Prolotherapy for SI joint pain

Posted by lara2323 @lara2323, Mar 6, 2022

I am considering undergoing prolotherapy for chronic SI joint pain. Unfortunately the practitioner couldn't tell me how long patients had relief.
Has anyone had prolotherapy on their SI joint? If so, how many treatments did you receive and how long did the pain relief last?

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No relief. Pain shots but Tropicin, Aleve and Vicodin.

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@sueinmn

Prolotherapy is an old treatment seeing a resurgence. Usually the substance used is a glucose solution, but it may be combined with other ingredients. Some factors to be aware of include: This is an unregulated treatment, so may be done by any practitioner allowed to do injections, without special training or qualifications. Prolotherapy appears to be more effective if the injections are done by a skilled pain injection practitioner who has skill in placing therapeutic substances exactly where needed for a specific condition. Therapy appears to be more successful when combined with other treatment such as stretching or PT.

Here is what the spine clinic experts at Mayo have to say about prolotherapy: https://www.mayoclinic.org/prolotherapy/expert-answers/faq-20058347

And what the docs on Spine Health have to say: https://www.spine-health.com/treatment/injections/prolotherapy-and-chronic-back-pain

The following is a lengthy review of studies of pain reduction from prolotherapy - only one addresses SI joint pain directly, and shows improvement in about 50% of people at 15 months (you would need to locate & read the complete study to see how many injections, adjunct therapy, etc.)

In doing your research on the technique, be sure to differentiate information published by the practitioners and those published by an independent group.

What practitioner has recommended prolotherapy to you? Have you already tried more conservative therapies including ice, stretching and physical therapy?
Sue

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Sue: A few things ... the Mayo citation is no longer ... and the discussion about who can give the treatment does not include the fact that most prolotherapy is done by MDs who are pain specialists. I was not aware that practitioners are actually done by just anyone.
Then there is the question about what is used for prolo ... in most places it is 'sugar' water, but can be other substances. The point though ...it is NOT the substance that matters because the whole idea is that the punctures, not really injections, create the physical signals for the 'self-healing' to begin. The practice is mostly done by Drs who call the practice Regenerative Medicine.
Finally, success depends on several things ... there are different techniques and the patient's response depends on the viability of the patient's own healing system.
I had a wonderful experience after 3+ years and many Drs. who misdiagnosed my hypermobile SIJoint. The 6th Dr's prolotherapy fixed the "lax" ligaments attached to the joint that had become disfunctional from matching the SIJoint's hypermobility, created by a leg length differential. I am hoping there will be definitive studies that will bring prolotherapy out of the shadows where it has been.

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@rjmtwit

Sue: A few things ... the Mayo citation is no longer ... and the discussion about who can give the treatment does not include the fact that most prolotherapy is done by MDs who are pain specialists. I was not aware that practitioners are actually done by just anyone.
Then there is the question about what is used for prolo ... in most places it is 'sugar' water, but can be other substances. The point though ...it is NOT the substance that matters because the whole idea is that the punctures, not really injections, create the physical signals for the 'self-healing' to begin. The practice is mostly done by Drs who call the practice Regenerative Medicine.
Finally, success depends on several things ... there are different techniques and the patient's response depends on the viability of the patient's own healing system.
I had a wonderful experience after 3+ years and many Drs. who misdiagnosed my hypermobile SIJoint. The 6th Dr's prolotherapy fixed the "lax" ligaments attached to the joint that had become disfunctional from matching the SIJoint's hypermobility, created by a leg length differential. I am hoping there will be definitive studies that will bring prolotherapy out of the shadows where it has been.

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I had pain in my shoulder and the osteo Doctor that I went to wanted me to travel to his home office for prolotherapy treatment. I did not want to travel that far, as I was already driving an hour to the facility, he worked at one day a week. He had a student with him that day and he proceeded to explain to her that he was going to do a manual type of treatment that brings about the same results as prolotherapy. He then took his thumb and pushed it very hard into my shoulder and rotated it around the joint. It was really painful, and he told me not to hold my breath because tears were rolling out of my eyes. I had my shoulder pain for over 6 months and after he did this to my shoulder it improved quickly. Now when I have a joint pain, I go into the joint with a lot of pressure and irritate it and that works really well for me. I have done it to my elbows and knees and it helped. Not sure why irritating a joint works, but he did tell the student that the prolotherapy shot is just sugar and water to irritate the joint.

