Tessie, a 50 year-old hospital medical coder and wife of our male nurse Joe, came to Caring Medical for a painful low back in November, 2008.

She never had a history of back problems until she reached for something behind her at work and felt something “snap.”

Tessie works at a computer all day and her posture admittedly was not the best. The day after this incident she had clicking in her lumbar region, and pain alternated from side-to-side in her low back and radiated into her groin.

She rated her pain an 8 out of 10. The physician at her hospital clinic ordered her to take 600 mg of ibuprofen per day, along with a muscle relaxant and Vicodin, a narcotic pain reliever, with instructions to return to the clinic in one week if no improvement.

The Anti-inflammatory ibuprofen really did not much for her pain, and the other drugs made her too sedated to work, and when they wore off, her pain was just as bad. After missing a week of work, she was beginning to get worried. She knew that the doctor would order scans and more drugs but she was not confident that he could help her get better quickly.

Fortunately for Tessie, she has heard the success stories from our clinic of how people with terrible pain would improve with Prolotherapy. She had also seen it firsthand as Joe had several areas from sports injuries treated over the years he has worked at Caring Medical, all with good outcomes. It did not take too much convincing that she was ready for a trip to see Ross Hauser, M.D.

At the time of her first appointment, most of her pain was only in her right side, so Dr. Hauser decided to treat her conservatively and only do Prolotherapy in the sacroiliac joint, using our normal solution. His diagnosis was an overstretched ligament caused by years of poor posture and the straw that broke the camel’s, or in this case, the medical coder’s back, was that abrupt reaching motion that caused a “snap.” Almost immediately after treatment, Tessie felt better and was able to move around the house much more easily. She took a few more days off from work just to be sure she would not reinjure herself, then resumed all normal activities. As the weeks went by, she reported that she was about 50-60% better, though the pain would still sometimes go to the right and left lumbar regions.
 

Tessie decided to do another Prolotherapy treatment in two and a half weeks, as that worked out best for her schedule. The clicking was gone in her back, but she still had some stiffness in her left side, especially after sitting in a chair for one to two hours. She  had discontinued all the previously prescribed drugs and was just using tramadol once or twice per day, which Dr. Hauser prescribed. It is a non-narcotic pain reliever that does not interfere with the immune system, and thus healing with Prolotherapy, as do narcotics. The ibuprofen, a non-steroidal anti-inflammatory drug NSAIDS was also stopped because it shuts down the healing inflammatory response that is needed to heal the area after Prolotherapy. Since she was having some symptoms now on her left side, Dr. Hauser decided to do an entire lumbar area treatment, including both sacroiliac joints.

Tessie felt better soon after the treatment, and within a couple of weeks, she reported at least an 80% improvement. Dr. Hauser discussed with her the importance of good posture in front of the computer at work as it was not unusual for her to spend twelve hours per day perched in front of her terminal. Also, he told her to do some exercises especially helpful for people who spend a lot of time with their back in a flexed position, like hunched over a computer keyboard.
 

Four months after her last Prolotherapy treatment, Tessie is still doing great. But what would have happened if she was not fortunate to be married to Joe? She may have well wound up seeing numerous specialists, undergone unnecessary imaging techniques exposing her to radiation, been on increasing dosages of medications that actual inhibit soft tissue repair or months of physical therapy which may or not have helped, though surely would have caused her to miss more work. Worst case scenario, they may have found a slipped or bulging disc or another abnormality on an MRI they may have wanted to do surgery on, instead of considering that it may have been a connective tissue injury like an overstretched tendons or ligament that may have been the cause of her pain. And as we have explained many times in our case study reports, abnormal discs, spinal stenosis and bone spurs do not always cause pain, in fact, quite the opposite is true, most “normal” people have some degree of these abnormalities if they are in or approaching middle age, but they do not have pain. Most of these spinal abnormalities mentioned do show up well on the various imaging techniques, and surgeons decide to operate on these surgical lesions with the hope that fixing the MRI problem will get rid of the patient’s pain.

This is at times necessary if the back pain is beginning to cause neurological deficits like difficulty voiding, atrophy of extremity muscles, gait difficulty or true numbness of the extremities. These nerve problems for the most part can be determined by physical exam and/or electromyography/nerve conduction study testing. (EMG-NCS) It is amazing how many people do have signs and symptoms of neuropathies and have never had these tests ordered. Even if they do have nerve problems, frequently a combination of Prolotherapy and nerve blocks by injection can help them without invasive surgery. Many surgeons forget or never learned that connective tissue injuries can mimic nerve symptoms, as mapped out by Drs. Hemwall and Hackett decades ago in their pain referral patterns. Our proof here at Caring Medical is how many clients we have helped post surgery for the above conditions that came here still in pain.

 

As stated earlier, Tessie was lucky enough to be acquainted with Prolotherapy when she injured herself and received treatment soon after it occurred before it turned into a chronic problem. Generally speaking, one should treat a joint or soft tissue injury quickly if it is not healing normally on its own. Most injuries, except in the case of fracture or other serious problems like completely torn connective tissues, should begin to feel better after a reasonable period of rest. Every week one should feel better but if your recovery stagnates, or begins to worsen, it may be time to seek the services of a good Prolotherapy doctor. Generally, the sooner we see you, the less treatment you will need, as was the case with Tessie. No telling how many treatments she may have needed if she let her condition worsen by covering up the pain with strong drugs or excessively immobilizing the area with long periods of inactivity such as staying home, not to mention the financial hardship of missing work and paying co-pay after co-pay for office visits, imaging, physical therapy sessions, and prescriptions.