Back and Neck Pain

Sport - Joint and Ligament Injuries

Chronic 'arthritis' pain

related topics

Further Prolotherapy Websites

www.prolotherapy.org

www.getprolo.com

www.prolotherapy.org

Prolo information used with permission from Dr. Ross Hauser and Marion Hauser's book cited in the Sports Prolo Section below.

Syages of Evolution

Backache must be one of the commonest complaints. Maybe it is right about the upright posture thing! Though my bet is the little guy on the left must get a lot of backache walking like that! He needs posture training. The second fellow has a constant sore neck.

The complex nature of spinal structures means there can be many possible sources of pain. Maybe that is why there are many treatment methods! Finding the cause is often difficult and you could get 5 different opinions from 5 different health experts!

Chronic Back Pain

When back, neck or other pain is unresolved, many patients go from from doctor to doctor, physio, osteo, chiro, acupunturist and so on. The stress alone winds up pain; it becomes a brain chemical problem as well. Many of these patients do very well with prolotherapy.

Some reasons for this is that certain structures are deep and inaccessible to examination. Moreover, pain from damaged ligaments or other structures can not only be felt by the patient at the site but also pain can be 'referred' away from the area, throwing more confusion as to the cause. Imaging techniques like xrays shed limited if any, light on cause. CT and MRI scans can be more helpful in determining causes such us compression on the spinal cord or nerve roots from prolapsed discs. More often than not, these techniques exclude a diagnosis rather than accurately pin-point the cause. So it comes down to taking a good history, examination, experience and deducing the cause. Suffice to say, many spinal problems arise from ligament strains, stretching, tearing and inflammation. They become more lax over the years and so allow more 'play' in the mobility or 'tightness' of the multiple and intricate joints. These discussions can equally apply to any joints in the body.

Prolotherapy

This should be the first treatment for chronic joint and ligament pain and also for acute injuries.

This term was first used by George Hackett in the 50's. He described the results of injuries as ligament relaxation. Original terms used for prolotherapy were sclerotherapy or proliferent therapy. The concept was to inject into the vicinity of ligaments a solution that would cause proliferation of new ligament tissue ie 'regrow' and strengthen the ligament. Many different solutions were used in those early days. Modern proliferant solutions are extremely safe.

Many research articles and text-books have been produced on Prolotherapy even up to current times. The concept of how prolo works is debated still. The fact remains, that injecting a harmless yet specific solution into or around certain parts of the damaged ligament results in reduction in pain and regrowth of ligament collagen fibres.

In fact, Hackett concluded that ligament relaxation was the initiating problem that lead to joint instability, wear and tear even disc prolapse. He said it was crucial to correct this laxity with prolo of you were to get to root cause of pain.

Of course other factors come to play such as increased muscle tone and spasm to support or splint the damaged ligament and joint function. Tight muscles become sore and can develop specific tender points called Myofascial Trigger Points (MFTP's) which also can be very painful locally AND refer pain and other unusual symptoms to distant areas. Skilled practitioners can recognise these patterns and quickly locate the source.

Pain is complex. It results from damage, release of chemicals to induce inflammation designed to commence a repairing process. These chemicals also stimulate nerve fibes which in turn transmit pain information to the brain which we the 'feel'. Al along the way, other processes can 'modulate' how much pain we actually 'feel'. When we go to the dentist out toothache feels better. At the doctor's, the stomach ache temporarily settles - much to our embarrassment. If we are tired or depressed, pain levels increase and so on.

Many times, that initial 'good' inflammation can go 'wrong' and not heal. It becomes chronic ie persistent. Chronic inflammation is what often drives people from pain treatment to pain treatment.

Back to Prolotherapy.

It is thought that the prolo solution at first settles the chronic inflammation, perhaps by reducing the proliferation of new blood vessels, blocking pain transmisson and so on. With repeated injections, new collagen fibres grow from the bone cells where the ligaments attach (the ligament entheses) up into the damaged ligament - strengthening it. The attachment of the ligament also improves - like a re-welding. Its called a 'fibro-osseous weld'. I call it 'spot-welding' the ligaments back on to the bone. Whilst not completely accurate, it creates the image.

There is no other treatment which has this potential. Anti-inflammatory drugs are very effective pain control, but they may do more harm long tem to the healing outcome, not to mention risks of stomach ulceration and bleeding.

Diagram A.

The right side shows the complex ligament structures of the lumbosacral region.

The letters indicate key pain areas which have characteristic pain referral patterns - that are not the usual dermatome areas which most practitioners are familiar with. On the left, is shown typical injection points.

(courtesy of Hackett-Ligament and Tendon Relaxation)

Pain Pattern for BACK

Pain referral patterns are looked for to identify the suspect ligament, then under local anaesthetic, the ligament injected.

We look for pain relief immediately or soon after to assist confirm diagnosis. See in diagram how distinct the pain patterns are and relate to specific ligaments.

Treatment is repeated at 2 weekly intervals. The total number of injections may vary from just one to 6-10.

Pain Pattern for NECK

Symptoms can refer (radiate) from specific neck ligaments to distinct locations in the head, face, arms to hands.

Pain, numbness, heaviness, tingling etc are complaints many patients have with neck ligament laxity and inflammation.

Associated almost always is muscle spasm, where tight tender bands are palpable within the muscles.

Along these at specific locations are MFTP's which can also refer pain patterns.

