Chiropractor Chandler AZ

PLATELET-RICH PLASMA PROLOTHERAPY FOR LOW BACK PAIN

Lower back pain is the number one cause of disability and inability to work worldwide. Lower back pain affects people of all ages. Most people experience lower back pain at least once in their lifetime. The 2010 Global Burden of Disease Study ranked lower back pain among the top 10 diseases and injuries responsible for disability worldwide. Prevalence of lower back pain varies from 49% to 70% worldwide.

In industrialized countries, the prevalence of lower back pain is 60-70%. In children and teenagers, the rate of lower back pain is low, but it is increasing with the modern lifestyle. Lower back pain leads to an inability to work, leading to economic burden on the individuals, families, industry, and the government. In the U.S, the estimated financial burden of lower back pain is $100 to $200 billion a year.

CAUSES OF LOWER BACK PAIN

Muscle strain

Lower back muscles act as a support and provide strength and mobility for daily activities. Muscle strain can be caused by overworked or weak muscles which lead to lower back pain.

Ligament sprain

The spinal vertebras are connected with the help of ligaments which provide stability to the lower back. Any stress, forceful or sudden movement can sprain and injure the lumbar ligaments.

Poor posture

Muscle fatigue, joint compression, and stress on the vertebral discs are caused by poor posture. These conditions lead to a muscular imbalance that includes muscle tightness and weakness which can lead to chronic pain.

Degenerative disc disease

Genetics and wear and tear of the spinal discs can lead to degenerative disc disease which can cause chronic pain.

Degenerative joint disease

Joint degeneration of the facet joints of the spine can cause degenerative joint disease.

Age

Normal aging leads to decreased bone density, weakness, and less ligament and muscle elasticity. These factors develop chronic lower back pain in older people.

Herniation

Also known as disc bulge, it can cause pressure on the nerve and compress it. The pain caused by the suppressed nerve radiates down the leg from the lower back.

Other causes

Lower back pain can also be caused by a bladder or kidney infection, cancer, endometriosis, and ovarian abnormalities.

SYMPTOMS OF LOWER BACK PAIN

• Sharp, localized pain in the lower back region especially after lifting a heavy weight
• Chronic pain in the lower back region after sitting or standing for a long period of time
• Pain radiating from lower back to the buttock, thighs, and calf
• Inability to stand still without pain in the lower back

DIAGNOSIS OF LOWER BACK PAIN

Blood and urine test

If the lower back pain is caused by infection, blood or urine tests will help to determine the cause of the pain.

X-ray:

If the lower back pain is caused by a bone fracture or any other anatomical abnormality, X-rays will help to locate the problem.

Imaging test

Imaging tests such as computed tomography (CT) or magnetic resonance imaging (MRI) scans may be needed to analyze the disc or soft tissue injury. Scans are helpful in case of numbness in the lower limbs, trauma to the back, and lower back pain with fever. Electromyogram (EMG) will be helpful in case of nerve damage or muscle injury.

TREATMENT FOR LOWER BACK PAIN

Rest

Avoiding strenuous activities, long periods of standing, sitting, and bending. Avoiding heavy weight lifting and twisting can be helpful in reducing lower back pain.

Ice

Applying ice to the lower back for 15 minutes every 1-2 hours is helpful in reducing pain. Heat must be avoided for the first 48 hours after an acute injury to the lower back.

Medication

To reduce lower back pain, the doctor can prescribe anti-inflammatory medication such as aspirin, Advil, Aleve, and ibuprofen or naproxen sodium.

Physiotherapy

Physiotherapy can be helpful in relieving pain. It reduces the severity and duration of the pain and can decrease the chances of recurrence of the pain.

Epidural Steroid Injections

Steroid injections are applied directly to the spine in case of extreme pain to relieve it. It does not heal the injury, but lowers the pain by reducing inflammation in the lower back.

Surgery

When the patient is unresponsive to the above mentioned treatments, surgery is the only option left. Surgery is mostly recommended in the case of sciatica and a slipped (prolapsed) disc.

PLATELET-RICH PLASMA PROLOTHERAPY

Platelet-rich plasma Prolotherapy is a next generation treatment method. It is a type of Prolotherapy that uses the platelet-rich plasma drawn from the patient's own blood. The word 'Prolotherapy' is a combination of proliferation and therapy. In this technique, the healing machinery of the body is manipulated and accelerated to heal the injury.

In platelet-rich plasma prolotherapy, the platelet-rich plasma is extracted from the patient under sterile conditions in clinical settings. This blood is then centrifuged and different components of the blood are separated into different layers. The platelet-rich plasma layer is separated and the rest of the material is discarded. The platelet-rich plasma is injected at the site of injury. When the platelet-rich plasma is injected at the site of injury, it releases alpha granules that cause the release of one's own growth factors. Growth factors are the proteins that initiate the tissue repair by cell growth and proliferation. Platelets cause the growth factors to stimulate the epithelial growth factors (EGF) which induce the cell migration and replication at the site of damage, causing the damaged tissues to heal quickly.

