Prolotherapy in patients with sacroiliac joint instability

What are we covering? An April 2018 study from the Department of Veterans Affairs, Northern California Health Care System finds Prolotherapy effective in cases of sacroiliac joint instability.

Doctors from the Department of Veterans Affairs, Northern California Health Care System, examined the role of Prolotherapy injections in helping patients with sacroiliac joint instability. Publishing in the journal Complementary therapies in medicine, the researchers were able to conclude that “a satisfactory proportion of patients with symptomatic sacroiliac joint instability as an etiology of low back pain can have clinically meaningful functional gains with prolotherapy treatment. The patients who are not likely to improve with prolotherapy are generally evident by lack of improvement following the initial prolotherapy injection.”(1)

  • In this study, patients referred for low back pain and diagnosed with SI joint instability received a series of three sacroiliac joint prolotherapy injections (15% dextrose in lidocaine) at approximately a one-month interval.
  • Of 103 treated patients returning for post-treatment follow-up at a median of 117 days:
    • 24 (23%) showed a minimum clinically important improvement despite an average 2 years with low back pain
    • Much of the improvement was evident after the initial prolotherapy injection.

In the journal Clinical medicine insights. Arthritis and musculoskeletal disorders, Ross Hauser MD described the the source of low back and buttock pain as related to the sacroiliac (SI) joint is present in as many as 15%–30% of back pain patients and perhaps up to 40% in patients who have had a previous lumbar fusion.

  • SI joint dysfunction may also produce pain similar to a herniated lumbar disk along the same sciatic nerve distribution.(2)
  • Low back pain patients who remain symptomatic despite tailored physiotherapy are believed to possess deficient ligament strength in the posterior elements of the SI joint, resulting in insufficient stability to permit effective muscle recruiting strategies.
  • Experimental studies have found prolotherapy effective in stimulating the production of collagen fibers, thus strengthening ligaments.

Ross Hauser explains the treatment

A 2010 study from Chonnam National University Hospital in Korea appeared in the Journal of alternative and complementary medicine which compared  prolotherapy versus steroid injection for sacroiliac joint pain.

In this study doctors examined the effectiveness of ligament prolotherapy in alleviating sacroiliac joint pain. Previously they noted inconsistent success rates reported in previous studies. They attributed this to variability in patient selection and techniques between studies.

What these reachers thought:

  • Patients who responded well to diagnostic block (cortisone injection) would respond well to Prolotherapy. The purpose of this study ten would be to evaluate the long-term effectiveness  prolotherapy in relieving sacroiliac joint pain, compared with intra-articular steroid injection.


  • Prolotherapy group (23 patients) | Steroid group 25 patients)
    • The pain and disability scores were significantly improved from baseline in both groups at the 2-week follow-up, with no significant difference between them.
    • The cumulative incidence of more than 50% pain relief at 15 months was 58.7% in the prolotherapy group and 10.2% in the steroid group representing a statistically significant difference between the groups.

The researchers of this study were able to conclude that: “Intra-articular prolotherapy provided significant relief of sacroiliac joint pain, and its effects lasted longer than those of steroid injections.”(3)

Also in 2010 a well received and cited study from Dr Manuel F Cusi, of the Sydney School of Medicine, University of Notre Dame published in the British Journal of Sports Medicine found positive clinical outcomes for the 76% of patients with sacroiliac joint problems.(4)

  • In this study all patients included in this study attended at least one follow-up visit at 3, 12 or 24 months.
  • This descriptive study of prolotherapy in private practice has shown positive clinical outcomes for the 76% of patients who attended the 3-month follow-up visit (76% at 12 months and 32% at 24 months).

Would you like more information about Prolotherapy and sacroiliac joint instability

1 Hauser RA, Lackner JB, Steilen-Matias D, Harris DK. A systematic review of dextrose prolotherapy for chronic musculoskeletal pain. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders. 2016 Jan;9:CMAMD-S39160. [Google Scholar]

2 Hoffman MD, Agnish V. Functional outcome from sacroiliac joint prolotherapy in patients with sacroiliac joint instability. Complementary therapies in medicine. 2018 Apr 1;37:64-8. [Google Scholar]

3 Kim WM, Lee HG, Won Jeong C, Kim CM, Yoon MH. A randomized controlled trial of intra-articular prolotherapy versus steroid injection for sacroiliac joint pain. The Journal of Alternative and Complementary Medicine. 2010 Dec 1;16(12):1285-90. [Google Scholar]

4 Cusi M, Saunders J, Hungerford B, Wisbey-Roth T, Lucas P, Wilson S. The use of prolotherapy in the sacroiliac joint. British journal of sports medicine. 2010 Feb 1;44(2):100-4. [Google Scholar]