Prolotherapy For Chronic Low Back Pain – Case Presentation

Prolotherapy is a type of injection treatment that has been utilized in clinical practices for over 80 years. It has been shown to be an effective treatment for patients who suffer from joint laxity or instability caused by connective tissue damage, overuse, and injury. In my practice, most of the patients referred for prolotherapy did not respond to regular treatments such as cortisone injection, prescription muscle relaxants, or active rehab.  

Kathy, a twenty-three-year-old female patient, came in with chief concern of constant pain in lower back and pelvic areas as well as headaches, neck pain, and pain in her right leg. The onset of these symptoms was approximately 10 years ago but the symptoms intensified after a motor vehicle accident in 2018.

The pain was gradually getting worse and started to affect her daily life. She describes her constant pain as cramping, sore, tingling and numbness in lower back, pelvis and both legs. Pain ranged from 2 – 7 out of 10 (10 being most severe). She was not able to sit for more than 30 minutes or stand for more than 5 minutes continuously without neurological symptoms. Neurological symptoms correlated to dermatome of L4 and L5 nerves.

Kathy underwent several chiropractic treatments with some success. She had improved moderately with pelvic physiotherapy with the goal being to reduce neurological symptoms. Before Kathy was referred to me for prolotherapy, she was put on a treatment plan of physiotherapy twice a week working on stretching quadricep muscles, hamstrings, gluteal muscles and piriformis, improving pelvic floor muscle strength, and strengthening core muscles.

The pain presented mainly as polyneuropathy, instability of lumbar and SI joints. There were some improvements with regular physiotherapy in addition to a rehab program, but a setback was experienced which resulted in worsening of the pain.

After initial assessment and explanation of prolotherapy procedure, Kathy reluctantly decided to give prolotherapy a try. She was not a big fan of needles! She had a dose of anti-inflammatories the day before the consultation so I did not perform prolotherapy on her as anti-inflammatory medications are relatively contraindicated for prolotherapy. Instead, I performed neural therapy at L4 and L5 nerve root. This type of injection also helps to promote healing of injured nerves and restoration of tissue function. Most patients notice a reduction of pain immediately after the first injection. Kathy was discharged and advised to come back for a series of 4 – 6 prolotherapy treatments, each treatment was scheduled 2 weeks apart.

Kathy’s second visit was 3 weeks later. She reported feeling good for 1 week after the injection. In her second visit I did prolotherapy utilizing dextrose solution at L1 – L5 interspinous and supraspinous ligaments, facets, sacroiliac joints, origin and insertion of iliolumbar ligaments, origin of gluteus muscles bilaterally. Her third visit was a week later and Kathy felt a lot better. Frequency and severity of shooting pain decreased. Muscles were not as tender upon palpation. In Kathy’s 4th visit, she reported that the shooting pain and tingling numbness was gone. In the 5th visit, lower back pain was not constant any more. Frequency was down to a couple times a week and severity was a bearable of 3/10 on pain scale. She had not had the need to take pain killers or a prescription muscle relaxant. Her last prolotherapy visit with me was 3 months into prolotherapy. Pain in lower back and pelvis were resolved. There was still some tightness in the back if she extended her back, but neurological symptoms did not return. She had some tingling in legs once after standing for an hour and it resolved after she sat down. Kathy then was referred to continue active rehab and physiotherapy to strengthen core strength and pelvic muscles.

Prolotherapy is gaining recognition as having a place in the management of chronic MSK pain which has gone on longer than 8 weeks such as low back pain, whiplash injuries, chronic joint instability. In PMC 2010 Mar 3 issue Prolotherapy in Primary Care Practice article, the authors concluded “Existing studies provide level B evidence that prolotherapy is effective for non-specific low back pain compared to a patient’s baseline condition. Given that subjects with refractory, disabling low back pain significantly improved compared to their own baseline status in the Yelland study, patients may reasonably try prolotherapy when performed by an experienced injector.” A dextrose solution Prolotherapy treatment plan would include 4 – 6 injection sessions, two weeks apart, then reassess. Prolotherapy would work well to strengthen joints, and a combination of prolotherapy injections, spinal manipulation, exercises, and other treatments can help chronic low back pain and disability.