The platelet-rich plasma injection is followed by three stages of healing:

1. Inflammation phase that lasts for 2-3 days. In this phase, growth factors are released.
2. Proliferation phase that lasts for 2-4 weeks. It is vital for musculoskeletal regeneration.
3. Remodeling which lasts over a year. In this phase, collagen is matured and strengthened.

The platelet-rich plasma Prolotherapy specialist makes sure that these three phases are completed to ensure the complete recovery from the injury.

Safety Issues:

The main safety concerns when using an invasive method are:

1. Immunogenic reaction
2. Disease transfer
3. Hyperplasia
4. Cancer
5. Tumour growth

Platelet-rich plasma Prolotherapy uses the blood of the patient thus there are no chances of immunogenic reaction or blood-related disease transfer. No studies have documented that platelet-rich plasma Prolotherapy causes tumor growth or cancer.

The symptoms are temporality worse after the injection. The possible side effects of platelet-rich plasma Prolotherapy are:

1. Infection
2. No relief of pain
3. Neurovascular injury
4. Scar tissue formation
5. Loss of limb or death is rare, but possible

PLATELET-RICH PLASMA PROLOTHERAPY FOR LOWER BACK PAIN

Platelet-rich plasma prolotherapy is a very promising technique for lower back pain especially in the case where the discs degenerate or a muscle, tendon or ligament is injured. PRP Prolotherapy is an experimental procedure which is still under research and it is not approved by the FDA, but research is going on to evaluate the effectiveness of PRP prolotherapy in the treatment of lower back pain.

In 2007, an in vivo study was conducted to evaluate the regenerative effects of PRP for degenerated intervertebral disc (IVD). The IVD was induced in rabbits and then treated with an injection of PRP gelatin hydrogel microspheres. After 8 weeks, the degeneration rate was observed to be slower as compared to the control group and there was no side effect in the PRP treated group. The researchers recommended PRP prolotherapy as an effective treatment option for the treatment of degenerated intervertebral disc.

The effectiveness of PRP prolotherapy is evaluated by preclinical and human cell culture studies. The studies have shown increased tendon repair without scar formation after PRP injections. Another study showed a 60% improvement in the patients treated with platelet-rich plasma Prolotherapy for a damaged tendon. The effectiveness of the PRP is also evaluated for muscle damage repair. Although limited studies are available that show the effectiveness of this technique in muscle damage repair, experiments done in the lab on human cells have shown the effectiveness of this technique for muscle repair and cell growth.

The role of platelet-rich plasma Prolotherapy in acute ligament damage has not been studied in humans, but there are studies on animals which suggest that platelet-rich plasma Prolotherapy is effective in treating ligament damage. Platelet-rich plasma injections are safe to use for cartilage damage and they have shown that platelet-rich plasma injections have improved the pain in the patients within 6-12 months. This technique has shown positive results in healing bone fractures.

Platelet-rich plasma prolotherapy is an experimental procedure, but the research has so far shown that it is an effective method with minimal side effects. It is cost effective as compared to some conventional treatment methods for chronic lower back pain, but more research is still required to establish the effectiveness of PRP prolotherapy and to develop optimal PRP prolotherapy procedures to treat lower back pain.

Conservative Treatments to Combine with PRP

Therapeutic treatments for addressing soft tissue injuries involve massage therapy, manual therapy, trigger point therapy, Graston Technique, or Active Release Technique. These treatments increase blood flow, decrease muscle spasms, enhance flexibility, speed healing, and promote proper tissue repair.

When these treatments are incorporated into a treatment plan, patients heal faster and are less likely to have long-term pain, soft tissue fibrosis, or scar tissue in the injured muscle. These soft tissue treatments are incorporated with therapeutic exercise and flexibility programs.

Chiropractic adjustments increase the movement of a joint complex. With injury, poor posture, sprains, and strains, muscles tighten up and the joints can become locked. This lack of movement is felt when you can not look over your shoulder without feeling pulling, dull pain, or a twinge of pain. Mildly stuck joints can be loosened up in the day with stretching and range of motion exercises. Moderately stuck joints often need a little help to restore their normal motion with chiropractic adjustments. Severely stuck joints cause a person pain whenever they put pressure upon the joint or try and move the joint complex.

There are multiple ways to get a joint moving again. The most important part is that the joint is moving in its proper range of motion and without pain. Many people think chiropractors only perform manual manipulation. Most likely their first experience with a chiropractic was years ago, and manual manipulation was the most common form of treatment. Over time and with technology, treatments have changed with the same goal of getting neck joints moving. Learn more about Chiropractic adjustments.

