In this artcile, Ross Hauser, M.D., discusses the role of massage therapy in chronic low back pain.
There is no question that massage therapy has its benefits and does offer pain relief. In a recent study released by the Annals of Internal Medicine, researchers found massage therapy to be an effective pain reliever for people with low back pain, although mostly on a temporary basis.
In this published study a placebo group that received no massage therapy was compared to two other groups that received two different types of massage therapy for low back pain. The results showed that one in three people in the massage groups had pain relief for about six months, while only one in 25 people in the placebo group received any type of pain relief.
Massage therapy addresses the muscular aspects of pain, but often times muscle spasms, tightening, or pain are due to an underlying ligament injury. Here’s what happens:an injured or lax ligament (the connective tissue that holds bones and cartilage together) causes instability in a joint leading to excessive movement. When the ligaments can no longer stabilize the joint or vertebrae, the muscles go into spasms. Recurrent muscle spasms almost always point to an underlying ligament problem. If left alone, the body will eventually overgrow bone to stabilize the joint, leading to osteoarthritis in the joint. So the best thing to do is to fix the ligament injury with Prolotherapy.
Since Prolotherapy injections help with ligament repair it typically helps permanently relieve low back pain. Generally people need three to six visits. The injections are typically given every four to six weeks. Massage therapy is an excellent option to use in conjunction with Prolotherapy and we encourage it over the use of painkillers or anti-inflammatories. Realize, however, that most chronic pain has an underlying ligament or tendon injury that must be addressed, and Prolotherapy is the perfect way to address it. For more information of Prolotherapy and to find Prolotherapy doctors
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Patients with chronic pain often suffer from depression, have trouble concentrating and struggle to remain positive. Current research shows why – chronic pain has an adverse effect on the brain, but it can be reversed with pain relief.
“Treating chronic pain can restore normal brain function in humans.”
In a recent study in the Journal of Neuroscience, researchers at McGill University in Montreal studied 18 people that had been suffering for six or more months from chronic low back pain. When compared to people with no chronic pain, they found that these people had decreased brain gray matter and impaired cognitive ability. Using an MRI, researchers observed thinner tissue and abnormal brain activity while subjects performed a cognitive attention-requiring task. In other words, chronic pain affected areas of the brain that deal with depression and impaired concentration, memory, mood, and social judgment.
Pain Relief and the Brain
Now here’s the interesting part: when the pain was relieved there was a reverse in the deterioration of the brain – the area of the brain (known as the dorsolateral prefrontal cortex) was no longer thinner than the control group. Additionally, there was no abnormal activity observed by MRI when the chronic pain patients performed a cognitive task. In the three people that reported no pain relief from treatment, there was no regeneration of gray matter. This study suggests that chronic pain takes a toll on the brain, but with relief it can regenerate itself.
Effective Chronic Pain Treatment
Each subject in the study chose to have back surgery or facet joint injections for pain relief and were reexamined six months after treatment. Unfortunately we don’t believe that surgery and facet joint injections (involving cortisone) are effective treatments because they don’t always reach the root cause of the problem.
As for cortisone injections, they can do more harm than good and tend to have an adverse effect on bone and soft tissue healing. They limit the amount of calcium taken in by bone, thereby weakening the fibro-osseous junction that is usually the root cause of the pain. They also inhibit the release of growth hormone that is used to heal injuries; they inhibit the synthesis of proteins and collagen and have an overall weakening effect on joints.
In my opinion, the most effective way to treat chronic pain is through Prolotherapy injections. Prolotherapy treatjments stimulates the body to repair painful injured areas when the body’s natural healing process is not able to do the job on its own. Just as the brain is able to regenerate itself, injured joints can regenerate collagen and soft tissue through an inflammatory process. Prolotherapy is able to induce an inflammatory process to lead to healing, pain relief and ultimately better mental clarity, moods and more.
Larn more about Prolotherapy research
If low back surgeries are so unsuccessful, why do surgeons continue to perform them? The main reason is because they find abnormalities on MRI scans. Ironically most MRI findings have nothing to do with why the person has pain and this is the reason for most back surgery failures.
