Sacroiliac Dysfunction and Case History
Prolotherapy injections are an effective and definitive treatment in many chronic pain syndromes traced to sacroiliac dysfunction. Sprained and stretched sacroiliac, iliolumbar, and lumbosacral ligaments destabilize the lower back. Instability is accompanied by spasm of the muscles whose job it is to move and at the same time reinforce the back. Hypertonic sacrospinalis muscles become swollen and cause a constant and distracting pain in the low back and sacrum, with referred pain patterns that can radiate into the thigh and leg. Over time the instability initiates osteoarthritis changes in the joint surfaces and calcification in the fibro-elastic connective tissue. Ligaments lose their ability to respond dynamically to stress to tissue which is brittle and non-dynamic, stretching reluctantly and loosing 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 ilium. Pain and spasm spreads to the lateral hip rotators: hypertonic gemellus, obturators, quadratus femoris and piriformis restrict lateral rotation of the hip 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. The patient gradually abandons physical activities, and becomes reliant on pain and anti-inflammatory drugs. Reflex spasm of the sacrospinalis, quadratus lumborum, and lower multifidi restricts movement and causes pain in the lower back. The illiopsoas muscle is recruited in further attempts to reinforce the sacroiliac joint, causing abdominal and lumbar pain, and often hyperlordosis. Disuse leads to loss of muscle mass in the muscles of locomotion as well as core muscles. The patient's quality of life is severely impacted.
Case History:
P.D. had been a dedicated cross-country runner until she over trained and developed severe pain and sacroiliac dysfunction. She pursued physical therapy, chiropractic treatment, and orthopedic consultations that led to multiple X-rays, CAT scans, and treatments that led eventually to steroid injections into her sacroiliac joints. Steroids provided short term reprieves too 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 osteoarthritis changes in the sacroiliac joints. Multiple drug regimens for pain, inflammation, and sleep replaced exercise and family outings. When her husband was hired by a high tech firm in Portland, 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.
P.D. 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 faceted approach beginning with prolotherapy injections to regenerate the sacroiliac, iliolumbar, and lumbosacral ligaments. She had to be taken off all anti-inflammatory drugs, as these medications were inhibiting 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, as we treated her with prolotherapy and trigger point injections, and ultrasound/ sine to her areas of need. Gradually she had increased mobility and began to spontaneously increase her activities.
She became comfortable sleeping again, and for the first time in years slept consistently through the night without pain or sleep medications. After 6 weeks she resumed a regular low intensity exercise routine. After 8 weeks she had increased her exercise and was power walking without difficulty. On a recent 2 week vacation to Florida she ran every day. I've had to remind her not to over do it in the early stages of her regenerative treatments.
Has the arthritis gone away? We don't know. For me, the smile on her face is good enough evidence of the progress of her healing. X-rays will just have to wait.