Sunday, March 1, 2015

More on Prolotherapy and PRP Injections for the SI Joint

I went to see a doctor about my si joint and getting prolotherapy to see if it can help stabilize everything around my hips and low back. I went to a doctor who specializes in this at the same clinic where I had my hip arthroscopic surgery in 2011. She is a physicist who specializes in prolotherapy and other regenerative techniques. I was waiting for an appointment at the end of the month, but got a call to come in this week. The only problem was that it was an early morning appointment and I had to get up at 5:00 (on my vacation week) to make it through traffic and get their on time.

She went through my history and did an evaluation. What I liked is that she doesn't just focus on one body part. It all works together. On the other hand, that means she can't pinpoint the actual problem for me. She says the si joint and hip joint all work together. She said she would have like to have seen me 10 years ago and that she would have done injection in my hip back then.

She explained that using prolotherapy on my si joint would be a good idea, but with the bit of arthritis found in my hip, it may mean that later, she might need to suggest PRP therapy in my hip joint. I read enough and I am ready to give it a try. The part I don't like is that insurance does not cover prolotherapy and I will have to pay for each visit (around $350) and she suggests that patients commit to coming in once a month for five to six months. She said we would know by the third visit if it is working. I would also have to not ride my ElliptiGO (at least at the intensity that I do) after the injections for a few days or longer. Then after she has worked on my si joint, the hip issue comes into play. I am quite sure PRP therapy is a lot more expensive and I am not sure I could go there, unless I was 100% sure for a positive outcome.

Meanwhile, everything around my left lower back, si joint, and left hip are somewhat troubling every day. I feel OK, but can't do the things I would like to do on a daily basis as everything keeps going out of balance and pinching or pulling all over the place. I started using my Serola Sacroiliac Belt and that gives me more freedom and stability, but I sure would like my body to do the work without resorting to a belt.

Anyway this gives me a bit of hope, even if not for running, just to get rid of the constant imbalances origination in my hips and si joint. She also wants me to work with an osteopath to get myself realigned before the injections. She knew a ostepathic physiatrist up in New Hampshire and gave me her information. It turns out that she has some office hours at one office just 3 miles up the road so I have an appointment next week. This is good as I was searching for a local osteopath last month, but gave up after the first office I called wanted to make it very difficult to even set up an appointment. I decided to skip it at that point. With my current insurance, I am at the point where I don't have to pay for office visit or even copays anymore, so I should take advantage of seeing specialists that may help.

On a related note, I went to visit a podiatrist again at the office where I had my orthotics made back in 2011. The world renowned podiatrist that used to work there is now retired, I had to pay out of pocket to see him a few years ago, but now my new insurance pays for the visit. Let's just say this new guy does the minimal  that I ask of him and shows no interest in me as a patient at all (something I notice a lot in the health care field). I visited him a month ago for the first time and he did what I asked: looked at my left foot and adjusted the cuboid bone and also the poplitius. That foot has felt fine since then, but the right foot felt out of whack. I asked him about that and he checked and adjusted something with the ankle, looked at my left foot and readjusted the cuboid and then he was basically done and out of the room before I could ask about anything I could do to help myself with stretches or something. I glad I didn't have to pay out of my own pocket for less than 5 minutes of his time. I mentioned that I was hoping to get some prolotherapy done and he said he had never heard of it. I find that interesting as a few people I know let me know that had it used on their ankle and feet with great results. I am often amazed at how little doctors know or are even curious about new or different therapies than what they were taught. I would think they would read up on everything they can about how to better service their patients (I read everything I can about teaching to improve how I teach). I guess I call that going through the motions and it is quite obvious that this is what this guy is doing.

Here is an article on Prolotherapy and PRP written 5 years ago concerning research at Harvard by the doctor I will be treated by and Dr. Hauser, who is the most visible prolotherapist in the country. Prolotherapy and Platelet Rich Plasma Research at Harvard: Interview with Joanne Borg-Stein, MD

This article is old, but this was interesting about PRP therapy (use you own blood plasma rather than a sugar solution) and labral tears: RH:

One condition you mention there was hip or labral issues. Do you find that is a condition that responds to regenerative injection therapy?
JBS: I don’t know yet. The hip girdle is complicated. Often times labral tears are incidental radiographic finding and not the proximate cause of pain. I think we need to be diligent and careful in our physical examination and assessment of the hip girdle: anteriorly, laterally and posteriorly. I don’t think there is any data yet, and certainly no radiographic data and pre- and post- studies, looking at what happens to the torn labrum if one gets regenerative injections.
Here is a Wall Street Journal acticle (again it is 5 years old):  A Pinch of Sugar for Pain concerning prolotherapy. Here Dr Borg-Stein is again quoted on the effectiveness of prolotherapy (I believe I am one of those carefully selected patients as I don't think she would waste my time otherwise). I do have back pain, but that is related to the si joint and the second doctor talks about how this responds well to prolotherapy.

The strongest evidence in the scientific literature is for chronic tendon problems such as tennis elbow, says Joanne Borg-Stein, medical director of the Spaulding Wellesley Rehabilitation Center in Wellesley Mass. Some studies suggest it can work for thumb and finger arthritis, she adds. The evidence for back pain is conflicting, but Dr. Borg-Stein says she finds it effective in carefully selected patients. 
One type of back pain, caused by looseness of the ligaments around the sacroiliac joint—near the hip—responds very well to prolotherapy, says Michael Osborne, assistant professor of physical medicine and rehabilitation at the Mayo Clinic in Jacksonville, Fla.
Here is a video of prolotherapy performed on the low back by Dr. Hauser. It is not for the squeamish or for those who dislike needles and but cracks:


Unknown said...

Did it help?

Jim Hansen said...

For me it worked really well. I only needed two appointments and she didn't think I needed any more injections! It helped my unstable sijoint for almost a year now. It was good to get rid of that discomfort! It didn't fix me for running as there are other issues.