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@jmd5

I had pain in my shoulder and the osteo Doctor that I went to wanted me to travel to his home office for prolotherapy treatment. I did not want to travel that far, as I was already driving an hour to the facility, he worked at one day a week. He had a student with him that day and he proceeded to explain to her that he was going to do a manual type of treatment that brings about the same results as prolotherapy. He then took his thumb and pushed it very hard into my shoulder and rotated it around the joint. It was really painful, and he told me not to hold my breath because tears were rolling out of my eyes. I had my shoulder pain for over 6 months and after he did this to my shoulder it improved quickly. Now when I have a joint pain, I go into the joint with a lot of pressure and irritate it and that works really well for me. I have done it to my elbows and knees and it helped. Not sure why irritating a joint works, but he did tell the student that the prolotherapy shot is just sugar and water to irritate the joint.

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I believe what you are doing, what the Osteo doctor did, is push the out of place joint back where it belongs. I have had the same kind of thing with 2 different joints. My leg, in response to an almost dislocation, could be pushed back and doing so was very painful. That was caused by my SI Joint. After I had the prolotherapy that stopped happening.

But I urge you to go get the prolotherapy because it treats the ligaments and other stuff that holds the joints in place, not really the joints themselves. As my Dr, explained, the hypermobile joint stretched the attached ligaments so they could no longer do their job. These 'lax' ligaments can also damage nerves. "Lax" ligaments cannot heal themselves if they are continually stretched trying to help the mobile joints.

Do find a way to get to the Dr. office. Good luck

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There is another type of prolotherapy, PRP or platelet rich plasma. Your blood is taken out in a large syringe, spun to concentrate platelets and then reinjected in the joint (and others if any is left over!). For my daughter's SI joint issues, after years of PT, this worked overnight and lasted 8 years.

You have to meet criteria after screening with imaging to make sure the issue is soft tissue. My daughter has hypermobile joints that "sublux" (move out of place) and tightening things really helped.

Pressing hard on a location with pain tends to ease muscle spasm but not sure how it would address loose ligaments or joints that have shifted slightly . Curious about this. I have learned to press hard on my shoulder to release a muscle there.

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After months of seeing doctors concerning lower back pain on my right side, and having injections that brought short term relief, I was diagnosed with an SI Joint issue. Doctor wants to operate and install the Medtronic system, but I have decided to pursue PRP procedure first. PRP doctor was very straight forward and said there are very few studies that give any indication on how effective the procedure would be on the SI Joint. I have an issue with my left knee, so trying the injection on both areas seems like the best avenue to pursue. Surgery is the very last option I will now use for any problem. I had my right knee replaced a few years ago, and it has never been the same, and never will be. Great doctor did my surgery, but the replacement knee is never as good as the original. I will post how things go.

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@frownie52

After months of seeing doctors concerning lower back pain on my right side, and having injections that brought short term relief, I was diagnosed with an SI Joint issue. Doctor wants to operate and install the Medtronic system, but I have decided to pursue PRP procedure first. PRP doctor was very straight forward and said there are very few studies that give any indication on how effective the procedure would be on the SI Joint. I have an issue with my left knee, so trying the injection on both areas seems like the best avenue to pursue. Surgery is the very last option I will now use for any problem. I had my right knee replaced a few years ago, and it has never been the same, and never will be. Great doctor did my surgery, but the replacement knee is never as good as the original. I will post how things go.

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Be sure to have someone check out your ligament and other 'stuff' that holds the joint in place. I do not know the medtronic system, but I had terrible SI Joint extensions that were primarily fixed with prolotherapy on the ligaments connected to the Joint. When the joint stretches that stretches and damage the attached ligaments. Prolotherapynashville.com website has a good discussion of this, especially about prolotherapy for the knee.
My SIJ ligament fix took care of all the walking etc problems. I still have an SI Joint that moves a small amount out of line and believe that is to be expected for hEDS syndrome people. For those joint movements I have a few exercises I do daily and they put it back where it should be. A knee to the chest while lying down is the best. I do that 2xdaily. I also gently stretch the hamstring and the illopsoas, that by dropping one leg off the side of the bed while lying along the edge. That muscle connects the spine to the lower body.
Good luck finding your answers. I agree that surgery should be a last choice.

