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Sacroiliac (SI Joint) Pain

We no longer offer PRP and Stem Cell procedures until further scientific evidence of its efficacy. We do PROLO Therapy for specific orthopedic conditions.

Prolotherapy for Spinal Conditions

In a systematic review of dextrose prolotherapy for chronic musculoskeletal pain by Hauser et al (Clinical Med Insights Arthritis Musculoskele Disord Jul 2016), the role of prolotherapy in spinal and pelvic pain was evaluated. The authors reviewed two randomized control trials looking at the effects of dextrose prolotherapy and corticosteroid injections for low back pain. One study (Kim et al) found a greater cumulative incidence of pain reduction (greater than or equal to 50%) for those given dextrose prolotherapy. However, in the second study that focused on iliac crest pain syndrome, there was no reported differences between dextrose and triamcinolone when looking at pain (VAS) and disability scores.

In another study by Hooper et al, patients with chronic cervical, thoracic, or lumbar pain showed significant improvement in pain and disability scores with dextrose prolotherapy. Dextrose prolotherapy has also been found to be effective for coccygodynia (tailbone pain) in randomized control trials and published case series.

The systematic review concluded that there is level 1 evidence that dextrose prolotherapy results in significantly greater long-term reduction in pain than cortisone injections in patients with sacroiliac (SI) joint pain. There is level 2 evidence supporting dextrose prolotherapy for short-term pain reduction vs. cortisone injection for SI joint pain. As for chronic neck, thoracic, and low back pain, there is level 4 evidence for improvement in pain and disability with dextrose prolotherapy.

This review again demonstrates that dextrose prolotherapy is efficacious for specific musculoskeletal conditions and is a safe alternative to corticosteroids in many cases.

Prolotherapy for Sacroiliac (SI Joint) Pain

Sacroiliac joint (SI Joint) dysfunction or sacroiliac syndrome as it is sometimes referred to as, can be a potential cause of low back pain. It is a condition that is not well understood as there is no gold standard for diagnosing and treating this problem. The SI Joint is considered a diarthrodial joint and connects the sacrum to the pelvis. Limited motion does occur and the SI joints are supported by surrounding muscles and strong ligaments. While not completely clear, it is believed that SI joint pain can be caused by either too much joint movement or too little movement. Pain can also come from surrounding structures including the discs and facet joints.

Diagnosis of SI joint dysfunction is often made based on tests conducted during a physical examination. Many practitioners also utilize a SI joint injection under fluoroscopic guidance (“live x-ray”) or CT guidance to confirm the diagnosis. If the patient receives relief of pain, even if temporary, then treatment can be focused on the SI joint. Non-surgical treatment options often include corticosteroid injections, manipulative physical therapy, and the use of non-steroidal anti-inflammatory medications. More advanced options include radiofrequency neurotomy and SI joint fusion. Results of a systematic review of the literature (Rupert el al 2009) found evidence for radiofrequency neurotomy use is very limited based on only a few quality studies. The number of SI joint fusions has increased significantly in the last few years including the use of minimally invasive approaches. The indications for a fusion is limited and there are concerns that by removing motion within the joint, more forces will be transmitted across the hips and lower spine leading to further problems.

So what other options exist for those who suffer from pain emanating from the SI joints? Prolotherapy has been suggested and has been used successfully in a number of documented cases. The medical literature is very limited in regards to using prolotherapy for this condition, but the results of some smaller studies have shown that Prolotherapy may be an option to consider. Cusi et al (2010) followed 25 patients with SI joint dysfunction following a hypertonic dextrose solution injection under CT guidance. A positive clinical result was present for 76% at 12 months after injection and 32% at 24 months. In a randomized controlled study, Kim et al (2010) compared Prolotherapy injections to corticosteroid injections. At 15 months post-injection 58.7% of those treated with a Prolotherapy injection had pain relief equal to or greater than 50% versus 10.2% for the corticosteroid group.

Going back to the underlying reason for SI joint pain, the common thinking is pain and dysfunction result from changes in ligamentous laxity. Prolotherapy is aimed at injecting an irritant into the joint and/or weakened ligamentous structures to promote a response by the body to heal the affected area. While limited data to support Prolotherapy for SI joint dysfunction exists, no significant adverse events have been reported in the literature and mostly observational studies have shown the treatment to be effective at alleviating pain for the subset of patients treated.