ProloTherapy of the Low Back (including Sacroiliac Areas)

83 Pages·2012·12.01 MB·English

Arden Andersen, D.O.
AOA Convention, October 2012,
San Diego, CA
The lumbar spine and sacral-iliac carry the

weight of the body and payload, maintain the
scaffolding for the body core muscles and
allow humans to stand erect.
One of the most common areas of pain,

injury, invasive and non-invasive therapy
from steroid injections to decompression,
from OMT to laser spine surgery
One of the most amenable areas to successful

prolotherapy
One of the easiest areas to inject as a

beginner and gain success and confidence
Low back injury at age 18, perhaps before as well

on the farm, chiropractic relieved/saved me from
exploratory surgery
During medical school had significant pain,

disability treated 5 days per week with OMT,
cranio-sacral and exercises without resolution.
Finally had prolotherapy at AOAPRM seminars

and got resolution of pain for over 5 years,
reinjured/Levaquin and now getting prolotherapy
again with improvement
Nothing has been as effective as prolotherapy

OMT/chiropractic doesn’t hold

Ligament structure are tender to exam

Ilio lumbar attachments to iliac area are tender

Inter spinous ligaments origin/insertion is

tender, painful to touch
Pain’s less when mobile. (The patient is in less

pain while in motion, but hurts more when still or
on arising in the morning.)
Local Anesthetic is diagnostic if all or most

symptoms are gone by 10-15 minutes after the
areas to receive prolo have been anesthetized.
(thus ruling out pain from non-ligament causes)
Rule Out: – lose style points for missing these

◦ neoplasm
aneurism
appendicitis
peritonitis
kidney infection
shingles
bladder infection
failed surgery
infectious processes
Any pain not of fibrous tissue enthesitis

origin
Nerve root impingement due to disc

fragmentation which compresses a nerve root
True spinal stenosis – relative as they may

still benefit from prolotherapy before or after
surgical intervention
Muscle atrophy of either lower extremities

Keep in mind that patient may have already

exhausted other options or refuses to go
anywhere else – YOU are it!
A preponderance of pain receptors are

located in or on ligamentous tissue.
When a legamentous area is tender upon

palpitation, it is due to the pain receptors on
the remaining intact fibers being over
stretched. For example, apply a pull on a
patch of scalp hair containing 100 or more
hairs. Then apply the same force on 10 hairs.
The ten hairs represent the weakened
ligament. This usually is well accepted by the
patient.
Why are we doing this?

What is our goal?

◦ Full disclosure and signed consent form
◦ What is the patient to expect over the next few days
◦ Is patient allergic to anything? Specifically local
anesthetics, corn, oils, etc.
◦ Are we merely giving local blocks to determine
diagnosis with actual treatment later?
 Depends upon time allotted for appointment
 Patient expectations or apprehensions
Study !