MRIs and low back pain

Ross Hauser, MD a chronic joint pain specialist and leading Prolotherapy doctor, recently commented on why there are so many unsuccessful low back pain surgeries – are MRIs the reason?

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.

New free access Prolotherapy research

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.

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Back pain and Prolotherapy

Prolotherapy research free access article low back pain

Free access to this Prolotherapy research on back pain can be found at the Journal of Prolotherapy

Dextrose Prolotherapy for Unresolved Low Back Pain: A Retrospective Case Series Study

Ross A. Hauser, MD & Marion A. Hauser, MS, RD

abstract
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.

introduction
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.

Prolotherapy and Back Pain Cortisone

● 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.

Sacroiliac joint pain

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!

Ross A. Hauser, M.D
Dr. Hauser the Medical Director of the comprehensive Prolotherapy clinic, Caring Medical & Rehabilitation Services in Oak Park, Illinois

Prolotherapy

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.

Prolotherapy Newsletter 1/12/2011

● Bone Marrow Prolotherapy – Hip
One of our first patients to receive Bone Marrow Prolotherapy to his hip has reported great results thus far (it’s only been a week and a half) but he says he can feel a difference. MG is a 46 year old contractor who does a lot of physical work. He received regular Hackett-Hemwall Prolotherapy with HGH to his severely arthritic hip from late 2007 to early 2009. He was much improved from this Prolotherapy but had not been able to return to full athletics because the increased activity would aggravate his hip. He was interested in trying out Bone Marrow Prolotherapy.

● Is it Loose Ligaments Causing Your Low Back Pain?
Read about some typical pain patterns experienced with ligament injury to the lower back.

● Knee Arthroscopy
The Patient thought her arthroscopy was for meniscal repair, but she received a resection – the case of Brenda from Boston – Prolotherapy would have been a much better option! Brenda from Boston came to Caring Medical with the desire to avoid getting bilateral knee replacements. She was already told by a surgeon that she was a great candidate for knee replacement surgery. Brenda is 70 years old.

Prolotherapy newsletter January 5, 2011

Prolotherapy newsletter January 5, 2011
We have a new video – bone marrow Prolotherapy What are growth factors? Why are growth factors important? Thank you for your interest in Bone Marrow Prolotherapy and how Prolotherapy is used at Caring Medical to help in the repair of ligaments, tendons, and cartilage. In this video, Ross Hauser, MD reviews what growth factors are and their role in treating pain and soft tissue injuries. Watch the video

Prolotherapy while undergoing chemotherapy Recently a potential new patient contacted Caring Medical about the possibility of getting Prolotherapy for some knee arthritis, while she underwent chemotherapy. She had been on Taxol (chemotherapy drug) for breast cancer.

Prolotherapy after back surgery Patients often have chronic low back pain persisting after surgery and are put into the category of people with “failed back surgery syndrome.” It is easy to find reasons why a back surgery patient would still have pain after the surgery. During surgery, for example, a discectomy (removal of the disc), the surgeon must spread some muscles and cut some of the ligaments in order to perform the surgery. The surgery itself can cause ligamentous laxity and instability of the spine.

When should the Prolotherapy start working? The anesthetic in the solution used during Prolotherapy sessions often provides immediate pain relief. The pain relief may continue after the effect of the anesthetic subsides due to the stabilizing of the treated joints because of the inflammation caused by the Prolotherapy injections.

Enhancing Healing Through Diet
● 7 ways to improve your breakfast
● Can your food cause Alzheimer’s disease



December 1, 2010 Prolotherapy Newsletter

 Prolotherapy Articles Failed Back Surgery – New Video
 

● Trigger Finger and Arthritis in the 81 year old patient
 David came to Caring Medical a few months ago from one of the local Chicago suburbs about 20 miles away to have Dr. Hauser evaluate the pain he experienced in both of his hands. He had been battling pain for over ten years with no relief. He had tried various rounds of cortisone shots and was told he needed surgery to his hands. At 81 years of age he was having trouble gripping objects and had pain when golfing, cutting the grass, and any activity that required grasping and gripping.
 
 ● Caring Medical offers second opinion on cases that appears to have plateaued
 We received the following email recently from a patient in Oklahoma, “I have received 3 Prolotherapy treatments from a local physician for my sacroiliac joint. The first treatment reduced my pain about 50%. The 2nd and 3rd treatments gave me marginal improvement, but it seems like I have plateaued in my progress.
 
 ● Diet Helps Healing When Jean was having trouble healing her back with Prolotherapy, we recommended Diet Typing to ensure that her body is able to support the immune response that Prolotherapy was stimulating. She was about 70% better than when she had started Prolotherapy treatments, but she was ready to get to 100% pain free living.
 
