Ross Hauser, MD, Danielle Matias, PA-C, Demi Foster, APRN

Here is a summary of this video:

• People will come into our office with MRIs that show a herniated disc, disc protrusion, or degenerative disc disease, and think that is the cause of their problem. There has been no discussion with the patient of the pain culprit possibly coming from the sacroiliac joint. When we ask patients if they had their sacroiliac joint examined, they often tell us that they do not even know what the sacroiliac joint is.
• When most people injure their back, they usually do it from a bending and twisting motion. When they come into our office they describe their back pain as the lower left side of the lower right side. They rarely say it is right down the middle.
• The sacroiliac joint is a very large joint that sits in a sea of spinal and pelvic ligaments, the tough connective tissue that holds bone to bone. In the illustration below the white bands of tissue that hold the sacroiliac joint are the ligaments. They sit on the left and right sides of the spine.
• In our office, we offer Prolotherapy injections. This treatment can stimulate the repair of the spinal ligaments and bring pain-free stability back to the lower back. pelvic, and sacroiliac joint.

Prolotherapy is an injection treatment that stimulates the repair of connective tissues such as tendons and ligaments. It causes a mild inflammatory response which initiates an immune response. This mimics what the body does naturally to heal soft tissue injuries.

The most common pelvic instability is sacroiliac instability, caused by injuries to the stabilizing ligaments of the sacroiliac joint. These ligaments are typically injured through the combined movements of spinal flexion and rotation.

Prolotherapy: Treating the ligaments in sacroiliac joint dysfunction

• Prolotherapy is multiple injections of simple dextrose into the damaged spinal area.
• Each injection goes down to the bone, where the ligaments meet the bone at the fibro-osseous junction. It is at this junction we want to stimulate the repair of the ligament attachment to the bone.
• We treat the whole low back area to include the sacroiliac or SI joint. In the photo above, the patient’s sacroiliac area is being treated to make sure that we get the ligament insertions and attachments of the SI joint in the low back.

• Why the black crayon lines? This patient has a curvature of her spine, scoliosis, so it is important to understand where the midpoint (center) of her spine is. In this patient, we are going to go up to the horizontal line into the thoracic area which is usually not typical of all treatments.
• After treatment we want the patient to take it easy for about 4 days.
• Depending on the severity of the low back pain condition, we may need to offer 3 to 10 treatments every 4 to 6 weeks.

For more information please see Prolotherapy treatments for lumbar instability and low back pain.

Research: the case for Prolotherapy as a non-surgical treatment of sacroiliac joint dysfunction and low back instability

As far back as 2009, our research team at Caring Medical has published research on outcome results in patients receiving Prolotherapy for low back pain. Here are the findings reported on 145 patients with unresolved lower back pain in the Journal of Prolotherapy:(1)

• One hundred forty-five patients, who had been in pain for an average of four years and ten months, were treated quarterly with Prolotherapy.
• This included 55 patients who were told that there were no other treatment options for their pain and 26 patients who were told by their doctor(s) that surgery was their only option.

In these 145 low backs:

• pain levels decreased  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.

The decrease in pain reached statistical significance for the 145 low-backs, including the subset of patients who were told there were no other treatment options for their pain and those who were told surgery was their only treatment option.

Further research on Sacroiliac joint-mediated pain and Prolotherapy injections.

In our own December 2021 paper published in the Journal of Back and Musculoskeletal Rehabilitation (2) on the effectiveness of Prolotherapy for sacroiliac joint pain, we cited the results of previously published research. These papers are summarized here:

A 2010 paper published in The Journal of Alternative and Complementary Medicine (3) compared the pain relief effects of Prolotherapy to corticosteroid injection. At 15 months, 58% of the patients treated with Prolotherapy reported that more than half of their pain was relieved, which was statistically significant compared with only 10% in the corticosteroid group who reported that same level of pain relief. The researchers here concluded: “Intra-articular Prolotherapy provided significant relief of sacroiliac joint pain, and its effects lasted longer than those of steroid injections. Further studies are needed to confirm the safety of the procedure and to validate an appropriate injection protocol.”

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.”(6)

• 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 of 2 years with low back pain
  • Much of the improvement was evident after the initial Prolotherapy injection.

Research appearing in the Journal of Alternative and Complementary Medicine from doctors at the Department of Anesthesiology and Pain Medicine, Chonnam National University Hospital in Korea, stated that “Prolotherapy provided significant relief of sacroiliac joint pain, and its effects lasted longer than those of steroid injections”(7)

Also in 2010, a well-received study from Dr. Manuel F Cusi, of the Sydney School of Medicine, the University of Notre Dame published in the British Journal of Sports Medicine found positive clinical outcomes for 76% of patients with sacroiliac joint problems. (8) This study was conducted to determine whether prolotherapy is effective in the treatment of deficient load transfer of the sacroiliac joint in 25 patients. In this study, 3 injections at 6-week intervals of a hypertonic dextrose solution were given into the dorsal interosseous ligament of the affected sacroiliac joint of each patient. Outcome measures standard test scoring to determine pain and function as well as an independent clinical examination by the paper’s two authors. The authors concluded that their descriptive study of prolotherapy in private practice showed 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).

We also concluded that:

• When patients experience weakness in the sacroiliac ligament, it can lead to pain similar to that caused by spinal stenosis – specifically, pain during walking and standing. This could lead to a misdiagnoses.
• If diagnosed as a ligament problem, these patients will typically respond to prolotherapy.
• Patients exhibiting distinctly unilateral symptoms frequently show improvement with ligament prolotherapy administered on the affected side of the body.
• Those suffering from listhesis and/or disc disease that contributes to the stenosis often find relief through prolotherapy at the corresponding spinal level.
• Decompressive surgery may worsen spinal instability. While sciatic pain often alleviates, lower back pain frequently worsens.

More published research

Evidence-Based Use of Dextrose Prolotherapy for Musculoskeletal Pain: A Scientific Literature Review: This paper has been cited by 45 research studies as we were able to demonstrate level 1 and 2 evidence to support the use of dextrose Prolotherapy for osteoarthritic pain and function, tendinopathies, myofascial pain syndrome, sacroiliac pain, and myofascial pain syndrome. There is level 3 evidence in support of the use of dextrose Prolotherapy for diffuse muscusloskeletal pain involving the spine, pelvis and peripheral joints. Dextrose Prolotherapy should be recommended for such musculoskeletal conditions as tendinopathy, ligament sprains, Osgood-Schlatter disease and degenerative joint disease, including osteoarthritis.

More articles:

Sacroiliac Joint Dysfunction Symptoms and Treatment Options : In this article, we will discuss treatments for sacroiliac joint dysfunction that could help you avoid SI fusion surgery. Many individuals who undergo fusion surgery for sacroiliac joint dysfunction experience great success, with their pain either completely gone or significantly lessened. However, there are others who, even after being informed that their surgery was a success, continue to experience pain. Additionally, some patients find that their surgery did not proceed as expected. Typically, we encounter post-surgical patients in these last two categories.

References

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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.
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8 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]