Sadly many surgeons proceed with low back surgery after misdiagnosing the cause of pain. Even worse, the uses of MRI’s seem to be increasing and are even being performed in surgeons’ offices. A study recently released by the Stanford University School of Medicine showed that MRI scan rates increase when a doctor buys or leases MRI equipment. The study also showed that patients were 34% more likely to receive back surgery when they had an MRI scan done by their doctor. In other words, seeing a doctor who has an in-office MRI scan increases your chances of getting a scan and getting surgery. Interestingly, the study author noted that MRIs and surgery are controversial because there are no proven benefits. She goes on to say that most people with low back pain do not need an MRI and even fewer need surgery. Therefore a patient should take caution when his doctor prescribes an MRI, especially if it is in the same office because your chances for receiving surgery may be increased. Unfortunately most doctors send patients straight to an imaging test without performing a physical examination or health history to determine the root cause of the problem. Since imaging tests tend to show abnormalities, even in patients with no pain at all, root causes of pain are misdiagnosed and wrong treatments are chosen. At Caring Medical, our Prolotherapy physician Dr. Ross Hauser performs a physical examination on each and every patient, even those who bring in MRI or X-ray results, to determine the exact cause of pain. He then chooses the best course of Prolotherapy treatment to heal the injury and rid the patient of pain. The average patient receives 3-6 treatments spaced four weeks apart. So if your doctor prescribes an MRI, take caution. A physical examination is essential in diagnosing pain.
The Journal of Prolotherapy is offering more free access complete Prolotherapy research and clinical outcome studies.
Below is a case study examining Prolotherapy and lower back pain, pelvic shifting benefit
Background Content: This case study examined the effects of a single Prolotherapy injection series on the left iliolumbar ligament. The ligament measurements were split between medial and lateral portions of the iliolumbar ligament and we hypothesized that growth would occur increasing the cross sectional area and thus provided added stability to the pelvis and lumbar spine.
Purpose: The purpose of our study was to answer two questions: 1) how do you know that the Prolotherapy injectant actually reaches the ligamentous structure you are attempting to heal; and 2) how long does it take for the ligament to recover?
Study Design: Single case study.
Methods: One subject, 32 year-old female with no history of lower back pain (LBP) participated in our study. Her job tasks as a physical therapist required her to twist turn and bend; putting pressure on her pelvis and ligamentous system. The primary author (A.A.) assessed her pelvic ligaments which lead to using a specified Prolotherapy solution for the left iliolumbar ligament. Ultrasound (US) guided imaging was used to take baseline measurements of the left iliolumbar ligament prior to Prolotherapy. Bi-weekly US measurements were up to six weeks to determine cross-sectional area (CSA) changes within the ligament.
Results: The results indicated that after the initial Prolotherapy treatment, there was growth in the left iliolumbar ligament at both the medial and lateral sites. The CSA increased by 27% for the medial measurement and 21% for the lateral measurement compared to baseline. The left iliolumbar ligament also appeared to change its characteristics and looked more uniform as a result of one Prolotherapy treatment.
Dextrose Prolotherapy for Unresolved Low Back Pain: A Retrospective Case Series Study
Ross A. Hauser, MD & Marion A. Hauser, MS, RD
Objective: To investigate the outcomes of patients undergoing Hackett-Hemwall dextrose Prolotherapy treatment for chronic low back pain.
Design: One hundred forty-five patients, who had been in pain an average of four years and ten months, were treated quarterly with Hackett-Hemwall dextrose Prolotherapy. This included a subset of 55 patients who were told by their medical doctor(s) that there were no other treatment options for their pain and a subset of 26 patients who were told by their doctor(s) that surgery was their only option. Patients were contacted an average of 12 months following their last Prolotherapy session and asked questions regarding their levels of pain, physical and psychological symptoms and activities of daily living, before and after their last Prolotherapy treatment.
Results: In these 145 low backs, pain levels decreased from 5.6 to 2.7 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 at the p<.000001 for the 145 low backs, including the subset of patients who were told there was no other treatment options for their pain and those who were told surgery was their only treatment option.
Conclusion: In this retrospective study on the use of Hackett-Hemwall dextrose Prolotherapy, patients who presented with over four years of unresolved low back pain were shown to improve their pain, stiffness, range of motion, and quality of life measures even 12 months subsequent to their last Prolotherapy session. This pilot study shows that Prolotherapy is a treatment that should be considered and further studied for people suffering with unresolved low back pain.
