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.
The Journal of Prolotherapy is offering free online access to complete Prolotherapy research articles.
In this article
Researchers investigated the outcomes of patients undergoing Hackett-Hemwall dextrose Prolotherapy treatment for unresolved knee pain at a charity clinic in rural Illinois. Eighty patients were studied, representing a total of 119 knees, that were treated quarterly with Prolotherapy. On average, 15 months following their last Prolotherapy session, patients were contacted and asked numerous questions in regard to their levels of pain and a variety of physical and psychological symptoms, as well as activities of daily living, before and after their last Prolotherapy treatment.
The results of this study showed that patients had a statistically significant decline in their level of pain, stiffness, crunching sensation, and improvement in their range of motion with Prolotherapy.
More than 82% showed improvements in walking ability, medication usage, athletic ability, anxiety, depression, and overall disability with Prolotherapy.
Ninety-six percent of patients felt Prolotherapy improved their life overall. Conclusion: In this study, patients with unresolved knee pain, treated with dextrose Prolotherapy, showed improvements in many clinically relevant parameters and overall quality of life.
Read the entire Prolotherapy and knee pain study
● 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.
A full access article on how injections to the hip are helping arthritis pain sufferers can now be accessed online at the getprolo Prolotherapy information website
The entire article appears at the Journal of Prolotherapy website
The Deterioration of Articular Cartilage in Osteoarthritis by Corticosteroid Injections
Ross A. Hauser, MD
The hallmark feature of osteoarthritis is the breakdown in the articular cartilage of joints such as the knee and hip. Both animal and human research has consistently shown that corticosteroid injections into normal and degenerated knees accelerate the arthritic process. A summary of the effects of the intraarticular corticosteroids on articular cartilage includes: a decrease of protein and matrix synthesis, matrix hyaline appearance becomes fibrotic, clumping of collagen, alteration in chondrocyte cell shape, chondrocyte cell proliferation inhibited, chondrocyte cytoxicity enhanced, loss of chondrocytes, surface deterioration including edema, pitting, shredding, ulceration and erosions, inhibition of articular cartilage metabolism, articular cartilage necrosis, thinning of articular cartilage, decrease in cartilage growth and repair, formation of articular cartilage cysts, and ultimately articular cartilage destruction.
The ankle ligament may be the most sprained ligament in the body. Every year up to 26,000 people sprain their ankles. Many of these people are runners—whether they are casual or serious athletes. Some of these injuries do not heal and will only get progressively worse until it is impossible for the runner to run anymore. Here are some of the common mistakes made by runners with ankle injuries that can lead to that unfortunate outcome:
- Taping or Bracing instead of Treating
Have you ever been to a high school soccer or lacrosse game midway through their season? There is tape everywhere! Every other player has a taped up ankle and the others all have taped up knees. The theory behind all of this taping and bracing is that it will disperse force away from the injured area. In the case of the ankle, this means that braces are applied to redirect the force from running away from the anterior talofibular ligament and toward other ligaments in the foot. This is a problem for two reasons. The first is that adding stress to other ligaments in the foot endangers them for injury as well. The second is that redirecting the force away from the injured ligament immobilizes it. It cuts off the blood flow to the ligament. This has many detrimental side effects, including, fatty tissue and/or scar tissue forming in the ankle, cartilage damage, and ligament laxity. Putting an incredibly tight band around an ankle injury does not help the injury to heal because it puts other ligaments at risk and it cuts off the blood flow to the ligament. Prolotherapy, on the other hand, encourages blood flow to the area to actually repair the damage. When Dr. Hauser treats runners, the goal is to heal the ankle joint to the point where they have no need for braces or tape! The average number of Prolotherapy treatments needed in our office is three to six, typically one month apart.
- Taking NSAIDs
Most runners have been taught to “run through the pain.” However, when the pain is chronic and happens every time the runner runs, this is a very bad idea. Remembering the old saying, many runners attempt to run through their pain by taking NSAIDs or non-steroidal anti-inflammatory drugs to mask the pain. Well, here’s another old saying: where there’s smoke, there’s a fire. When a runner is experiencing chronic pain, it’s the body’s way of saying that there is something wrong! Covering up the pain by taking NSAIDs, which decrease inflammation, takes away the body’s warning system. Inflammation is crucial to healing. In fact, the reason that injuries become swollen in the first place is because the body increases blood flow to the area. This causes the redness and swelling that is common to ankle injuries. Suppressing this process, the way that NSAIDs do, actually prolongs the healing of the injury because the body can’t get its job done. Prolotherapy, on the other hand, speeds up the healing process without the need for continued medication.
Remember, it’s not “just” ibuprofen. Athletes should not try to rationalize taking it regularly. The detrimental long term effect of regular anti-inflammatory use on joint health can be severe. This is why we are so zealous about seeing athletes ditch these old fashioned treatment methods- we see the terrible side effects that happen years later!
- Not Cross Training
Runners love to run- and often that is their only sport. Then if the ankle pain is too bad, the person stops and becomes inactive. Others will continue to take NSAIDs and tape the ankle just to continue to run, without looking into the benefits of cross training. Exercising is great for healing injuries. Exercising a body part increases its strength, while doing nothing decreases strength. For Caring Medical patients who get Prolotherapy to heal ankle pain, we encourage exercise, although it may be in the form of cross training in other sports. Typically, the recommended exercises will concentrate on range of motion to help nourish the injured joint.
