Marc Heller, DC writes that “When the sacroiliac is difficult to stabilize, it is also very difficult for the patient to heal,” (Dynamic Chiropractic, July 2, 2005). Various authorities have identified ligamentous instability or ligamentous laxity as a condition that can interfere with the progress of chiropractic adjustments. Chiropractic physicians such as Marc Heller, Manuel Duarte, DACBO, and Warren Hammer, DACBO have written about the positive effects of prolotherapy in these cases. When you have a low back pain patient who is not progressing, prolotherapy delivered by Neal Taub, MD may be the adjunctive treatment that can prepare your patient for healing.

Over time, repetitive stress can lead to degenerative changes in the ligaments and ligamentous laxity. Ligaments serve as passive support structures of the low back. When those structures are compromised, the sacroiliac (SI) joint can become hypermobile and/or, as Dr. Heller asserts, the surrounding musculature can become hypertonic as it attempts to stabilize the structures of the low back.

Prolotherapy has been shown to thicken and make stronger the ligaments and fascia.¹ Prolotherapy involves injecting dextrose, a local anesthetic, and mild irritants into ligaments, tendons, fascia, and facet capsular sites. The irritants initiate first stage healing also known at the inflammatory process. While ligaments typically have poor blood supply and prove to be slow-healing bodies, prolotherapy incites fibroblastic hyperplasia, the laying down of new tissue to repair and strengthen the structure. The therapy typically includes nutritional supplements and specific exercises to enhance the effects of the injections. However, research has shown prolotherapy to improve chronic low back pain in the absence of enhancements or any other interventions.² If you already prescribe nutrition or exercises as part of your chiropractic care, Dr. Taub will coordinate with you to discuss the incorporation of prolotherapy specific exercises and nutrition. The treatments typically involve four to six visits over three to four months.

Hypermobility on motion palpation serves as an indicator for prolotherapy. However, Heller writes that the SI joint can feel fixated or stuck because the surrounding musculature has become chronically tightened in an attempt to stabilize the joint. Various other indicators for prolotherapy in chiropractic care have been suggested:

The least complicated indicator cited by chiropractic physicians, and the one most used by physiatrists, is tenderness on palpation of ligaments, tendons, and fascia implicated in low back and buttock pain.

The private practice of Neal S. Taub, MD receives new patients through referrals. As a physiatrist, Dr. Taub helps patients with specific goals and specific treatments, and then returns patients to the long-term care of the referring physician.

When you have patients who suffer chronic pain with a ligamentous laxity component, please contact
Neal S. Taub, MD, Physiatrist.

References:

1. Hackett GS, Hemwall GA, Montgomery GA. Ligament and Tendon Relaxation Treated by Prolotherapy. Springfield, Ill, Charles C. Thomas, 1958.
   
2. Yellan MJ, Glasziou PP, Bogduk N, et al. “Prolotherapy injections, saline injections, and exercises for chronic low back pain: a randomized trial.” Spine 2004; 29(1): 9-16.