Low back pain is one of the leading causes of physical limitation and disability in the United States today. Each year, 65,000 patients are permanently disabled by conditions associated with back pain, and 80% of the U.S. population is estimated to suffer back pain at some point in their lives.1,2 Though acute back pain is believed to be self-limiting, it recurs at a rate of approximately 90%.3 In one study, only 25% of the patients who consulted a general practice about low back pain had fully recovered 12 months later.4 For those who do recover, relapses can be frequent and severe, with two to seven percent developing chronic pain.5
There is some consensus in the medical community on how to treat acute low back pain, but treatment of chronic pain presents many challenges and little agreement on standard of care. Nonsteroidal anti-inflammatory drugs and antidepressants provide some short-term benefit, but no published data warrant their long-term use.6 Manipulative therapy, physiotherapy, and massage therapy studies have also shown only temporary benefit.7,8 Long-term results on more invasive therapies, such as intradiscal electrothermal therapy (IDET) or surgery, have been poor.9,10 Some believe the poor results for the treatment of chronic low back pain stem from the fact that too much emphasis has been placed on pain arising from the intervertebral discs and not enough on chronic low back pain originating from the sacroiliac joint and ligaments.11,12 Because of the limited response to traditional therapies, many people have looked to other approaches for pain control. Prolotherapy (proliferative therapy), also known as regenerative injection therapy, is a nonsurgical injection therapy used to treat unresolved musculoskeletal pain and has shown some promise in relieving lower back pain.13 The procedure involves injecting soft connective tissue with one or more proliferants designed to provoke local inflammation, stimulating the body’s production of collagen at the injection site. The resulting growth of new ligament and tendon tissue is believed to alleviate pain.
In this Prolotherapy video presentation, Ross Hauser, M.D., discusses sciatica and Prolotherapy treatments for it. Dr. Hauser is the medical director of Caring Medical and Rehabilitation Services in Oak Park, Illinois.
Ross Hauser, M.D., noted Prolotherapy specialist demonstrates Prolotherapy for tail bone pain in this new video.
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● Back pain patient saved from traditional therapies with Prolotherapy
Here at Caring Medical Dr. Hauser sees lot of people who we wish would have come in before they entered the traditional “pain management system” soon after they received a painful injury, and began a journey that led them nowhere. One of our nurse’s spouses was fortunate to have heard about Prolotherapy and was able to be treated with regenerative injection therapy (Prolotherapy) soon after she sprained her back at work.
● Prolotherapy an alternative non surgical treatment option for herniated discsDisc herniation occurs when the small, flat discs (composed of a tough, outer shell surrounding a jellylike material) that cushion the spine bulge or break open. When healthy, these discs act as shock absorbers for the spine and keep the spine flexible. When damaged by injury, wear-and-tear or disease, they herniate. Herniated discs can occur anywhere on the spine, but are most common in the lower back and the neck.
● Prolotherapy Research: Prolotherapy is an effective alternative to surgeryIn this study, Prolotherapy caused a statistically significant improvement in pain and stiffness levels in 34 patients who were told by their medical doctor/surgeon that surgery was needed, including 20 who were told they needed joint replacemnents and nine arthroscopic procedures. Instead, they were treated with Prolotherapy, an injection technique that stimulates the body to repair the injured area using the Hackett-Hemwall technique of Prolotherapy.
● Cortisone or Prolotherapy?
Long ago I realized that in almost every published Prolotherapy study where significant pain improvement was achieved in patients, the results was obtained using either traditional Hackett-Hemwall Prolotherapy and/or dextrose Prolotherapy. To verify this, all one needs to do is examine all of the human Prolotherapy studies performed. It will become clear that the most effective scientifically proven method (at least to this point) is Hackett-Hemwall dextrose Prolotherapy. Certainly the prolotherapy research we have published confirm that! Click here to read any or all of those studies on our research website http://www.prolotherapy.org.
● Prolotherapy and Lumbar Spinal Fusion Common sense would tell anyone that when you fuse two or three spinal segments together, that spinal movement has to come from somewhere. Where? The spinal segments above it and below it will have to move “excessively” because of the spinal fusion. Ultimately, this extra movement and strain will cause accelerated degeneration of the disc, ligaments, and joints of these segments, thus making the person more prone to pain in these areas. This is most likely the explanation for the increased pain a few years down the road and the “need” for more operations later. Is there a better way?
● Exercise induced low back painHilary, a 51-year old woman who had a long history of yoga practice. She was fit, lean and believed that yoga had helped her get that way. Unfortunately, her low back had been in pain for over a year after she injured it in a yoga position. As a result she had decreased her strength and cardio workouts and lost muscle mass. She went from working out everyday to working out twice a week with back pain after both workouts. Her low back pain included sciatica and episodes of her back going out. She continued yoga and even used a special headstand to self-adjust her spine. She had also tried massage therapy and trigger point therapy. She had short term relief after acupuncture and she had it done every week. As the weeks started to add up she was ready for a permanent solution to her back pain. When she heard of Prolotherapy she decided to give it a try.
