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July 1, 2011

PROLOTHERAPY AND BACK PROBLEMS

Patients often ask me if prolotherapy is effective for complicated back problems; many times they have undergone imaging studies demonstrating advanced degenerative changes, disc protrusions, narrowing of openings that nerves pass through, etc. Others have undergone one or more surgeries on their backs and are left with a persistent painful condition. These back problems may be years or even decades in the making. They want to know if prolotherapy will work for their specific circumstances.

Prolotherapy will usually result in significant improvement of a wide range of back problems, even the more serious and chronic variety. How is this so? The goal of prolotherapy is to stabilize an entire region, in this case the low back. This is what makes prolotherapy unique: it's not a single shot to target pain, such as a nerve root block, but is instead a system designed to strengthen the many ligament and tendon connections that underlie the structural integrity of the spine and joints. As the spine stabilizes, there is less pressure on discs or nerves that may be irritated. Weakened ligaments that generate pain are strengthened. When this is achieved the result is typically pain relief and better function.

But what about the abnormalities seen on X-rays and MRI, those bad discs and spinal structures? First of all, it is well known that imaging studies such as X-rays, MRI and CT scans are often unreliable in determining the cause and/or location of pain, especially when it comes to spinal problems. Many people with abnormal imaging studies have no pain at all. And many people with pain have normal MRIs. What does this mean? Spinal pain is a complex problem that usually originates from more than one structure or area. Disc pain is common, but ligament pain is even more common. Our ability to pinpoint the source or sources of spinal pain still relies on the combination of a good history and structural physical exam combined with the results of imaging studies.

X-ray and MRI are of course useful tools to rule out serious or surgical conditions of the spine. They also may help us to know when targeted injections such as epidurals, nerve root blocks or medial branch blocks may be beneficial. And they can help to determine the prognosis of back pain with treatment. But if we focus too much attention on specific pathology seen on an MRI, we may unnecessarily narrow our treatment options. For example, we may come to believe that only surgical repair of a disc will cure the problem.

Prolotherapy offers an excellent option for those who are suffering from chronic back pain. It stabilizes many of the supportive structures of the back. It is regenerative, stimulating the body's healing system. Many people improve with the treatment. They may find that they don't need the ongoing treatments from their chiropractors and massage therapists anymore. And they may avoid having steroid injections and surgeries now or in the future.

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