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@rjmtwit

Sue: A few things ... the Mayo citation is no longer ... and the discussion about who can give the treatment does not include the fact that most prolotherapy is done by MDs who are pain specialists. I was not aware that practitioners are actually done by just anyone.
Then there is the question about what is used for prolo ... in most places it is 'sugar' water, but can be other substances. The point though ...it is NOT the substance that matters because the whole idea is that the punctures, not really injections, create the physical signals for the 'self-healing' to begin. The practice is mostly done by Drs who call the practice Regenerative Medicine.
Finally, success depends on several things ... there are different techniques and the patient's response depends on the viability of the patient's own healing system.
I had a wonderful experience after 3+ years and many Drs. who misdiagnosed my hypermobile SIJoint. The 6th Dr's prolotherapy fixed the "lax" ligaments attached to the joint that had become disfunctional from matching the SIJoint's hypermobility, created by a leg length differential. I am hoping there will be definitive studies that will bring prolotherapy out of the shadows where it has been.

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Thank you Sue for those comments. My SI hypermobility has been a result of a bad foot surgery which left my right foot totally fused. . . like walking with a brick. The inability to "walk off" my foot, along with a slightly shorter right leg, causes my SI to rotate leaving me with bulging lumbar discs. I'm told that a screw placement now has replaced prolo. But of course, they will not do if you have osteoporosis. There are a few old timers who will do prolo, but do not insist on proper alignment prior to the procedure. And they wonder why they only have 50% success rates. I also am a type 1 diabetic, but have been told that the "sugar water" will not affect my blood sugar levels. Having been in PT for 20+ years, I'm ready to try prolo. Can you recommend a doctor or center with high success rates for complicated patients. I live a few hours from Duke University Hospital, but am having a difficult time finding this "soft tissue" physician my rheumatologist says I need to locate. Also, I was finally told that the asymmetrical yoga positions I practiced to stay limber were also pulling my SI out. Thanks!

REPLY
@jmd5

I had pain in my shoulder and the osteo Doctor that I went to wanted me to travel to his home office for prolotherapy treatment. I did not want to travel that far, as I was already driving an hour to the facility, he worked at one day a week. He had a student with him that day and he proceeded to explain to her that he was going to do a manual type of treatment that brings about the same results as prolotherapy. He then took his thumb and pushed it very hard into my shoulder and rotated it around the joint. It was really painful, and he told me not to hold my breath because tears were rolling out of my eyes. I had my shoulder pain for over 6 months and after he did this to my shoulder it improved quickly. Now when I have a joint pain, I go into the joint with a lot of pressure and irritate it and that works really well for me. I have done it to my elbows and knees and it helped. Not sure why irritating a joint works, but he did tell the student that the prolotherapy shot is just sugar and water to irritate the joint.

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Good to heqarr the DO's movement worked for you.
Not sure where you live but check out National Spine and Pain Centers ... My treatment was at one of their affiliated centers in Chevy Chase, MD. And if you want to check our prolotherapy check out the website for ProlotherapyNashville. The Dr. there has some good explanations.
The idea is that the irritation of the shots tells your body that something in that ligament needs to be fixed and initiates the body's own healing system that for some reason has not done it's job. For me, my hyperextending SI Joint relied on the attached ligament and that damaged it. It became "lax" and could no longer do its job. I also had the leg length differential fixed by an operation on the other hip after a fall on the ice. UGH! Now I can put it back from it's small extensions by pulling a knee to the chest and keeping my major leg muscles in good shape. The subluxing leg stopped after the prolotherapy!

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@rjmtwit

Good to heqarr the DO's movement worked for you.
Not sure where you live but check out National Spine and Pain Centers ... My treatment was at one of their affiliated centers in Chevy Chase, MD. And if you want to check our prolotherapy check out the website for ProlotherapyNashville. The Dr. there has some good explanations.
The idea is that the irritation of the shots tells your body that something in that ligament needs to be fixed and initiates the body's own healing system that for some reason has not done it's job. For me, my hyperextending SI Joint relied on the attached ligament and that damaged it. It became "lax" and could no longer do its job. I also had the leg length differential fixed by an operation on the other hip after a fall on the ice. UGH! Now I can put it back from it's small extensions by pulling a knee to the chest and keeping my major leg muscles in good shape. The subluxing leg stopped after the prolotherapy!

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If I had a clinic close to where I live, I would definitely go there for help. I have had a couple of other injuries over the years, and I just irritate it myself and as much as it hurts, it does make it feel better after. My family thinks I'm crazy to do this, but it does work for me so I will continue with it when needed. Thanks for your reply. It does explain how it works. Prolo therapy is just sugar water to irritate the injury, and my fingers can irritate the injury also. Some may not be able to use this method because it is extremely painful to irritate the area deeply with your fingers. Take care, cheers, Judy

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