Low back pain and Prolotherapy
The first step in determining ligament laxity or instability in the lower back is by physical examination. The examination involves maneuvering the patient into various stretched positions. If weak ligaments exist, the stressor maneuver will cause pain.

Do this simple test at home: Lie flat on your back and lift your legs together as straight and as high as you can, then lower your legs. If it is more painful to lower your legs than to raise them, laxity in tile lumbosacral ligaments is likely. During physical examination by a physician, laxity can be "tested" by palpating various ligaments with the thumb to elicit tenderness. A positive "jump sign" indicates Ligament laxity.

Low back pain is one of the easiest conditions to treat with Prolotherapy injections. Ninety-five percent of low back pain is located in a 6-by-4 inch area, the weakest link in the vertebral-pelvis complex. At the end of the spine, four structures connect in a very small space which happens to be the 6-by-4 inch area. The fifth lumbar vertebrae connects with the base of the sacrum This is held together by the lumbosacral ligaments. The sacrum is connected on its sides to the ilium and iliac crest. This is held together by the sacroiliac ligaments. The lumbar vertebrae is held to the iliac crest and ilium by the iliolumbar ligaments. This is typically the area treated with Prolotherapy for chronic low back pain.
 

Sacroiliac Ligaments
The diagnosis of ligament laxity in the lower back can be made relatively easily. Typical referral pain patterns are elicited-the sacroiliac ligaments refer pain down the posterior thigh and the lateral foot, the sacrotuberous and sacrospinous ligaments refer pain to the heel. The iliolumbar ligament refers pain into the groin or vagina. Iliolumbar ligament sprain should be considered for any unexplained vaginal, testicular, or groin pain.

The most common cause of unresolved chronic low back pain is injury to the sacroiliac ligaments which typically occurs from bending over and twisting with the knees in a locked, extended position. This maneuver stretches the sacroiliac ligaments, placing them in a vulnerable position. 

How effective is Prolotherapy in relieving chronic low back pain? In one of his original papers, George S. Hackett, M.D., noted 82 percent of people treated for posterior sacroiliac ligament relaxation considered themselves cured and remained so 12 years later.