The arms and legs work with the lumbar spine as a comprehensive unit performing many of the repetitive tasks at home, work, and recreational sports. Injuries to one area of the musculature often indicate that additional damage has been incurred by other muscles. Combine this with possible dysfunction in the scapula, arms, and legs, and many muscles could be operating at less than optimal levels.

Many physical therapeutic exercises can help restore proper strength and endurance to the back and core muscles. Isometric and range of motion exercises are often the initial treatment exercises. Followed by single plane exercises for hip, knee, shoulder, neck, and back, flexion, extension, adduction, abduction, circumduction, inversion, and eversion. Dynamic exercises involving stability foam, rubber discs, exercise balls, and BOSU balls can be performed on the floor. The more unstable the surface, the more effort and stabilization is required of all the back, hip, knee, and ankle joint muscles. More on enhancing proprioception and leg strength exercises.

Vibration plates enhance neuromuscular learning throughout the ankle, knee, foot, hip, and back muscles. Additional strength exercises can be found on the hip, knee, and foot strengthening pages. More information for injuries, treatments, and exercises for back pain.

Cold Laser Therapy Treatments

1. ACCELERATED TISSUE REPAIR AND CELL GROWTH

Photons of light from lasers penetrate into tissue and accelerate cellular growth and reproduction. Laser therapy increases the energy available to the cell so it can work faster, better, and quickly get rid of waste products. When cells of tendons, ligaments, and muscles are exposed to laser light they repair and heal faster.


2. FASTER WOUND HEALING

Laser light increases collagen production by stimulating fibroblasts. Collagen is the building block of tissue repair and healing. Laser therapy increases fibroblast activity and therefore collagen production to speed healing.

3. REDUCED FIBROUS TISSUE FORMATION

Low-level laser therapy decreases scar tissue formation. Scar tissue can be a source of chronic pain and poor healing. By eliminating excessive scar tissue and encouraging proper collagen production, painful scars and chronic pain is reduced.

4. ANTI-INFLAMMATION

Laser therapy causes vasodilatation (increases size of capillaries) which increases blood flow. The treatments also increases lymphatic drainage to decrease swelling or edema. Therefore, laser therapy reduces swelling caused by bruising or inflammation while speeding the recovery process.

5. PAIN RELIEF

Cold laser therapy decreases pain by blocking pain signals to the brain. Some nerve cells sense pain and send signals to the brain. Chronic pain can be caused by overly active pain nerves. Specific wavelengths help "shut off" the pain signals, thereby eliminating your pain.

Low level lasers are excellent at decreasing inflammation, which also increases pain nerve activity. Cold laser therapy also increases endorphins and enkephalins, which block pain signals and decreases pain sensations. Overall, laser therapy reduces painful nerve signals and reduces your perceived pain.

6. INCREASED BLOOD FLOW

Blood carries nutrients and building blocks to the tissue while carrying waste products away. Increased blood flow to tissues increases and enhances cellular healing. Cold laser therapy increases the formation of capillaries in damaged tissues. Specific laser frequency also increases blood flow to the area treated to enhance injury repair.

7. INCREASED REPAIR AND REGENERATION

Low level lasers increase enzyme activity to improve metabolic activity which affects cell repair and regeneration. The enzymes are turned on "high" to speed the healing.

8. NERVE FUNCTION AND REPAIR

Nerves heal very slowly. Lasers speed up this process. Damage to nerves causes numbness, pain, muscle weakness, and altered sensations. Laser therapy treatments enhance nerve function, healing, and reduce pain.

9. INCREASED ENERGY PRODUCTION - ATP

ATP is like gasoline for cells, it is the energy source that cells operate. Injured cells often have low levels of ATP, which decreases their ability to heal and repair. By increasing ATP and "gasoline storage levels," cells have more ATP for healing and repair. Increased mitochondrial production is very important with nerve pain.

10. ACUPRESSURE AND TRIGGER POINTS

Low-level laser therapy decreases trigger points and stimulates acupuncture points to decrease muscle and joint pain.

We combine low-level laser therapy with a variety of techniques and treatments. Cold laser therapy can be used alone as a single treatment modality or in conjunction with other chiropractic, physical therapy, massage therapy, or medical treatments.

BIBLIOGRAPHY:

Nagae, M., Ikeda, T., Mikami, Y., Hase, H., Ozawa, H., Matsuda, K.-I., et al. (2007). Intervertebral Disc Regeneration Using Platelet-Rich Plasma and Biodegradable Gelatin Hydrogel Microspheres. Tissue Engineering, 147-158.

Ko, G. D. (2010). Platelet-Rich Plasma Prolotherapy for Low Back Pain Caused by Sacroiliac Joint Laxity. Practical PAIN MANAGEMENT, 55-67.

Koes, B. W., Tulder, M. V., & Thomas, S. (2006 ). Diagnosis and treatment of low back pain. British Medical Journal, 1430–1434.