A Return to First Stage Healing

Chiropractic physicians often write that the condition of tendons and ligaments affects alignment and the patient’s ability to hold an adjustment. For this reason, many chiropractic authorities are in favor of treatments designed to strengthen tendons and ligaments. Prolotherapy works to do exactly that. Neal Taub, MD, ABPM&R provides prolotherapy treatments at his office in Charlotte. In cases of chronic low back pain, you may find that prolotherapy delivered by Dr. Taub serves as the correct adjunct to your chiropractic care.

How do you strengthen tendons and ligaments? You get the body’s own healing response to do it. Prolotherapy essentially irritates specific tendons and ligaments implicated in the patient’s condition and causes the body to restart first stage healing. There are no drug side effects. Prolotherapy uses a solution consisting of an irritant, such as glucose, and a local anesthetic, such as lidocaine. Dr. Taub uses clinical reasoning and palpation to identify tendons and ligaments that are tender and possibly contributing to chronic back pain. He then injects the prolotherapy solution into the problematic structures. The body interprets the highly specific irritation as some sort of injury and rushes in to make repairs as part of the first stage healing response. This inflammatory response incites fibroblastic hyperplasia, the laying down of new tissue to repair and strengthen the structure.

Without intervention or re-injury, this highly specific strengthening may never take place. Ligaments typically have poor blood supply. This leads to slow healing and incomplete healing. Furthermore, the widespread use of non-steroidal anti-inflammatories (NSAIDs - specifically COX-2 inhibitors) may interfere with the body’s unsupervised attempts at first stage healing. COX-2 inhibitors interrupt the inflammatory process responsible for repairing and strengthening structures such as tendons and ligaments.

In the prolotherapy protocol, first stage healing is re-initiated and professionally managed with nutritional supplements, exercises specific to the therapy, and advice on NSAIDS. If your chiropractic patients already receive nutritional supplements or perform specific exercises as part of their chiropractic care, Dr. Taub will coordinate with you on the incorporation of the enhancement strategies.

The ligaments often involved with chronic low back pain include the sacrotuberous ligament, the sacrospinous ligaments, the iliolumbar ligaments, and the long posterior sacroiliac ligaments. The tendons often include the tendons of the gluteus maximus, gluteus medius, and the piriformis. In cases of non-specific, low back pain, tenderness of these structures on palpation indicates that the stress of normal daily activities has exceeded the strength of the structure and exceeded the structure’s current capacity to provide stabilization for the spine. Many practitioners choose not to palpate all of the ligaments and tendons that may contribute to sacroiliac instability because of their location.

Dr. Taub invites chiropractors to refer patients for an initial prolotherapy assessment and follow-up treatments (if indicated).