Prolotherapy sciatica treatments

Dr. David Woznica ProlotherapistDavid N. Woznica, MD

In this article Dr. David Woznica discusses the challenges of accurately diagnosing and treating sciatica including surgical options, and non surgical treatments that include Comprehensive Prolotherapy and stem cell prolotherapy.

You have been diagnosed with sciatica

You went to the doctor concerned about leg pain and/or severe knee pain and a burning, numbness sensation in your legs from hip to toe. The doctor at this point may suspect sciatica symptoms and will be  looking at the possibility of a herniated, slipped, bulging disc and need a sciatica treatment plan.

Recommendations to reduce physical activity is generally made, heavy lifting is to be avoided. Hamstring stretches and abdominal strengthening or low back exercises may be encouraged to strengthen the spine. A physical therapy plan may be encouraged.

Your doctor may recommend a pain relief plan and tell you about an epidural injection or nerve block for sciatica nerve painpain-killers, NSAIDs anti-inflammatory therapy or corticosteroids. Your doctor will likely issue warnings to you about the realistic expectations of pain relief you may achieve and what type of herniated disc sciatica recovery time you may expect.

Research has called into question all of these “remedies,” as effective for sciatica patients.

Pain medications and pain management for sciatica research: It is unclear if pain medications provide relief. What is clear are the side-effects of the medications

Epidural corticosteroid injections and pain management : Epidural corticosteroid injections have no demonstrated benefit beyond the placebo effect

Most patients with a symptomatic lumbar disc herniation who opt for a second injection or surgery do so within the first 6 months. Reliable prediction of the long-term treatment response based on short-term pain relief is not possible.(5)

Diagnosing Sciatica and leg pain. Long-term problems can begin with a confusing diagnosis

Sciatic Nerve Prolotherapy

The term sciatica is thrown around loosely and is often used for any pain traveling down the leg. In fact some patients come in asking for sciatic nerve treatment.

True sciatica is a nerve injury that causes extreme pain and is caused by the sciatic nerve being pinched due to a herniated disc, spondylolisthesis, or foraminal or lumbar stenosis commonly referred to as spinal narrowing.

However, many patients are diagnosed with “sciatica” when, in fact, their sciatic nerve is not getting pinched.

This problem with accurate diagnosis can lead to long-term problems of hit and miss and potentially harmful treatments. In research from doctors in the United Kingdom, the researchers called the identification of clinically relevant subgroups of low back pain the number one low back pain research priority in primary care. (6)

What does this mean?

Surgery for Sciatica

When the above non-surgical treatments are unsuccessful, the recommendations may turn towards lumbar spine surgery. This recommendation may be confirmed by an “abnormality” on an MRI scan. You may get a sciatica surgery options such as laminectomy and spinal fusion,  Your surgeon will provide you with realistic expectations of the surgery and the appropriate warning involved.

Sciatica and long-term risk of increased levels of disability. Sciatica and low-self esteem and depression in older men

In this side-note we are looking at research from a Swedish team publishing in the journal Age and Ageing who made these observations:

It is important to realize the significance of a patient’s depression and overall disability in offering care. This is especially important in the patient who has had failed treatments for back pain. Please see our accompanying article When depression and anxiety prevent healing of back pain.

Non-surgical sciatica treatment

It is important to note that many people have herniated disks or bone spurs that will show up on MRI’s and other imaging tests but cause no symptoms. So a herniated disc according to MRI does not cause sciatica in all patients.

The sciatica complaint very possibly is a simple ligament problem in the sacroiliac joint. For the majority of people who experience pain radiating down the leg, even in cases where numbness is present, the cause of the problem is not a pinched nerve but sacroiliac ligament weakness.

Sciatica may be due to ligament laxity in the sacroiliac joint, which can cause radiating pain down the side of the leg, as well as numbness, a symptom that has traditionally been attributed only to nerve injury.

Indications the symptoms are caused by a “pseudo sciatica” ligament injury rather than nerve injury

Prolotherapy treatment for Sciatica

Rather than boosting degeneration in the low back with cortisone, or taking the drastic approach of surgery, we recommend regenerative ligament repair with Prolotherapy. Prolotherapy eliminates pain in the local ligament, in this case the sacroiliac ligament in the sacroiliac joint, as well as the referred pain, and is curative in most cases of “diagnosed” sciatica.

Comprehensive Prolotherapy for sciatic pain involves treating all of the affected areas, such as the sacroiliac ligament attachments and the lumbosacral area as necessary. Prolotherapy injections stimulate the body’s own natural healing process which is through inflammation. The inflammation causes the blood supply to dramatically increase in the injured areas, alerting the body to send reparative cells to the ligament site. Ligaments, such as the sacroiliac ligament are made of collagen. In this healing process, the body deposits new collagen. The sacroiliac ligament will then be strengthened and tightened as this new collagen matures. The sacroiliac joint which was unstable, will then become strong and stabilized, and the symptoms will abate.

If you have question about sciatica treatments, you can get help and information from our Caring Medical staff

1 Pinto RZ, Verwoerd AJ, Koes BW. Which pain medications are effective for sciatica (radicular leg pain)?. BMJ. 2017 Oct 12;359:j4248. [Google Scholar]
2 Rasmussen-Barr E, Held U, Grooten WJ, Roelofs PD, Koes BW, van Tulder MW, Wertli MM. Non-steroidal anti-inflammatory drugs for sciatica. Cochrane Database Syst Rev. 2016 Oct 15;10:CD012382. [Google Scholar]
3 Ferreira ML, McLachlan A. The Challenges of Treating Sciatica Pain in Older Adults. Drugs Aging. 2016 Oct 13. [Google Scholar]
4 Sciatica and epidural corticosteroid injections. Prescrire Int. 2015 Feb;24(157):49.
5 Joswig H, Neff A, Ruppert C, Hildebrandt G, Stienen MN. The Value of Short-Term Pain Relief in Predicting the Long-term Outcome of Lumbar Transforaminal Epidural Steroid Injections. World Neurosurgery. 2017 Aug 23. [Google Scholar]
6 Stynes S, Konstantinou K, Dunn KM. Classification of patients with low back-related leg pain: a systematic review. BMC Musculoskeletal Disorders. 2016;17:226. [Google Scholar]
7. Machado GC, Witzleb AJ, Fritsch C, Maher CG, Ferreira PH, Ferreira ML. Patients with sciatica still experience pain and disability 5 years after surgery: A systematic review with meta-analysis of cohort studies. Eur J Pain. 2016 May 12.[Google Scholar]
8. Hsu E, Murphy S, Chang D, Cohen SP. Expert opinion on emerging drugs: chronic low back pain. Expert Opin Emerg Drugs. 2014 Dec 18:1-25. [Google Scholar]
9. Kherad M, Rosengren BE, Hasserius R, Nilsson JÅ, Redlund-Johnell I, Ohlsson C, Mellström D, Lorentzon M, Ljunggren Ö, Karlsson MK. Risk factors for low back pain and sciatica in elderly men—the MrOS Sweden study. Age and ageing. 2017 Jan 19;46(1):64-71. [Google Scholar]

 

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