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Prolotherapy for the Pelvis
The prolotherapy trial in Sydney, Australia is being performed under the guidance of the Low Back Interest Group (LBIG Australia):
Dr Mel Cusi MB BS, FACSP, Cert Sp Med Sports Physician, Conjoint Lecturer, UNSW
Orthosports: Tel: 02-9399 5333 or 02- 9744 2666
Dr Jenni Saunders ASM, MB BS, FACSP, CIME, Sports Physician
Premier Orthopaedics: 02-9553 9655
Barbara Hungerford PhD, B. App.Sci (Physio) Consultant Physiotherapist
Trish Wisbey Roth M. Sports Physio, B. App.Sci (Physio) Sports Physiotherapist
Please be aware that referral for prolotherapy under the LBIG trial can only be provided by Dr Cusi or Dr Saunders. If you require a medical opinion or advice about this treatment you will need to make an appointment with either of these medical practitioners at their clinics. The physiotherapists at Sydney Spine & Pelvis Physiotherapy Centre are unable to refer any person for prolotherapy.
Prolotherapy involves the injection of a proliferant solution into a ligament, with the aim to cause proliferation of growth of collagen tissue which is the principle component of ligaments. There are many proliferant solutions, however, in the trial being undertaken in Sydney, glucose has been chosen because it is the safest option. The strength of the glucose solution has been researched in order to produce optimal results, that is, to produce collagen as close to normal ligament structure, rather than scar tissue which has been shown to stretch over time.
Biological Effects
The proliferant solution works by creating a cascade of biological events that cause the release of pre-collagen growth factor (PGF) which encourages specific cells, known as fibroblasts, into the injection area. It is the fibroblasts that secrete the collagen tissue. This is a biological process that takes about 6 to 8 weeks to be completed. This explains why people undertaking prolotherapy injections do not immediately feel better, and also why we wait 6-8 weeks between injections.
Why would prolotherapy be indicated?
Prolotherapy may assist collagen growth in ligaments that have been damaged by trauma or injury. At present the joints being treated in this trial are the sacroiliac joint, the pubic symphysis, and the costo-transverse joints.
Prolotherapy in the pelvis
The joints of the pelvis, the sacroiliac joints and the pubic symphysis, are inherently stable joints. That means that, normally, the ligament structure and muscles surrounding the joints support the pelvis so that very little movement occurs, even under large loads such as walking or running. During late pregnancy and labour, the amount of movement occurring at the sacroiliac joints and pubic symphysis will increase due to the effects of hormones such as relaxin. Under normal circumstances, however, movement will return to normal and the ligaments will become firm again within a short time of giving birth.
Pain originating from the pelvic joints, ligaments, and muscles, can be debilitating, and can make it difficult to sit, walk, stand, and even sleep. In most instances, pelvic pain and sacroiliac pain can be successfully treated with manual therapy and specific exercise rehabilitation. Occasionally, the force of the injury (for example due to a nasty fall or motor vehicle accident) may be sufficient to strain the pubic or sacroiliac ligaments. The majority of ligament strains also heal with time, and with appropriate treatment, however in a small percentage of people, the collagen within the ligament remains damaged, and creates ligament laxity. This affects the ability of the pelvis to maintain its stable joint alignment so that weight can be transmitted from the upper body down onto the legs. It is this small group of patients who have increased laxity of the pelvic ligaments that have been shown to respond to prolotherapy (Dorman et al, 1995), when the injection is given under CT Scan guidance (ensures that the proliferant is placed correctly, and where it will have the best effect).
At present, any patients seeking prolotherapy must undergo a complete examination from one of the therapists listed above. They will determine whether there is any indication that there is significant ligament damage and laxity that may indicate prolotherapy could be of some benefit toward improving function. All candidates for prolotherapy into either the sacroiliac or pubic ligaments must undergo a 3 month trial of specific lumbo-pelvic stability exercises before being accepted into the program. This is because the prescribed exercises improve muscle activation around the lumbar spine and pelvis, and in many cases these exercises alone will improve lumbo-pelvic stability so that the prolotherapy is not needed.
PROLOTHERAPY IS NOT A FORM OF PAIN RELIEF. It may improve pain over time because the ligament structure gets stronger and this improves the ability of the underlying joint to cope with forces placed onto it, for example, when walking. In fact, the injection may initially increase pain. The pain usually settles within 3 to 4 weeks.
In order to maintain the effects of the injections, patients need to continue performing the lumbo-pelvic exercises, and this should also accelerate improvement.
View the medical/physiotherapy treatment protocol
Prolotherapy and Medication
DO NOT TAKE ANTI-INFLAMMATORY MEDICATION
(Aspirin, Nurofen, Nurofen plus, Voltaren, advil, prednisone, hydrocortisone, other prescription antinflammatories etc). Although they can effectively reduce the pain, they will fight the very effects of the injection!
Pain relieving drugs such as digesic, panadol, panadeine, and tramyl are accepted.
Activities following treatment
You should carry on with your normal activities as much as possible. Do not engage however in high level activity, putting more than the average physical load on your pelvis (running and cycling are not a good idea. Other activities which you do should be checked with the physiotherapist.
Prospective patients will be provided with more detailed information during their medical consultation.