After 2.5 years of SI joint trouble, I'm seriously considering prolotherapy. All the stuff I've read seems pretty positive on the procedure. None of the information seems to be biased, commercial-type advertising. I was wondering what you know about it. Do you know of any horror stories?
Thanks for your question! To answer your question, I have seen little FUNCTIONAL success, yet I have seen pain relief. The problem is most people are led to believe if the pain is gone, they’re "OK" as if the problem was fixed. So, to assist you in your decision making, I have defined prolotherapy and the "holes" that exist. I will follow this with SIJ considerations you can explore.
What is Prolotherapy?
Prolotherapy is a time-tested injection method used to treat chronic pain. It is defined by Webster's New Collegiate Dictionary as "the rehabilitation of an incompetent structure, such as ligaments or tendons, by the induced proliferation of new cells." Often applied to soft tissues in the body, which include ligaments, muscles-fascia, tendons and joint capsules are also called "connective tissues" because they connect to bones, thereby supporting the bony skeleton. It is proposed prolotherapy causes these connections to be rebuilt and strengthened. It is for this reason that prolotherapy has also been called ligament reconstructive therapy or stimulated ligament repair for pain-induced areas.
Questions to ask include, what defines strength? How is strength measured (isolated or functional)? What is meant by “rebuilt?” If you rebuild one area in isolation through an unnatural means, will you also stimulate the proprioceptors to function correctly? Is this therapy JUST a means of reducing pain? Pain is a symptom - NOT a cause! Therefore, are we just reducing a symptom without finding a solution to the cause? How is prolotherapy success measured - by pain relief? It is true that pain relief will allow the system to move better, but that doesn't mean more efficiently. If it moved efficiently in the first place, the SIJ wouldn't be aggravated.
SI Joint Considerations:
- First and foremost, the SIJ is a reactor joint. This means it reacts to gravity, ground reaction forces, momentum, etc. The question with regards to your situation is, how is your SI reacting to what's above it and what's below it? My immediate suggestion is to "clear" your subtalar joint, hip joint and thoracic spine. These areas are the key to rotation and ultimate function. First, you need the mobility followed by stability-strength-power in ALL planes of motion.
- Because the SIJ reacts to above and below forces both intrinsic and extrinsic, it is critical that it is assessed during movement not in a lying position. My suggestion is to videotape your movements, especially the ones that aggravate you the most, and attempt to figure out why the SIJ is overstressed. The reason for spasm, muscle guarding is simple (in most cases): someone's working too hard while someone else isn't working hard enough, and your SIJ is taking the blame (this is why clearing the subtalar, hip and thoracic spine is the most logical place to start).
- If an SIJ dysfunction exists, it most likely didn't come from the SIJ, and therefore, therapy to the SIJ pain region will most likely just relieve pain without addressing the cause.
My strong recommendation is to purchase Gary Gray's Functional Video Digest Series on the SIJ. Out of all the SIJ courses I've attended, this was the most useful to my clients and their success.