PROLOTHERAPY IN THE TREATMENT OF NECK AND BACK PAIN AND OTHER JOINT INSTABILITY SYNDROMES

One out of three people, at some time in life, experiences spinal disease significant enough to lead to professional treatment. In America alone, $7.4 billion are spent on drugs every year to treat pain originating in the spine. This amounts to an average of $30 for each person, each year. Every day, one out of five people in Western countries (and probably worldwide) suffer from debilitating spinal pain.

Loss of work time in America amounts to $80 billion each year! Fifteen million Americans consult a physician for back pain or neck pain every year, paying these physicians a total of $20 billion. And what do we get for our money? Do we get a cure? Not exactly. The truth is, physicians in general have no effective treatment for spinal aches to offer you. Physicians and chiropractors typically offer the following palliative treatments, in this order:

anti-inflammatory medications (some of which are effective for no more than a few days, but also cost a fortune),
cortisone injections (causing dramatic but, alas, only temporary relief),
surgery and more anti-inflammatory medications, including more cortisone, resulting in damaged and iatrogenically (doctor induced) degenerated joints,
spinal adjustments (in the case of chiropracters), usually repeated over and over because the adjustments do not hold.

Let us take a look at what spinal disease really is, so we can see why the standard medical/surgical approach is the only thing worse than spinal ache itself. The human spine is made of 24 individual, movable vertebrae, and nine fused vertebrae. Each articulates with the one above and below it. There are seven cervical vertebrae, twelve thoracic vertebrae and five lumbar vertebrae, the last of which articulates with the sacrum. The sacrum is formed in the embryo by the fusion of five vertebrae. At the end of the sacrum is the coccyx consisting of four vertebrae fused together. The coccyx is made of four tiny, fused vertebrae and moves independently of the sacrum. It is the so-called "tail bone" which can easily be damaged when one falls backward to the sitting position. Each vertebrae of the spine, whether fused or not, has corresponding nerve roots in the spinal cord. The total number is therefore 7 + 12 + 5 + 5 + 4 = 33.

While problems of the spinal column can occur at any level, the most common area to be affected is the low back with the neck running a close second. As the body ages, the ligaments which hold the vertebrae together become weaker, predisposing you to a greater risk of back and neck injuries with each passing year. Athletic people, and people who perform heavy labor for a living, are most likely to experience an injury due to ripping and tearing of these increasingly fragile ligaments.

Disk degeneration disease is a natural phenomenon, eventually present in everyone. It should be considered normal, and it is not, by itself, a cause of back pain or neck pain. The proof of this assertion is the fact many people have degenerated intervertebral discs, but no pain. Many doctors are not aware of this fact, and they will point to an x-ray revealing disc degeneration and tell you the cause of your back pain or neck pain has been found. Do not believe it!

The cause of back pain and neck pain is the instability of vertebrae, which results from weakened and/or damaged ligaments. The vertebrae are held in their proper position in relationship to each other by muscles and by ligaments. Muscles alone are not able to do the job. Nevertheless, they can help, and this is the rational basis of exercise as a treatment for an unstable back or neck.

Strong ligaments are necessary for a stable spine. However, instability is not, in itself, the cause of pain. The cause of pain is inflammation. Inflammation happens when vertebrae rub against each other in an abnormal way due to the presence of damaged ligaments. This is why anti-inflammatory agents, including cortisone, can result in temporary relief of pain. However, since the underlying condition is not treated with anti-inflammatory agents, this suppression of symptoms is like putting your finger in a dike. The flood will come sooner or later.

When it does, your doctor may recommend surgery, specifically: fusion of the vertebrae. This is an attempt to create stability in an artificial way, replacing two to five (rarely more) vertebrae with a single structure made by fusing together all these vertebrae, substituting the strength of these fused vertebrae for the lost strength of aging, damaged ligaments. Occasionally this maneuver is successful in the treatment of pain. However, there is a cost: decreased mobility. When vertebrae are fused together, the spine is less flexible than before. In more than one-half of cases, pain is still present, and mobility also is compromised.

Clearly the standard medical/surgical model of treatment of spinal problems is not the way to go, with the possible exception of the treatment of blunt trauma which requires surgical correction of fractured vertebrae to relieve acute pressure on the spinal cord. Even though medication/surgery is not the way to go in most cases involving back pain and neck pain, you will be recommended these treatments anyway because, in general, this is all doctors know to do. Even they will tell you chances of a real cure are slim with surgery and nonexistent with medication.

Nonsurgical reconstructive therapy - also referred to as "prolotherapy" or "proliferative therapy" - evolved out of a treatment pioneered by H. I. Biegeleisen called "sclerotherapy," which was originally (and still is) used to treat varicose veins. Prolotherapy involves the injection of an "irritant" solution into the area where ligaments are weak and/or damaged. Over the next few days, cells called "macrophages," literally big eaters, are attracted into the area by the presence of this irritant solution. Once they arrive, these macrophages pick up the irritant solution and carry it away for disposal (they are the garbage men of the body). As the macrophages are finishing their job, the body sends in "fibroblasts," literally connective tissue builders, to lay down fibrous tissue wherever they detect damage to connective tissue such as ligaments.

Of course, prolotherapy can be used on any weakened ligament or tendon in the body. The determining factor is the doctor's skill in introducing the needle to exactly the right locaiton. Knees, hips, elbows, shoulders, in fact every joint in the body can develop problems which can be addressed with prolotherapy.

The doctor's job is to introduce the irritant solution into the places where ligaments are weak or damaged. If properly placed, this causes the repair of ligaments, and the result can be a supporting structure for the spine up to forty percent stronger than the original! This new supporting structure pulls the vertebrae back into close relationship with each other correcting instability and therefore putting an end to inflammation. When inflammation disappears, so does pain! Stability is restored along with mobility.

That is the long and short of prolotherapy. Studies demonstrate it effects marked improvement in 92% of cases and, if properly administered, does not violate the first rule of medicine: do no harm. These claims cannot be matched by standard medical/surgical treatment methods.

Not only that, this treatment is relatively inexpensive. While a typical surgical procedure on your back pain or neck can cost $5,000 and more while prolotherapy is performed for a fraction of that figure. Usually not more than ten to fifteen treatments are necessary to bring a typical back pain or neck pain syndrome under control - permanently!

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