Case History of Severe Low Back Pain
Noel Peterson, ND
Prolotherapy injections are an effective and definitive treatment in many chronic pain syndromes traced to SI dysfunction. Sprained and stretched sacroiliac, illiolumbo, and lumbosacral ligaments destabilize the lower back. Instability is accompanied by spasms of the muscles whose job it is to move and at the same time reinforce the back. Hypertonic sacrospinalis muscles become swollen and cause constant and distracting pain in the low back and sacrum, with referred pain patterns.
Over time the instability initiates osteoarthritic changes in the joint surfaces and calcification in the fibroelastic connective tissue, changing the tissue from that which responds dynamically to stress by expanding and retracting elastically, to tissue that is brittle and adynamic, stretching reluctantly and remaining overstretched, and losing the ability to contract or rebound to its original shape and form. Loss of the dynamic regulation of sacroiliac movement triggers spasm of the muscles, which have their fibro-osseous origin on the sacrum and ileums. Pain spreads to the lateral hip rotors. Hypertonic gammellus, obturators and piriformis restrict hip joint movement, and can compress the sciatic nerve as it courses through and between them. Sciatic nerve compression and swelling often leads to aching pains, numbness, and weakness in the hip, thigh, knee, lower leg and foot.
Walking, sitting, and virtually any upright activities cause pain, and the patient gradually abandons physical activities, and becomes reliant on pain and anti-inflammatory drugs. Reflex spasm of the quadratus lumborum restricts movement and causes pain in the lower back. The illiospoas is recruited in further attempts to reinforce the sacroiliac joint, causing abdominal and lumbar pain, and often hyperlordosis and lumbar pain and spasm. Disuse causes loss of muscle mass in the muscles of locomotion as well as core muscles. The patient's quality of life is severely impacted. Pam had been a triathlete until she over trained and developed sacroiliac dysfunction. She pursued physical therapy, chiropractic, orthopedic consultations, which led to multiple CAT scans, X-rays, and eventually steroid injections into her SI joints. Steroids provided short-term reprieves to her pain, but had to be repeated at more and more frequent intervals, until these too failed. Her pain and disability worsened, and she could no longer sleep comfortably. She gradually gave up more and more activities. New X-rays revealed osteoarthritic changes in the sacroiliac joints. Multiple drug regimens for pain, inflammation, and sleep replaced exercise and family outings. When a high tech firm in Portland hired her husband, she moved their family to the beautiful Northwest. They enjoyed camping, but family hikes and backpacking were out of the question. Life was good except for the pain and fatigue. That's when she consulted with me about her sleep disorder.
Pam fit the profile of progressive loss of function and escalating pain that all to often is the norm for sacroiliac degeneration. Recovery would require a multi pronged approach beginning with Prolotherapy injections to regenerate the sacroiliac, illiolumbo, and lumbosacral ligaments. But first she had to be taken off all anti-inflammatory drugs, as these medications inhibit the collagen synthesis that Prolotherapy induces. She began a focused nutritional supplement protocol, took herbal pain relievers, and Bromelain to support repair. The first few weeks were rough, and we included trigger-point injections, ultrasound, and electro-stimulation to her areas of need.
Gradually, she had increased mobility and naturally increased her activities. She became comfortable sleeping again, and for the first time in years slept consistently through the night without pain or sleep medications. She has now resumed a regular low intensity exercise routine. I have to remind her not to over do it in the early stages of her regenerative treatments. Has the arthritis gone away? I don't know. For me, the smile on her face is good enough evidence of her recovery. X-rays will just have to wait.