What's your opinion on prolotherapy?

[loft33]

I was wondering what physios' opinions are on prolotherapy? Specifically to help improve SI joint stability?

When is it indicated (after how many weeks/months of PT)?

How often does one get it done?

Thanks!

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[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!

[GrantP]

some very good and sound info here from all
plan conservative, physio with emphasis on spinal and SIJ stabilistaion +/- belts and acupuncture.
if after 3-6 mths of intense adherehece to exercises and if you cannot progress them due to pain, then yes prolotherapy is a good and very effective option. we used it in the UK when i was there and had very good results but only after exhausting all conservative measures first.
it is paramount to continue with the stabilisation as the injection will not in itself cure you but enable you to do the exercises and progress them

[violablue]

I'd like to know how your SIJ was assessed. Certain issues gain excess (fad) focus sometimes, and I wonder did you have the five battery test to actually prove you have SIJ. For this to be so, you must have 3/5 +ve's. Or was one test completed and this became your diagnosis. There are many back and hip problems that can also the cause of SIJ-type symptoms, so I'm not yet sold on you as and SIJ issue. The battery includes: Distraction, compression, Gaenslen's, FABERs, Thigh Thrust.

[loft33]

Hi Viloa,

Well, my PT says he can put his fingers under my joint - and he shouldn't be able to do that. A separate DO and physiatrist said my joint was mobile, but not too mobile.

BUT.. then I was going over my X-rays. The radiologist report said that "SI joints appear normal." But would you have a look at my x-ray below. If I'm right, the right SIJ looks like its got a lot more space than my left one. I wouldn't call that normal....

SO confused....

0001.jpg

[violablue]

Hi Loft,

I really don't have much training in reading X-rays and tend to listen to what the X-ray radiologists say about it.

I do agree with Grant about the prolotherapy timeframe. Keep up with the physio. If you're not progressing prolotherapy may be a good option.

You do say the SIJ belt is helping, so that is a good thing.

What are your signs and symptoms?

[GrantP]

xrays and link to symptoms is always difficult. don't always correlate. agree that right SIJ looks wider but seems you may be rotated to the camerea, and so the beam shoots down it at differnet angle therefore looks wider - like viola - i am not a radiologist.
think the advice before is what to try, make sure you have been assessed and treated by physio etc exeprienced in SIJ dysfunctions - give conservative rehab exercises a go, if fail then prolotherapy good option to try.

check out this presentation from John, who I worked with at Bupa Wellness in the UK - havent read it but searched for it and will give some information, search him out and see him for advice

http://www.bimm.org.uk/uploads/publi...olotherapy.pdf

good luck- say hi to him from me

[loft33]

Hi Viola and Grant. Thanks for your replies. Grant - thanks for the link to the presentation! If you guys are interested, I've posted a picture of an interesting find on my MRIs and also the results of a standing leg length X-ray - right is 9mm shorter than left. Not sure if I should use a heel lift though (read the report and you'll see why).

Viola, to answer your question - these are my signs and symptoms:

- SI joint feels "off", like a peg is missing and the joint can't support my upper body.
- I have no burning pain in the joint. I know many people report a "hot knife" feeling in the joint when they have an SI problem, but I don't have that. Matter of fact, I have no pain in the joint at all. What I have is a feeling of instability.
- I can squeeze my legs together very slightly (almost no effort or force at all) and many times can get an audible click in the joint - and I'm sure it's coming from the SI and not the pubic symph.
- It's easier to stand than sit. While I'm sitting I don't have radiating or increased pain or anything, I just feel like there is extra pressure on the joint and all my muscles ABOVE the joint kick in overtime to try to keep me stable since the joint won't do it.
- When I walk I have a non-painful clicking in the joint with almost each step
- sometimes I get so exhausted sitting because it feels like my body is doing everything to stabilize itself since the joint is "off"

One thing I did notice when feeling around my backside the last few days is that my right glute max (the side where I have the instability) is almost nonexistent compared to my left. So last night I decided to review my two lumbar MRIs I had in the past. What I noticed is interesting. The first MRI was taken in July 2010. The second MRI was taken in June 2011 - 11 months later. If you look at the side by side comparison of the two at the same level, you'll see that in those 11 months the top of the right glute max pretty much atrophied. (I know why this happened - because I stopped working out for 11 months, but what is interesting is that the clicking while walking sensation came on around 10 months after I stopped working out.) Perhaps the weekend glut max is the cause of this? [BTW - my MRIs are normal and there was no change between them --- except for the glute max muscle which the radiologist failed to mention.]

Today I showed what I found on the MRIs to my PT and he agreed to start me on some glute bridging exercises.

It's only been two weeks since I started exercises, so I will give it more time before prolo. Just what sucks is that it's really uncomfortable to sit....