Sacroiliac joint pain treatment
In this article, Dr.Speciale updates information based on new research that the common problems of low back pain and sacroiliac (SI) pain can be treated successfully with Prolotherapy and Stem Cell Therapy, even in patients who had pain for decades.
Why so many fusions? Because there is a lot of back pain
Approximately 90 percent of adults experience an episode of low back in their lifetime. Sacroiliac joint dysfunction has been shown to cause approximately 13-30 percent of low back pain episodes. Sacroiliac joint fusion surgery is becoming an increasingly popular treatment alternative for Sacroiliac joint dysfunction dysfunction.1
In October 2014, doctors writing in the European Spine Journal, said that referred pain from the sacroiliac joint can be isolated to the anterior ligament sacroiliac joint region, and that by treating the ligaments pain can be alleviated. 2
This clearly presents a solution in sacroiliac joint pain treatment where doctors say a solution does not exist. Recently, published research in the medical journal Pain Physician said:
- Doctors generally accept that approximately 10% to 25% of patients with persistent low back pain may have pain arising from the sacroiliac joints. Despite this there are currently no definite conservative, interventional, or surgical management options for managing sacroiliac joint pain.3
So they looked at the medical literature to determine what has shown to be effective, granted their research was published before the above paper in the European Spine Journal.
Sacroiliac Joint Pain Treatments
They found that the evidence for:
- cooled radio frequency neurotomy in managing sacroiliac joint pain is fair.
- The evidence for effectiveness of intraarticular steroid injections is poor.
- The evidence for periarticular injections of local anesthetic and steroid or botulinum toxin is poor.
- The evidence for effectiveness of conventional radiofrequency neurotomy is poor.
- The evidence for pulsed radio frequency is poor.
- A lot of poor results.
But you can offer poor results more often! Recently doctors said that image-guided injections of the epidural space and of the sacroiliac joints are effective techniques for the treatment of pain; their effectiveness is sometimes not lasting for long periods of time, but considering the low associated risk when performed by trained personnel, they can be easily repeated.4
Treating the ligaments in sacroiliac joint dysfunction
As far back as 2009, Caring Medical has published research on outcome results in patients receiveing Prolotherapy for low back pain. Here is what was reported onfindings of 145 patients with unresolved lower back pain in the Journal of Prolotherapy: One hundred forty-five patients, who had been in pain 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 was no other treatment options for their pain and those who were told surgery was their only treatment option.5
- Research appearing in the Journal of Alternative and Compementary Medicine stated that “Prolotherapy provided significant relief of sacroiliac joint pain, and its effects lasted longer than those of steroid injections”6
Prolotherapy for SI pain
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.
We have found that it is fairly rare for people’s SI/back pain to be caused by a pinched nerve or by a slipped or herniated disc. Much more common is a ligament injury which caused ligament laxity or ‘looseness.’
In the scholarly journal Spine, a 1995 article written by A. Schwarzer wrote:
- “ligament laxity in the sacroiliac joint is the number one reason for ‘Sciatica’, or pain radiating down the side of the leg, and is one of the most common reasons for chronic low back pain.”7
Our clinical experience has been that if we treat back pain with Prolotherapy, administering injections into the lumbar and SI ligament attachments that exhibit tenderness, the pain and referred pain diminishes, even when MRI’s showed disc abnormalities. The injections are not given near the discs yet the back pain is completely healed.
Ligaments and the SI Joint
Ligaments are bands of fibrous tissue that connect bones to each other, like the vertebrae to each other and the sacrum to the pelvis. The sacrum is the part of the spine below the fifth and last lumbar vertebrae and above the coccyx. The uppermost portion of our pelvis is called the ilium. The area that connects these structures is called the sacroiliac joint (SI): sacro from the sacrum, iliac from the ilium. There is an expansive mesh of ligaments that make up this sacroiliac joint which is frequently injured. The function of the SI ligaments and the ligaments of the spine is to provide stability to these bones while allowing normal motion to occur. The hub of many people’s back or pelvic pain is one of both SI joints. A problem here can affect the groin, pubis, hips and lower lumbar areas as well. Try moving one of these structures alone without moving another one. Maybe a yoga expert could, but most can’t. The point is that other structures have to compensate for the lax ligaments in the original injured structure, and they come to have lax ligaments as well.
For more information on lower back pain treatments please see Prolotherapy for chronic low back and lumbar pain.
References for this article:
1. 1. Carlson SW, Magee S, Carlson WO. An algorithm for the evaluation and treatment of sacroiliac joint dysfunction. S D Med. 2014 Nov;67(11):445-9, 451.
1. Kurosawa D, Murakami E, Aizawa T. Referred pain location depends on the affected section of the sacroiliac joint. Eur Spine J. 2014 Oct 5. [Epub ahead of print]
2. Hansen H, Manchikanti L, Simopoulos TT, et al. A systematic evaluation of the therapeutic effectiveness of sacroiliac joint interventions. Pain Physician. 2012 May;15(3):E247-78.
3. D’Orazio F, Gregori LM, Gallucci M. Spine epidural and sacroiliac joints injections – when and how to perform. Eur J Radiol. 2014 Jun 7. pii: S0720-048X(14)00299-X. doi: 10.1016/j.ejrad.2014.05.039. [Epub ahead of print]
4. Hauser R, Hauser M, Dextrose Prolotherapy for Unresolved Low Back Pain: A Retrospective Case Series Study Journal of Prolotherapy. 2009;3:145-155.
5. 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.
6. Schwarzer AC, April CN, Bogduk N. The sacroiliac joint in chronic low back pain. Spine 1995;20:31-37