Archive for November, 2014

Hip labral tears

Written by Regenerative Health on . Posted in Treatment Discussions

The labrum is a smooth ring of fibrocartilage which lines the hip socket, deepening it and acting as a seal for the head of the femur. The function of the labrum is shock absorption, pressure distribution, joint lubrication and hip stability. A tear in the hip labrum commonly occurs in sports such as soccer, ice hockey, golf and ballet. Pain in the hip or groin, weakness, stiffness and clicking or catching may be felt when the labrum is damaged.

Causes of labral tears

Hip labral tears can be caused by:

  • Trauma – injury or dislocation of the hip joint. For example, during motor vehicle accidents or contact sports
  • Congenital abnormalities – structural changes of the hip joint from birth may accelerate wear and tear of the labrum
  • Overuse injuries – repetitive twisting or pivoting on the hip joint during physical activity or sports, such as golf

 

Complications

When there is significant damage to the hip labrum, the stabilising function is compromised which may lead to hypermobility of the joint, predisposing it to degeneration and osteoarthritis in the future.

Treatment

Traditional approaches to treatment are often unsuccessful because the labrum has a poor blood supply. Pain medication, rest and physiotherapy does little to repair the labrum and therefore, patients are often referred for surgery. However, surgery does not always guarantee successful return to function, especially when the labrum is debrided. During a debridement, part of the labrum is removed, compromising its function. This means that the stresses and strains within the joint will increase, and its stability will decrease.

Dr Ross Hauser points out that research of patients 45 years or older, who had arthoscopic labral surgery have a relatively high re-operation rate and minimal overall improvement with small clinical benefit.

Comprehensive Prolotherapy is an excellent alternative to surgery for hip labral tears. Prolotherapy is an injection technique which causes an inflammatory process to start at the injection site. This causes cell proliferation and remodeling of damaged tissues, leading to healing. It is through this mechanism that the stability of the joint is restored and chronic pain is alleviated. It also prevents the development of future degeneration and osteoarthritis of the joint.

Iliolumbar syndrome

Written by Regenerative Health on . Posted in Treatment Discussions

The iliolumbar ligament joins the fourth and fifth lumbar vertebrae and the iliac crest at the back of the pelvis. It is an important pelvic stabiliserIliolumbar syndrome, or iliac crest pain syndrome, involves inflammation or a tear in the iliolumbar ligament. This injury is commonly caused by repeated bending and twisting, often involved in sports such as volleyball, tennis and golf.

Signs and symptoms

Symptoms can include persistent attacks of severe pain in the back, usually an acute stabbing sensation. This is exacerbated by physical activity involving twisting and bending of the spine. Sustained sitting or standing can also aggravate the pain, and the area may be tender to the touch. In some cases, pain may be referred to the groin, pelvis, hip, back and even testicular, vaginal and rectal regions.

If untreated, iliolumbar syndrome can lead to more serious conditions involving the lower lumbar spine, such as degeneration, herniated discs or nerve root compression.

Conventional Treatment

Iliolumbar sydrome is typically treated with rest, ice and anti-inflammatory medication. However, not only do these modalities inhibit the healing process, but they also do not repair the injured ligament, and therefore do not alleviate the chronic pain associated with iliolumbar syndrome.

When conservative management fails, surgery may also be recommended, but this scarcely alleviates the pain and often even makes the problem worse!

Our Treatment

Prolotherapy is a much more sensible approach to treating Iliolumbar syndrome since it eliminates the source of the problem – ligament weakness. Prolotherapy strengthens the iliolumbar ligament by inducing a mild inflammatory response, leading to healing and regeneration. According to an article in the Journal of Prolotherapy by Auburn et al (2009), Prolotherapy treatment has been proven to increase the cross-sectional area in both the medial and lateral portions of the iliolumbar ligament. This enhances the stabilising function of the ligament and gives the lumbar spine and pelvis increased support, leading to a decrease in pain. 

Clamping down on spinal stenosis

Written by Regenerative Health on . Posted in Treatment Discussions

Spinal stenosis refers to the narrowing of the space in which the spinal cord and spinal nerves travel. It most commonly occurs in the neck and the lower back. This narrowing may compress the spinal cord and nerve roots, leading to the possibility of symptoms such as pain, numbness, weakness, and loss of bladder and bowel control. Spinal stenosis is usually caused by degeneration.

Signs and symptoms

Degeneration of the lumbar or cervical vertebrae is the most common cause of spinal stenosis. The degenerative changes associated with ageing can lead to collapse of the vertebral disc space, hypertrophy of the facet joints, weakness of the ligaments, muscles and tendons, and the formation of osteophytes. As these structures begin to encroach on the vertebral spaces, the nerves may become irritated and inflamed. This may lead to symptoms such as pain, weakness, numbness and loss of bladder and bowel control. 

Spinal surgery and its prognosis

Spinal stenosis surgery is often recommended in cases where there are severe symptoms of pain, weakness or numbness. The most common procedure is called a decompressive laminectomy. A spinal fusion is sometimes also performed in order to stabilise the spine.

Studies show that although surgery decompresses the neural structures, often pain persists following the surgical procedure. This is indicative of the fact that the cause of the pain may be attributed to ligament laxity and vertebral instability, which is sometimes seen in the areas above and below the affected segments, or in the sacroiliac joint.  

Therefore, the main reason for failed spinal stenosis surgery is that it does not address the cause of pain.

The needle is mightier than the scalpel (Dr Ross Hauser)

Prolotherapy has been found to be superior to surgery in the treatment of spinal stenosis pain and the response to Prolotherapy is said to be excellent. This is because it focuses on treating the cause of pain! Prolotherapy is able to strengthen the spinal ligaments and prevent vertebral instability, thereby relieving the chronic pain associated with spinal stenosis. Prolotherapy is an injection therapy which initiates an inflammatory response, causing a reparative cascade. It helps to generate new collagen and extracellular matrix, enabling the connective tissue to withstand force and loading. Prolotherapy is often administered to the affected area, as well as the area above and below, and the sacroiliac joint. At least six comprehensive Prolotherapy sessions are usually required in order to be effective.