

Activity following Prolotherapy must use proper back mechanics. The lower back was not meant to sustain a twisting motion while it is in the flexed position. Core exercises that involve flexing at the waist and twisting, will in all likelihood, lead to low back pain. Always consult your Prolotherapy doctor for an exercise plan to strengthen your lower back and core based on your individual case and ask for general exercise recommendations.

Questions? Contact us here.
1. Shiri R, Solovieva S, Husgafvel-Pursiainen K, Telama R, Yang X, Viikari J, Raitakari OT, Viikari-Juntura E. The role of obesity and physical activity in non-specific and radiating low back pain: The Young Finns study. Semin Arthritis Rheum. 2012 Dec 25. pii: S0049-0172(12)00227-2. doi: 10.1016/j.semarthrit.2012.09.002. [Epub ahead of print]
2. Wang XQ, Zheng JJ, Yu ZW, et al. A Meta-Analysis of Core Stability Exercise versus General Exercise for Chronic Low Back Pain. PLoS One. 2012;7(12):e52082. doi: 10.1371/journal.pone.0052082. Epub 2012 Dec 17.

Technology is always changing and getting better – perhaps one day it will be as good as human assessment for knee pain.

The subject of MRIs is one that we cover quite frequently. The reason? Many patients visiting a Prolotherapy office come in by introducing their MRI as exhibit “A” in the evidence for their joint pain. It is with great surprise that Prolotherapy doctors ask the “court” to dismiss this evidence as being subjective, open to interpretation, and often be a “roadblock,” in helping the patient heal.

Patients are incredibly well educated when it comes to their pain. This is why Prolotherapists introduce other evidence. While this evidence is equally subjective and open to interpretation, it can put the MRIs perspective into place when treating their pain. In other words we are casting a “reasonable doubt.”

MRI questionable for osteoarthritis diagnosis

Published in May 2013 is new research which says that assessing the patient’s symptoms through physical examination are likely to be more informative for understanding, treating, and potentially preventing functional limitations than radiographic assessments in osteoarthritic patients. 1

This is in agreement with research from  January 2013:

“The use of MRI techniques to investigate tissue pathology has become increasingly widespread in osteoarthritis [OA] research. Semiquantitative assessment [non precise - subject to interpretation*] of the joints by expert interpreters of MRI data is a powerful tool that can increase our understanding of the natural history of this complex disease.

Several reliable and validated semiquantitative scoring systems now exist and have been applied to large-scale, multicentre, cross-sectional and longitudinal observational epidemiological studies.

Such approaches have advanced our understanding of the associations of different tissue pathologies with pain and improved the definition of joint alterations that lead to disease progression.

Semiquantitative MRI outcome measures have also been applied in several clinical trials in OA.

Indeed, interest in MRI-based semiquantitative scoring systems has led to the development of several novel scoring systems that can be applied to different joints: a knee synovitis scoring system based on contrast-enhanced MRI; the MRI Osteoarthritis Knee Score (MOAKS); the Hip Osteoarthritis MRI Score (HOAMS); and the Oslo Hand Osteoarthritis MRI score (OHOA-MRI).”¹

Here is the big finish: “Although these new scoring systems offer theoretical advantages over pre-existing systems, whether they offer actual superiority with regard to reliability, responsiveness and validity remains to be seen.”²

The entire abstract points to the use of MRI as a valuable tool until the end, which states in theory this should work, but that remains to be seen. In other words – there is a doubt that the latest in MRI enhancements help the patient’s situation. For more, see the most recent article we did on MRIs versus physical examinations.

MRI use in osteoarthritis consultations

On January 16, 2013 another research paper was released. Incredibly the paper cites that little exists with regards to published literature to help a doctor to have a proper osteoarthritis consultation. Listen to what they say:

“Osteoarthritis (OA) is a common condition managed in general practice, but often not in line with published guidance. The ideal consultation for a patient presenting with possible OA is not known. The aim of the study was to develop the content of a model OA consultation for the assessment and treatment of older adults presenting in general practice with peripheral joint problems.”³

Side note: This should dispel any notion the MRI is all-knowing. There is a lack of consensus in 2013 of how to perform the proper consultation in determining how to help a patient.

Here is what these researchers revealed:

“The model OA consultation included 25 tasks to be undertaken during the initial consultation between a GP and a patient presenting with peripheral joint pain. The 25 tasks provide detailed advice on how the following elements of the consultation should be addressed:

1. assessment of chronic joint pain
2. patient’s ideas and concerns
3. exclusion of red flags
4. examination
5. provision of the diagnosis and written information
6. promotion of exercise and weight loss
7. initial pain management
8. arranging a follow-up appointment

This study has enabled the priorities of GPs and patients to be identified for a model OA consultation. The results of this consensus study will inform the development of best practice for the management of OA in primary care and the implementation of evidence-based guidelines for OA in primary care.”²

The study did not say – look at film and treat. Hopefully technologies of the future will assist in making a determination of the patient’s true cause of pain, but for today, from a Prolotherapy standpoint – physical examination and patient history is superior to the current technology.

* (Non precise – subject to interpretation*) parenthesis added.

1. Nelson AE, Elstad E, Devellis RF, Schwartz TA, Golightly YM, Renner JB, Conaghan PG, Kraus VB, Jordan JM. Composite measures of multi-joint symptoms, but not of radiographic osteoarthritis, are associated with functional outcomes: the Johnston County Osteoarthritis Project.
Disabil Rehabil. 2013 May 3. [Epub ahead of print]

2. Guermazi A, Roemer FW, Haugen IK, Crema MD, Hayashi D. MRI-based semiquantitative scoring of joint pathology in osteoarthritis. Nat Rev Rheumatol. 2013 Jan 15. doi: 10.1038/nrrheum.2012.223. [Epub ahead of print]

3. Porcheret M, Grime J, Main C, Dziedzic K. Developing a model osteoarthritis consultation: a Delphi consensus exercise. BMC Musculoskelet Disord. 2013 Jan 16;14(1):25. [Epub ahead of print]