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PROLOTHERAPY FOR DISCOGENIC PAIN AND
ANNULAR TEARS Ross A. Hauser, M.D. ‘My doctor, who does Prolotherapy, has said that my chronic pain is likely due to discogenic pain (pain coming down from the torn disc itself). He said that he does not believe Prolotherapy can help. Everything I have read about discogenic pain is horrible. Some say it cures itself in 2 years or so, others say that it is chronic and will never go away. Have you had success treating patients with this condition? The answer is a resounding yes! When other Prolotherapists say “not a Prolotherapy candidate,” often we believe the opposite is true. MRIs, CT scans and Discograms are all types of imagining techniques that show problems in the discs. The real problem however is that you can not definitely correlate that the finding on imaging correlates with a person’s symptoms. In other words, people have degeneration in discs, annular tears and other abnormalities and have no symptoms. Your disc bulges every time you bend over. So disc bulging by itself doesn't mean that is causing a person’s symptoms. In other words, the history is the most important determining factor in the majority of pain cases including low back and neck pain. Imaging just confirms what the clinician already knows. If someone has exhausted all possible treatment options including Prolotherapy and then is considering surgery, in that instance an imaging technique like MRI, discogram or CT scan makes sense. For the person not contemplating surgery, how will getting the MRI or discogram change the course of treatment? If it won’t change the course of treatment why get the scan? The discs in the spine have a gelatinous material in the middle and are surrounded by ligamentous tissue called the annulus. This ligamentous tissue can tear. This is an annulus tear. Also when the ligamentous tissue gets stretched it can cause buldging discs. Ultimately if the condition continues the disc material in the middle can herniate (out through) the annulus and pinch on a nerve. Typically discogenic pain gives symptoms of low back pain that is worse with prolonged standing or sitting. Pain can go down the buttocks or down the back of the leg, but typically stays over the knee. As you can imagine these types of symptoms can occur with sacroiliac problems, facet joint issues, and other low back conditions. As you all know I like simple. Typically disc problems are posterior. Every time we bend over we have increased pressure on the posterior (back) portion of the disc. So if someone’s pain is increased with flexion (like bending down or sitting) then we know the problem is occurring posterior. If the pain is central (right in the midline of the lumbar spine, not sacroiliac joints), then most likely it is discogenic pain. What the person needs is to increase the anterior pressure forces. One can do this by hyperextending the low back (or neck) by doing McKenzie Extension Exercises throughout the day. The other method, which is more permanent is for the person to get Prolotherapy to the lumbar or cervical spine. By tightening up the ligaments in the lower back and neck, you, in essence, are increasing the force on the lower back or neck to go from back to front. So if there is something bulging and hurting in the back, the increased strength of the lumbar or cervical ligaments will help decrease the pressure on the disc and increase the pressure going forward, so disc bulges and protrusions should diminish. Bottom line is in the vast majority of the cases, the symptoms go away after three to six Prolotherapy sessions. In the course of treating discogenic pain, annular tears, and other “MRI or discographic findings,” I could count on one hand the number of cases that didn’t respond to Prolotherapy and went on to need surgical intervention. After having said all of the above, if the person has MRI findings of discogenic disease but has pain primarily in the sacroiliac region and has a clicking sensation in the SI joint, then most likely the cause of the person’s pain is a loose SI joint. Treating the discs is fine with Prolotherapy, but to get cured of the pain the person will need to get sacroiliac Prolotherapy. We find that most chronic low back pain clients have sacroiliac issues rather than disc issues. I would even go on to say that about 90% of chronic low back pain is related to the sacroiliac joints and not the disc. What does it mean for you? If you have been told you have discogenic pain, annular tear, or other MRI pathology, I’d encourage you to get a Prolotherapy evaluation. Many people are looking into alternatives, especially when the Orthopedist wants to do surgery. Sometimes the recommendation is surgical fusion. In the history of our clients over the course of the past 15 years, we have not had one client get surgical fusion that I know of. Why? Because Prolotherapy works so well to stabilize the area. Why fuse it completely? You need some motion in the area. What the area needs is just stabilization. The best treatment to stabilize the low back or neck in my opinion is Prolotherapy. Typically it takes 3 to 6 sessions of Prolotherapy, spaced out one month apart. |
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