These are treated by injection of hypertonic glucose to the tender points at the back of the skull, and tips of the cervical vertebrae at the attachments of the supraspinous and interspinous ligaments. These superficial points are easy to treat and will relieve most neck problems. More advanced practitioners can treat the cervical facet ligaments11.
Strengthening and tightening the ligaments around the Temporomandibular joint relieves the pain and muscle spasm and prevents locking. [illustration]
Typists, hairdressers and other who lean forward constantly in their work often develop upper back pain, due to the tendency of collagen to undergo ‘creep’ when a constant force is applied. This means that the supraspinous ligament is ‘too long’ and paraspinal muscles must work harder than normal to maintain posture. This is one of the easiest areas to treat with prolotherapy. [illustration]
The fibrous acromioclavicular joint is easy to treat with prolotherapy. Tears
of the rotator cuff, eg supraspinatus tendinitis also can be treated with accurate
placement of the prolotherapy solution at the site of the attachment of the
tendon to the humerus. [illustration]
Assuming that there is strain of the ligaments of the sacro-iliac joints in most low back pain, prolotherapy injections are used in a wide area, including the posterior sascroiliac ligaments, the ligaments of the lower lumbar facet (or zygapophyseal) joints and the ilio-lumbar ligaments. Once these ligaments are strengthened and tightened, the pelvis becomes more stable and walking, bending, standing on one leg (eg for dressing) become less painful and more efficient8. In most cases pain in these movements can be significantly relieved. [illustration]
2 randomised double-blind controlled trials in low back pain from California showed significantly greater improvement in the treated group compared to controls9/10.
It is often assumed that all leg pain is sciatica. In fact lateral leg pain
is more common than true sciatica and is usually referred from the sacro-iliac
joint. This is very useful diagnostically, and when the patient indicates lateral
thigh pain, palpation will reveal tenderness of the sacro-iliac joints confirming
the diagnosis. Unless there are sinister points in the history, Xrays or MRIs
for disc lesions etc are usually unnecessary as these pain patterns are so distinctive.
They were mapped by George Hackett in the 1930s and 40s and have stood the test
of time.
True sciatica is, of course, a surgical condition and should be treated surgically,
but the patient may also need prolotherapy to the pelvic ligaments, whose instability
may have contributed to the disc lesion. [illustration]
When groin pain is not referred from the ilio-lumbar ligament, it may be due
to strain of the adductor muscles at their attachment to the pubis. Prolotherapy
is effective. Osteitis pubis responds well to prolotherapy in most cases. I
have treated 5 cases with good results: one in the last weeks of pregnancy,
two after pregnancy, one sportsman, and one old lady with a pelvic fracture
after a fall. All except one of the post pregnancy patients responded with complete
resolution of their pain. [illustration]
Knee pain is often due to sprain or strain of the external knee ligaments. This responds well to prolotherapy, and surprisingly even medial cruciate ligament laxity can often be helped12. A recent DB study of prolotherapy into the knee showed 44% decrease in pain in knee osteoarthritis and some regeneration of cartilage13. In 16 knees with ACL laxity, 9 were normal at 1 year and 10 were normal at 3 years. [illustration] [research information]
A Lancet 2002 report from Holland showed that steroid injections for lateral epicondylitis had a poorer long term outcome than physiotherapy or “wait and see” approach14. Prolotherapy has good results and is more logical, as the inflammatory response is utilized for healing rather than being suppressed. [illustration]
Osteoarthritis of the thumb and finger joints often respond well to stabilization of the surrounding ligaments, by injection at the tender points, eg pain in thumb joints with lifting heavy plates, or painful Heberden’s nodes. A DB trial showed 42% improvement in pain in the dextrose group compared with 15% in the placebo group. Movement also was significantly improved 15. [illustration] [research information]
Sprains of ankle ligaments respond well, painful sagging arches can be strengthened, the pain of bunions relieved and hammer toes can be straightened. Spurs of the plantar fascia are painful to treat but respond well. [illustration]