In prior issues, I have discussed prolotherapy and how it helps with musculoskeletal pain. Today, I will briefly summarize how prolotherapy works and then focus on how prolo helps back pain. Prolotherapy is a natural treatment that strengthens ligaments, tendons and cartilage. This is achieved by a solution that stimulates a reaction in the body that leads to the growth of collagen, which is the building block of ligaments and tendons. The beautiful part of prolo is that the injury is treated by strengthening tissue. This stands in contrast to traditional treatments such as steroid injections, which can potentially degrade tissue. Physical therapy is effective for building and stretching muscle, but does not strengthen the ligaments and does not heal a tendon injury. Prolo is effective for tendonitis, such as rotator cuff and tennis elbow; sprains, such as ankle and wrists; and arthritic joints, such as knees and hips. There are multiple studies that have shown that prolo works, including randomized double-blind studies. Without getting too technical, this type of study is the gold standard of medical research.
Two of the most common causes of low back pain are disc herniation and spinal stenosis. In those up to 60 years old, lumbar disc herniation is a common cause of back pain. The disc is a fibroelastic circular tissue that acts as a shock absorber for the vertebral bodies of the spine. When the ligaments around the disc weaken, the disc is more vulnerable to the routine forces that stress the disc. The disc has a gelatinous center surrounded by layers of fibrous tissue. As we age the layers weaken. When enough of these layers weaken, the central gel of the disc—also known as the nucleus pulposus—will push through, or herniate, and press into the nerve area. This may cause severe back pain and neurologic symptoms in the legs including pain, weakness and numbness. The disc tends to push out onto the nerves with activities that increase disc pressure, including lifting, sitting and bending. Thus, sitting worsens disc herniation pain. Prolotherapy solution is not placed into the disc, but by treating the ligaments in the area of the disc, the area is strengthened. With stronger tissue surrounding the disc, the disc pressure is reduced and there is less pain from the disc. Prolotherapy helps those with disc-related pain by strengthening the ligaments. This reduces pressure on the disc for long-term relief.
The most common cause of back pain in those over 60 is spinal stenosis and related spine arthritis. The disc space narrows as we age. As this occurs, the bones in the spine start to rub together, which leads to bone spurs. When these spurs grow into the spinal canal, this results in stenosis or narrowing of the spinal canal, causing back pain and neurologic symptoms in the legs including pain, weakness and numbness. The spinal canal narrows further with extension so walking and standing are especially painful with stenosis. Prolotherapy helps this condition in two ways. One is that the ligaments themselves are a source of arthritic pain, so by strengthening the ligaments, a primary source of pain is reduced or eliminated. The other is that by strengthening the ligaments around the spine, the spine segments are stabilized and the stress on the bones is reduced. This helps reduce the progression of arthritis. Prolotherapy helps stenosis in the short-term by reducing pain and in the long-term by strengthening the spine.
When a disc or bone spur applies pressure to the nerve, leg symptoms may develop as noted above. This is because the nerve being pinched supplies different areas of the leg. However, the spine ligaments may also cause referred pain to the leg. Dr. Hackett delineated this concept in the 1950s, which was summarized by showing the pain patterns generated in the leg by each of the spine ligaments. When a particular ligament is treated it is common for the patient to report a referred sensation to the leg that mimics their pain referral. Fortunately, with the treatment, the ligament is strengthened and the referred pain improves. What is referred to as ‘a pinched nerve’ is often a weak ligament referring pain to the leg. This weak ligament is treatable with prolotherapy.
Another area of pain that responds to prolotherapy is sacroiliac joint strain. The sacroiliac joint unites the sacrum, which is the lower base of the spine, with the ilium of the pelvis. Because there are so many ligaments surrounding the joint, some consider the joint fixed and immobile. However, I suggest that the reason there are so many ligaments around the joint is because it is mobile and needs to be held in place. When these ligaments slacken, the joint becomes painful, typically producing buttock pain with referred pain to the thigh and even distal leg. By strengthening the ligaments around the sacroiliac joint, prolotherapy stabilizes the joint and relieves the sacroiliac pain.
For many with back pain, the cause is not obvious. The discs may appear normal and there is no obvious arthritis. This is common in my patients between their 20s and 40s. There are other structures that may be a source of pain, such as the facet joint or muscle, but one that is often overlooked and in my experience is a frequent source of back pain is the ligament. Weakened spinal ligaments result in pain with movement and increased stiffness after periods of immobility, such as with prolonged sitting or lying down. By strengthening the spinal ligaments with prolotherapy, long-term relief is achieved in those who have had multiple treatments, which have provided no relief and/or temporary relief. This is because these other treatments do not treat the source of the pain, which is the ligament.
In summary, back pain is attributed to many structures, including the disc, the facet joints, spinal nerves, back muscles and sacroiliac joints. All of these structures are more susceptible to injury with weakened spine ligaments. By strengthening the ligaments, prolotherapy is effective for back pain as it eliminates the actual source of pain and stabilizes the spine so pressure on the painful structure is reduced. Prolotherapy for back pain provides short-term relief by treating the source of pain and long-term relief by stabilizing the spine.
By Warren Slaten, M.D.
Dr. Slaten is a pain wellness physician in Ridgewood. For more than 20 years, he has been practicing with great skill and an open mind. For more info, check out njprolo.com.
