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SI Joint Pain & Regenerative Medicine

Most patients that seek either prolotherapy, platelet rich plasma (PRP) treatment, or stem cell therapy of their lower back pain come to Dr. Merson as a last-chance effort. Some patients have also had surgeries on their back – fusions, laser spine surgery, discectomy, and decompression. Unfortunately, most patients who have chronic lower back pain sometimes give up, and are told to “deal with it.”

So, why would prolotherapy, stem cells, and PRP work so well for this large subset of patients? Why would a patient who suffered each and every day in pain for 20 or 30 years experience relief within a few months of starting prolotherapy or PRP? The answer is simple. The back pain is not just a disc problem. The disc is a shock absorber for vertebrae, and while this shock absorber can become defective, there are so many other parts of the lower back and support structure for the lower back that can cause pain.

si-joint-ligamentsTake, for instance, the sacroiliac joint (or SI joint). Not only can this joint become arthritic, but all of the ligament and tendon structures that hold this joint together can become stressed, strained, or torn, but may appear normal on MRI (which is not very accurate at diagnosing sacroliliac pain). Additionally, most back pain patients have a functional leg length discrepancy / tilted pelvis which further exacerbates sacroiliac joint pain.

If you have the opportunity to examine and study the anatomy of the lower back and pelvis, look at the ligament structure. The ligaments that insert into the L4 and L5 vertebrae (which are the most common to herniate in the lower back), actually are contiguous structures with the sacroiliac joint, coccyx, and insert into the ischium (sit bones). Therefore, dysfunction in any part of this ligament structure can impact what happens with the L4 and L5 disc and vertebrae. Just a tilt in the pelvis completely disrupts the balance between the left and right sides of the back and contributes to back and pelvic pain.

Now, if you are skeptical, and still think that prolotherapy and platelet rich plasma injections in the lower back are without merit, realize that not only has this treatment withstood the test of time, with doctors practicing prolotherapy dating back to the 1950s, but randomized medical studies have shown significant success (greater than 85%) in patients with chronic lower back pain.