The First Visit for Radiculopathy
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PROLOTHERAPY AS AN ALTERNATIVE TO SURGERY FOR RADICULOPATHY
A patient came to the office discouraged. He had already had one back surgery and now because of lumbar radiculopathy the doctor wanted to another one. He heard about Prolotherapy and came in to Caring Medical in Oak Park for a visit.
The patient agreed that his EMG did show radiculopathy but he had a lot of tenderness around his right sacroiliac joint. It was explained to the patient that we would like to just do Prolotherapy to his degenerated discs and previous surgery sites, but believed his primary symptoms are stemming from injury to his right sacroiliac joint. If his leg pain didnt improve then other treatments such as nerve blocks or Neural Therapy would be done at the next visit. He received eighty Prolotherapy injections, (Watch where do Prolotherapy injections go and do they hurt?) on the first visit. When he came for follow up he definitely noticed a decrease in his back and leg pain. He received a total of five Prolotherapy sessions over the course of the next five months. He was able to get off of all of his pain medications. He is now back to exercising regularly and believes that chronic back and leg pain is in his past!!!
Another patient had severe back of shoulder, neck, and arm pain. Her MRI showed a herniated disc at C6-7 and bulging discs at a couple of other locations. On physical examination she had significant tenderness in her right shoulder Rotator Cuff area and in the back of shoulder/upper back region where the first few ribs attach to the vertebrae. She was very guarded in her whole neck though the right side was worse then the left. Her muscle strength and sensation was intact.
She was told she had a pinched nerve and needed surgery. We disagreed. She received Prolotherapy to her whole neck, upper back and right shoulder. She felt about 15% better so she was seen in two weeks because she still had a lot of pain. She needed a total of six visits over the course of 4 months to get resolution of her symptoms.
How does Prolotherapy help radiculopathy?
Radiculopathy by definition means a nerve is being compromised leading to symptoms in the extremity. We find that 90% of people coming in with the diagnosis of radiculopathy dont have a nerve getting pinched. The majority of these people have referred pain down the extremity (leg or arm) from a ligament injury in their pelvis, lower back, neck, or upper back.Three to six Prolotherapy sessions and the majority of these pains subside. For the other 10 percent that have a true radiculopathy the following is typically present:
- Crippling pain. The person is in obvious awful pain
- The person is desperate. The pain is there 24 hours/day. The person is not sleeping and needs help fast!
- The MRI shows an acute herniated disc.
- The MRI finding is consistent with the persons symptoms and exams
- The EMG collaborates the MRI
In such an instance what we typically do at CMRS is get the person some pain control while the Prolotherapy is working. The person with a true radiculopathy needs to decrease the inflammation of the disc material pressing on the nerve while the Prolotherapy is helping to stability the herniated areas.
The best approach, in my opinion, is to give a steroid injections right around where the disc herniation is located. We do that in our offices in Oak Park.This is called a nerve block.Sometimes anone, but we like putting the medication directly where the problem is located. The person is also prescribed muscle relaxers and rarely oral steroids. Yes the steroids block some of the Prolotherapy effect, but the person needs immediate pain relief. A medication to help sleep is also warranted sometimes. Obviously, the person also gets Prolotherapy to the areas. The person is seen in follow-up in one week. At this time if they still have a lot of pain, then another steroid injection is given to the painful area. Up to three of these are done. At the two week point, sometimes another Prolotherapy session is done. Up to four Prolotherapy sessions are sometimes needed.
The above approach has been used at Caring Medical for years. It has kept a lot of people out of surgery. In our experience the above approach even with herniated discs is around 90% successful. Of course, we have our handful of cases that have needed surgical consultation and surgery. We are grateful the surgeons are there for back-up. But read that again they are their for back-up. Even for an acute herniated disc the surgeon is second line therapy, or the person with a pseudo- or true radiculopathy the treatment of choice is Prolotherapy!
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