One particular high school athlete seen at Caring Medical was an elite high school runner. She came to Caring Medical because she had ankle pain and wanted to run pain-free again. While she received Prolotherapy injection treatment, Dr. Hauser also recommended an exercise program so she would not lose her strength before track season. One part of her cross training program involved running in the pool. This made her body stronger without the high-impact force of running outside on pavement. She was told not to run on pavement until one week before sectionals. Although this may have seemed non-traditional to her trainers, she ended up winning sectionals and then going on to take state in the one-mile event! Instead of bracing, masking the pain, or resting she came to Caring Medical and got her body stronger with Prolotherapy and cross training exercises.
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 running related injuries. Dr. Hauser is one of the leading experts in the treatment of chronic pain and sports injuries with Prolotherapy.
Ross Hauser, M.D. explains the different types of Prolotherapy injections.
Ross Hauser, M.D.
People are confused because doctors, most commonly orthopedic surgeons, give them diagnoses that they do not understand. In one study, 51 surgeons were asked to give the four most common diagnoses used for patients with low back pain and a total of 50 different terms were used. Some of the diagnoses were the following: facet syndrome, mechanical low back pain, degenerative disc syndrome, arthritis, degenerative instability, central stenosis, failed low back syndrome, radiculopathy, herniated disc, spondylosis, sprain, fibromyositis, and about 35 other terms. (Fardon, D. Terms used for diagnosis by English speaking spine surgeons. Spine. 1993; 18:274-277.)
This study was done in 1993, so there are probably another 10 terms by now! By and large, however, the terms used were just variations on the condition of the disc. The main focus in orthopedic surgery, as it relates to neck and low back pain, is that the source of the pain evolves from disc deterioration. Most surgeons would say the majority of pain complaints in the neck, mid back, and low back are from problems in the discs. This is why so many MRIs and surgeries are performed. Prolotherapy doctors do not have to argue this point. Even if this was the case (which we do not think), then the best treatment is still to strengthen the ligamentous support around the disc so it does not have to bear as much weight. Even if the discs are the cause of the pain, the treatment required is still Prolotherapy.
Back Braces? Support or Folly? Over the years, numerous studies have been done to see what would happen if workers wore back supports, belts, or braces. Would these help, hinder, or have no effect on the worker developing back pain? One study, for instance, took 312 workers at a major Dutch airline whose jobs included loading and unloading cargo pallets both manually and with a forklift truck.back pain during the intervention period and 10 percent took sick leave because of low back pain. The study found no statistically significant differences among the groups. The back supports did not prevent the development of back pain in these workers. (Van Poppel, M. Lumbar supports and education for the prevention of low back pain in industry. JAMA. 1998; 279:1789-1794)
What about back surgery? Nearly 95 percent of all the low back pain occurs in a six by four inch area. This is the place where the fifth lumbar vertebra connects with the base of the sacrum and they both connect to the pelvis by various ligaments.lumbosacral ligaments, the sacrum to the iliac crests by the sacroiliac ligaments, and the lumbar vertebrae to the iliac crests by the iliolumbar ligaments.
This is the most common area in the back treated by Prolotherapy.pinched nerve. Many patients who have all kinds of disc abnormalities that show up on MRI and CT scan, say they didn’t even know because they had no symptoms! Scott Boden, M.D., found that nearly 100 percent of people he tested, over age 60, with no symptoms had abnormal findings in their lumbar spines on MRI scans. Maureen Jensen, M.D. and associates published in The New England Journal of Medicine the fact that only 36 percent of people with no back pain had normal MRI scans of the back. The conclusion to the study stated, “Because bulges and protrusions on MRI scans in people with low back pain or even radiculopathy may be coincidental, a patient’s clinical situation must be carefully evaluated in conjunction with the results of MRI studies.” In other words, DO NOT cut on a person based on MRI studies. Likewise, CT scans find a lot of abnormalities on people who have no back pain symptoms.
Prolotherapy cures the back pain because it addresses the root cause of back pain-ligament laxity. These workers were randomized into one of four groups: lumbar support and education, education only, lumbar support only, and no intervention. The education involved three classes on proper lifting technique. Those in the lumbar support groups were to wear the lumbar supports at all times during working hours. What happened? Thirty-five percent of workers experienced an episode of low One commentary on this study stated the following, “This is the fourth randomized controlled trial (the standard of modern medicine) to assess the role of lumbar supports in preventing low back pain in the workplace, and the third to show no effect. While an observational study has shown a benefit, the preponderance of evidence argues against the routine use of lumbar supports, particularly since compliance with their use, even in this setting, is so low. This study also raises the question of whether the use of lumbar supports in workers without back pain may actually increase sick leave. (Mitchell, L. Effectiveness and cost effectiveness of employer-issued back belts in areas of high risk for back injury. Journal of Occupational Medicine. 1994; January: 90-94.) Specifically, the lumbar vertebrae connect to the sacrum by the Patients often come in to our clinic with detailed stories about how an orthopedist performed a discogram and CT scan, MRI, and various other x-rays, and is confident that they have disc problems. It is sad to say, but many patients who have been to orthopedic or neurosurgeons tell us that the doctor never even touched them when making the diagnosis that the pain was caused by a herniated disc or The Long Term Risks of Surgery The back is a weight-bearing structure. It means that when any tissue is removed, whether it is bone or disc tissue, the likelihood of further long-term pain and arthritis is increased. The patient will often undergo a stabilization procedure with rods or bony fusion, including the areas above or below a previously operated on vertebral segment, because the area has become lax and degenerated.