What's your opinion on prolotherapy?

[Crystal R. Westergard]

Dear loft33, I generally align the SI joint and then put an SI belt on the person to try for a while when the joint isn't stable.
If you haven't tried stabilizing the joint with a belt, that would be next. In Canada we have a renown physio name diane lee
and she has designed a belt that is pretty much the premium belt used here. YOu can google it to get one mailed to you.
It comes with stretchy "correctors" that velcro on in addition, which you physio puts on if you have other malalignements
in you pelvis to correct for. Have your physio put the main belt on you while you are lying on your sacrum.(any good SI
treating physio will know this!).
I will not comment on prolo, it is pretty new here, and wouldn't be tried in Canada untill
after conservative care is tried. Perhaps in the US they are more aggressive?
Crystal

[loft33]

Thanks for the reply. I'm getting the feeling that prolo is used much more in Europe and starting to be used more in the US.

I've only been in PT for three weeks, but it's been bugging me for three months. Maybe I should give PT more time?

I found two recent articles on it in the WSJ and the New York Times.

Injections to Kick-Start Tissue Repair - New York Times

Health News: Does Prolotherapy Work? Sugar Injections Evaluated - WSJ.com

[Crystal R. Westergard]

There are many things to consider about continuing the PT. For one, you've got to have great communication and trust. Does the PT feel that the SI is unstable?
Is that his/her choice of words? Because sometimes I say "your SI is out" to a person, but it isn't unstable, just out of position. If the PT feels that you are unstable,
there are very few things to do. 1. adjust it into alignment and belt it in, and hope it heals there 2. do number one and ad prolo as soon as you can get it. I understand that England and Canada have similar systems when it comes to healthcare. So, here it would take months and months to get prolo perscribed through our public healthcare system. How about there? Is it even an option? If it's not, it's not. Kinda ends the discussion.

[loft33]

You sound like you're suggesting a core and glute strengthen program is pointless if the SIJ is unstable? Is that correct?

[Crystal R. Westergard]

well, core programs are always good for overall strength. but they will not stiffen your SI joint up, no. Can you possibly compensate for an unstable SI with good glutes and core, maybe, but you'll be compensating, not fixing the underlying problem.

[loft33]

I take it "fixing the underlying problem" means prolotherapy since the medical world doesn't have a way to regrow ligaments yet?

[Crystal R. Westergard]

Well the SI joint is tight enough and built for conformity that it does "regrow" it's ligments at times, meaning that if you bring the two sides together with a belt it stands a chance that the two ends of broken ligs will "find each other". You will see this done with ankles, when there is no break, "just" a sprain or tearing of ligs, they'll pop the person in a cast boot to try to get the ends to meet again. But yes, if the ligs are completely shot, nowhere to be found, we can't regrow them. the prolo causes a reaction that I'm not an expert on, but mimicks ligaments I believe by making everything stiff.

[loft33]

I really appreciate your replies, Crystal.

RE: my SIJ. The PT said it was a little bit unstable on the right side. But there are no torn ligaments - as in ruptured or completely severed. The SIJ belt seems to help a lot and it's become more stable over the last few weeks.

I'm still at a loss as to how this could have happened. I didn't have any traumatic injuries (falls, car accidents, etc). But I did do a lot of walking (2 hours a day) over the last year. Maybe from that.

Oh, by the way, is it generally okay to do isolated glute max strengthening exercises to help realign the SIJ and hold it in place? Someone told me you don't want to do glute max strengthening until the SIJ is perfectly healed. That didn't make sense to me since the glute max - as I understand it - tends to pull the pelvis down and keep it level.

[marj]

Dynamic stabilization exercises including those that activate glut max are the gold standard. In most cases the Si is hyper mobile from genetics or pregnancy, rarely unstable from trauma. This is common in gymnasts and dancers but with balnced exercise
they are able to function at a high level.

Consideration must also be given to avoiding end range positions.

If this approach fails prolotherapy should be considered but all the same principles apply re exercise and education in conjunction with prolotherapy and it is not a quick fix. It frequently requires a series of injections over several months and if people are
deconditioned it will be a very slow process of recovery.

Diane Lee and LJ Lee have an excellent book that includes many exercise ideas and is available through Diane Lee's website. Be patient.

[loft33]

Hi marj. Thanks for your input. I have a few questions based on your reply.

1. I'm a man, so my one sided instability can't be gender related. If it were genetics related could I expect laxity in my other joints as well? (I don't have any other instability)

2. I've heard others say don't take your SIJ through "end range of motion.". What exactly is this end range? Can you give me some functional examples?

Thanks!