 For the Athlete
 ● Snapping Scapula Syndrome
 ● NSAIDs: Why We Do Not Recommend Them
 ● Treatment for shin splints with Prolotherapy
 
 Enhancing Healing Through Diet
 · Sleep and insulin resistance – what is the connection?
 · Can your food cause Alzheimer’s disease
 · There’s a Whole Lot of Whole Grain Options
 · The Hauser Diet for Diabetes

Prolotherapy Newsletter 11/03/2010

Prolotherapy Articles
● Loose bodies on Arthroscopy Loose bodies are fragments of bone, cartilage, or collagen that are located in the joint cavities. The most common location is the knee. Sometimes these loose bodies, truly are loose, they move freely within the joint and can be entrapped between the articular surfaces of say the knee bones (like the femur and tibia). This can cause symptoms such as intermittent joint locking, limitation of motion, pain and sometimes swelling. There are other types of loose bodies that are not so loose. The fragments attach into a bursa (a fluid filled sac that prevents friction between bone and soft tissue structure such as a tendon) or stabilize onto some structure such as the synovium. Most loose bodies do not produce symptoms and are found incidentally on X-ray.

● My MRI is Terrible Does Caring Medical order MRIs? Almost never. In my opinion, most MRI findings have nothing to do with why the person has pain and is thus the reason for most ‘failed surgery syndromes.’ Almost all people even after surgery are not pain free. Surgery for pain in the best case scenario should be done only after all of the conservative treatments have been tried and failed. This includes Prolotherapy! Degenerated joints, including degenerated or herniated discs, signify ligament laxity. Ligament laxity or vertebral instabilities are the reason that discs become degenerated. A herniated disc by definition means the nucleus pulposis (gelatin part of the disc) has herniated through the annulus fibrosis, which is ligamentous tissue. Caring Medical has helped many people with acute and chronic disc herniations and degenerated discs resolve their pain and disability without surgery. For a person in relatively good shape and immune function (good healing ability) the likelihood of success is even higher. Prolotherapy by stimulating the ligaments to heal, helps the vertebral segment become stabilized and thus eliminates the reason for the degenerated disc.

● Prolotherapy for the Achilles Tendon 5 treatments – 5 months Mark was an avid runner and softball player who was struggling with painful Achilles tendonitis. The pain was present for over a year and after no relief from cortisone shots or electrical stimulation.

Back Pain Links
● Degenerative Disc Disease Articles
● Low back pain
● Low Back Pain and Prolotherapy
● Low and mid back pain
● Low back and sitz bone
● Arachnoiditis
● Ankylosing Spondylitis
● BACK PAIN-WHAT’S THE DIAGNOSIS?
● Loose Ligaments and Back Pain
● Prolotherapy-Back Surgery-Spinal Fusion
● Compression Fracture
● Facet Syndrome
● Sacroiliac Pain
● Tarlov Cysts
● The problem with getting properly diagnosed: SI strain
● Prolotherapy Spondylolisthesis
● SPINAL DISC PROBLEMS
● Diffuse idiopathic skeletal hyperostosis
● Scoliosis and Prolotherapy
● Spinal Stenosis and Prolotherapy
● Spinal Cord Stimulators
● Spinal Stenosis and Prolotherapy
● MRIs, Herniated Discs, Prolotherapy
● Radiofrequency denervation
● Women, Back Pain and Hormones
● Sacroiliac Blog
● BACK PAIN BLOG

For the Athlete
● Ross Hauser, MD on Shoulder Injuries in swimmers in USMS
● Rugby knee injury in high school athlete
● Post fracture pain treated with Prolotherapy
● Platelet Rich Plasma (PRP) Prolotherapy for Athletes
● The shoes you wear can affect knees and joints in arthritic patients

Enhancing Healing Through Diet
● The Hauser Diet For Lower Cholesterol
● Are you exercising, but still overweight? 

Ross A. Hauser, M.D.
Dr. Hauser is the Medical Director and co-founder of the Chicago area based chronic pain clinic Caring Medical & Rehabilitation Services in Oak Park, Illinois. CMRS is nationally recognized as a leading center specializing in Prolotherapy and PRP Prolotherapy (Platelet Rich Plasma Therapy),

Dr. Hauser is one of the leading experts in the treatment of chronic pain and sports injuries with Prolotherapy and PRP Prolotherapy. He, along with his wife Marion, have many books and Prolotherapy research papers on the topic of Prolotherapy.

CMRS 715 Lake Street Suite 600, Oak Park Il, 60301 708-848-7789