Read more about MFTP's >>>

What patients are suitable

Chronic low backache

If you have low back pain and any of these symptoms, ligament laxity is likely and there is a good chance prolo will benefit:

Sports Injuries - "Prolo Your Pain Away"

I am indebted to Dr. Ross Hauser, MD, and Marion Hauser, MS, RD, for permission to use information and five diagrams from their excellent book 'Prolo Your Sports Injuries Away!' Pages 110, 111, 112, 115 and 478 - Beulah Land Press, 2001.

Almost any joint-ligament injury can be very responsive to prolo. In fact some expert prolotherpists around the world will ONLY use prolotherapy for ligament damage. Steroid (cortisone) injections should never, or very rarely, be used into ligaments as they weaken the ligament tissue long term.

Diet for athletes

Traditional is high carb but better is higher protein content. The outdated Food Pyramid has produced an obesity pandemic. Enlightened nutritionists are downplaying carbs and increasing protein and high quality oils.

Food Pyramid

Promoting Healing

Here there are widely differing views from the orthodox. Many now believe it isnt a good thing to rest joints and ligament too long. In fact exercise and movement enhance tissue regrowth and remodelling. The vast amount of healing and new collagen formation is done by the 6th week. It starts after only a few days. You can see the danger of using cortisone, execss rest, Anti-inflammatories and ice during this phase. It is still healing even into the 12th month - when a badly strained ligament may still only be 70% of its full strength.

Early mobilisation is superior to prolonged. See table:

RICE or MEAT?

Immediately after injury ice may relieve muscle spasm and pain. Dont use it after this as it will interfere with healing.

Heat on the other hand promotes blood flow, and stimulates healing.

So that really means no RICE apart from the very first 24 hrs or so.

RICE is (Rest-Ice-Compress-Elevation)

MEAT is (Movement-Exercise-Analgesic-Treatment )

Analgesics (pain relief). Use minimal drugs, avoid NSAID's, natural proteolytic enzyme supplements are very good at reducing bruising and swellig (such as papain from papaya and bromelain from pineapple). take in sufficient amounts is can outstrip NSAID's as well as quantums safer.

Treatment - heat, physio techniques, PROLOTHERAPY ideal if available

Use of proteases

The Technique of Prolotherapy

Following an examination and diagnosis, Dr. Reeder locates the ligaments most likely to be responsible for the pain pattern. Pressure on these will usually elucidate similar pain but not always. Antiseptic solution is applied to the points and a tiny 'bleb' of anaesthetic is injected into the skin. The prolotherapy solution is then injected at the points right into or near the problem ligaments. Some conditions require a technique that does not actually touch the ligament or tendon. A good example of this is the Archilles. Tendonitis here responds very well to a course of prolo.

Fees

Depends on number and time but on average NZD$185 a treatment. (Preliminary consultation at usual rates)

Neurofasciotomy

Also known as Nesfield's Treatment or Rhyzolysis

Another very interesting and highly successful treatment of back or spine ache is this technique developed post-war in the UK by a Dr Nesfield. It was popularised by Dr Skyrme Rees, a Welshman who had been a Fellow of the Royal College of Surgeons in London. Immaculately dressed in pinstripes, fob-watch, monocle and with impeccable upperclass accent, Dr. Rees migrated to Australia and practised solely this technique to help thousands of back-pain sufferers all over the country.

He was not especially liked by the Australian orthopaedic surgeons for he was sought after all over the world because of his great success with this strange treatment. Dr. Rees also trained many doctors there and in the US. One such doctor was an ageing Dr. Alan Moynagh from Tauranga. It was he who introduced me to Rhyzolysis and trained me. Dr. Moynagh sadly died rather suddenly 2 years later. A thorough gentleman and the epitome of the committed and caring GP of the past. I was priviledged to have the knowledge passed to me.

Neurofasciotomy is strange in some ways. I think the exact mde of its success is not yet mapped out. It involves tiny incisions made with a special fine surgical blade into precise locations adjacent to the posterior spinal processes. There is more to this than that, but it describes briefly the technique.

What does it do?

It was thought that the incision cut a very fine pain nerve carrying over-expressed pain information to the brain. In other words, even though there was an injury or chronic pain (which serves no healing purpose), the body's complex pain and nervous system never was able to shut down properly. Pain, out of context to the actual state of the back structure, just reverberated on, and even became amplified. Cutting the nerve was like cutting the telephone lines. It reduces even stops pain - the person can function and mobilise more which further promotes healing as you read above in the Prolo section.

There are several other views including possibly deactivating MFTP's, Neural therapy and so on. Skeptics believe its all in the mind. If that was the case then great work. It sure is a ton safer than being on painkillers and anti-depressants every day.

It is a very interesting treatment for chronic back or neck pain that is safe and can be extremely effective - but for which a good explanation is still to be clarified. But remember, a high percentage of all kinds of treatments by orthodox doctors are empirical and have unclear explanations - yet they work. It is the art of medicine.

What is the success rate?

I find with appropriately screened cases about 60-80% will respond with excellent to good response.

Side-effects

Is very safe. As long as the patient is not allergic to local anaesthetic.

Local bruising is minor - no stiches required

Very rarely can the delicate blade snap off inside the muscle. This is more of a nuisance effect but does require extracting under xray imaging.

Worst thing is a nill response in about 10-20%.

How long does it last?

I have many patients who had chronic years of pain which resolved after one treatment! Others have got varied durations of relief from months to years. Several 'levels' may need to be treated. Some patients they may come back after another injury and repeating treatment at the same levels may give a response.

Neurofasciotomy can be a very effective option for many back ache sufferers. It is not suitable for severe TRUE sciatica.

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