Research appearing in the Journal of Alternative and Compementary Medicine says that “Intra-articular prolotherapy provided significant relief of sacroiliac joint pain, and its effects lasted longer than those of steroid injections”
Kim WM, Lee HG, Jeong CW, Kim CM, Yoon MH. A randomized controlled trial of intra-articular prolotherapy versus steroid injection for sacroiliac joint pain.J Altern Complement Med. 2010 Dec;16(12):1285-90.
The researchers noted:
The numbers of recruited patients were 23 and 25 for the prolotherapy and steroid groups, respectively. 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 pain relief at 15 months was 58.7% in the prolotherapy group and 10.2% in the steroid group-there was a statistically significant difference between the groups.
Significant improvement in sacroiliac pain revealed In Korean study
by Ross Hauser, MD
A few years ago, it finally dawned on me that almost every published Prolotherapy study that revealed significant pain improvement results was either using traditional Hackett-Hemwall Prolotherapy and/or dextrose Prolotherapy.
All one has to do examine all of the human Prolotherapy studies ever done and it will be clear that the most effective scientifically proven method (at least to this point) is Hackett-Hemwall dextrose Prolotherapy.
The dextrose Prolotherapy study cited above was performed at Chonnam National University Hospital in Korea, a randomized controlled trial of intra-articular Prolotherapy versus steroid injection for sacroiliac pain. This study was perfromed through the department of anesthesiology and pain medicine. The patients were confirmed to have sacroiliac pain because each patient received a diagnostic block to the sacroiliac joint. In other words, the pain was blocked to that area and all of the patients experienced short term pain relief. All of the patients previously failed traditional medical therapy for long term pain relief, meaning they were considered “tough” sacroiliac pain problems. They each received either a steroid shot or dextrose Prolotherapy done under fluoroscopic guidance done biweekly for a maximum of three times. As would be expected both the steroid and Prolotherapy group had significant pain relief at two weeks but at 15 months the difference reached statistical significance with Prolotherapy giving statistically significantly more pain relief than the steroid group.
What does this mean?
If a person has sacroiliac pain and you want long-term relief, you have a much greater chance of achieving it with dextrose Prolotherapy versus a steroid shot!
Why? In my opinion, the reason is because Prolotherapy stimulates the repair of the injured sacroiliac ligaments. In other words, it helps stabilize the sacroiliac joint!
Patient uses Prolotherapy for 5 body parts over 5 years
AJ is a 57 year old active woman who is a school teacher, loves to walk her dogs, and spend time with her family. She is no stranger to Prolotherapy. In the past four years Prolotherapy has provided chronic pain relief in her shoulder, hand, knee, buttock, and, most recently, her foot. When she first came to see us in 2007 she was having severe shoulder pain. Her doctor had recommended surgery but she was skeptical and went in search of another option. She discovered Caring Medical and Prolotherapy and decided to try this alternative before undergoing surgery.
AJ’s introduction to Prolotherapy: Her course of treatment with Dr. Hauser involved 10 Prolotherapy injections strengthened with human growth hormone (HGH). She received three treatments to her shoulder and was healed of all pain. AJ regained complete range of motion and avoided a costly surgery.
Shoulder surgery avoided!
AJ also wanted to feel her best so at that time she also did hormone testing and Diet Typing. She found out that her progesterone and testosterone levels were low and that her blood was acidic. She started on natural hormone replacement therapy, as well as the Hauser Otter Diet (higher protein, lower carb diet) and found great improvement in her overall energy as well.
Time for more Prolotherapy! Over the next few years she paid attention to her body and acted quickly when pain would arise. Whether it was an overuse injury in her hand or an acute knee injury from a fall while walking her dog, AJ immediately came to Caring Medical for relief. In fact, she only needed one treatment to heal her pain in her hand, knee, buttock, and foot.
Foot Pain treated with Prolotherapy
Injury strikes again: Her most recent pain was on the top part of her foot. It was sporadic pain for a few weeks and then turned constant. She came to Caring Medical right when the pain became constant and received 20 Prolotherapy injections to her foot. She also picked up the recommended supplements and began using toe stretchers at home. Again, one treatment was all she needed.
Prolotherapy for any type of joint pain: AJ told us that she is Prolotherapy’s biggest fan. She doesn’t mess around with chronic pain; she goes straight for the treatment that will bring quick and effective healing. AJ knows that chronic pain is nothing to play around with and that Prolotherapy is an excellent alternative to traditional treatments.
Ross A. Hauser, M.D.
Dr. Hauser the Medical Director of the comprehensive Prolotherapy, PRP, and Bone Marrow Prolotherapy clinic, Caring Medical & Rehabilitation Services in Oak Park, Illinois. Dr. Hauser is one of the leading experts in the treatment of chronic pain and sports injuries with Prolotherapy.