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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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