Prolotherapy for Sacroiliac (SI) Joint Pain ?
Did you know that your low back pain might be due to SI joint inflammation, injury or dysfunction?
As I recall back from my Chiropractic College years the importance of addressing the entire “Kinematic chain” even when the MRI or X-rays indicate a degenerated disc condition. SI Joint dysfunction might be caused by direct or indirect injury, obesity, pregnancy, poor posture or gait, etc.. Hence, the treatment for the “low back pain” or more specifically SI joint dysfunction would be to address the cause while alleviating the pain.
In our practice, the Integrative approach would be recommending weight loss, with an individualized diet program, rehabilitation, and physiotherapy to strengthen weak muscle(s), custom orthotics (when indicated) for gait correction, Chiropractic treatment to hypo mobile joints, combined with Prolotherapy injections to hyper mobile joints, in addition to Acupuncture for pain control.
The following study reviews the efficacy of Prolotherapy in comparison to Steroid injections for SI joint dysfunction.
A randomized controlled trial of intra-articular prolotherapy versus steroid injection for sacroiliac joint pain.
Controversy exists regarding the efficacy of ligament prolotherapy in alleviating sacroiliac joint pain. The inconsistent success rates reported in previous studies may be attributed to variability in patient selection and techniques between studies. It was hypothesized that intra-articular prolotherapy for patients with a positive response to diagnostic block may mitigate the drawbacks of ligament prolotherapy. The purpose of this study was to evaluate the efficacy and long-term effectiveness of intra-articular prolotherapy in relieving sacroiliac joint pain, compared with intra-articular steroid injection.
SUBJECTS:
The study included patients with sacroiliac joint pain, confirmed by ?50% improvement in response to local anesthetic block, lasting 3 months or longer, and who failed medical treatment.
INTERVENTIONS:
The treatment involved intra-articular dextrose water prolotherapy or triamcinolone acetonide injection using fluoroscopic guidance, with a biweekly schedule and maximum of three injections.
OUTCOME MEASURES:
Pain and disability scores were assessed at baseline, 2 weeks, and monthly after completion of treatment.
RESULTS:
The numbers of recruited patients were 23 and 25 for the prolotherapy and steroid groups, respectively. The pain and disability scores were significantly improved from baseline in both groups at the 2-week follow-up, with no significant difference between them. The cumulative incidence of ?50% pain relief at 15 months was 58.7% (95% confidence interval [CI] 37.9%-79.5%) in the prolotherapy group and 10.2% (95% CI 6.7%-27.1%) in the steroid group, as determined by Kaplan-Meier analysis; there was a statistically significant difference between the groups (log-rank p?<?0.005).
CONCLUSIONS:
Intra-articular prolotherapy provided significant relief of sacroiliac joint pain, and its effects lasted longer than those of steroid injections. Further studies are needed to confirm the safety of the procedure and to validate an appropriate injection protocol.
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