Bob's ACL WWWBoard On-Line Knee Library |
------
Document Title: Yelland-S-Jan04.shtml
Article Title: Prolotherapy Injections, Saline Injections, and Exercises for Chronic Low-Back Pain: A Randomized Trial
Authors: Yelland, Michael J. FRACGP, FAFMM; Glasziou, Paul P. PhD, FRACGP; Bogduk, Nikolai MD, DSc; Schluter, Philip J. BSc(Hons), PhD; McKernon, Mary RN, Grad Dip Nurs Admin
Publication: Spine, Lippincott Williams and Wilkins Incorporated
Date: January 2004
Volume 29(1), 1 January 2004, pp 9-16
Keywords: Prolotherapy, Sclerotherapy, chronic pain, low back pain, spine, osteoarthritis, saline solution, comparison, randomized clinical trial, randomized controlled trial, injections, exercise.
(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form. This article contains no tables nor figures.)
Comments: Yelland et al. found that prolotherapy is no better at relieving low-back pain than simply injecting a saline (salt-water) solution; both bring a relief in pain but nothing substantive in terms of actual injury healing. Please note that with regards to treating knee-ligament injuries, prolotherapy brings a lot of very serious concerns, given the enormous biomechanical stresses that the knee is subjected too. The knee is the most vulnerable-to-injury joint in the entire body, primarily because it bears weight (i.e. dynamic loadings, not just the static weight of the body) and because it is situated at the interface of the body's two longest lever arms (tibia and femur, each of which is several times as long as any household wrench). It is both inappropriate and extremely risky to expect any injected substance to engender any type of useful knee-ligament healing, particularly in the context of the cruciate ligaments (ACL and PCL). By delaying pursuit of meaningful knee-injury treatments such as tendon-graft ACL reconstruction, prolotherapy introduces the danger of returning to knee-demanding activities with an inherently unstable knee (and therefore having the knee give way catastrophically and incur additional, permanent, and cumulative damage to articular cartilage and menisci...thereby heightening the already worrisome spectre of premature osteoarthritic degeneration). The best that can be expected with prolotherapy injections into knees is simply scarring throughout the joint space (and this in itself can be very troubling).
Abstract
Objectives. To assess the efficacy of a prolotherapy injection and exercise protocol in the treatment of chronic nonspecific low back pain.
Design. Randomized controlled trial with two-by-two factorial design, triple-blinded for injection status, and single-blinded for exercise status.
Setting. General practice.
Participants. One hundred ten participants with nonspecific low-back pain of average 14 years duration were randomized to have repeated prolotherapy (20% glucose/0.2% lignocaine) or normal saline injections into tender lumbo-pelvic ligaments and randomized to perform either flexion/extension exercises or normal activity over 6 months.
Main outcome measures: Pain intensity (VAS) and disability scores (Roland-Morris) at 2.5, 4, 6, 12, and 24 months.
Results. Follow-up was achieved in 96% at 12 months and 80% at 2 years. Ligament injections, with exercises and with normal activity, resulted in significant and sustained reductions in pain and disability throughout the trial, but no attributable effect was found for prolotherapy injections over saline injections or for exercises over normal activity. At 12 months, the proportions achieving more than 50% reduction in pain from baseline by injection group were glucose-lignocaine: 0.46 versus saline: 0.36. By activity group these proportions were exercise: 0.41 versus normal activity: 0.39. Corresponding proportions for >50% reduction in disability were glucose-lignocaine: 0.42 versus saline 0.36 and exercise: 0.36 versus normal activity: 0.38. There were no between group differences in any of the above measures.
Conclusions. In chronic nonspecific low-back pain, significant and sustained reductions in pain and disability occur with ligament injections, irrespective of the solution injected or the concurrent use of exercises.
To access the full text of this article, please click here.
There is no charge for viewing articles. However, a password is required.
If you do not already have a password, please e-mail Michael Frind at frind@execulink.com for one.
Prior to requesting a password, please make certain you have read the
Site Terms of Use
pertaining to this site.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Copyright Spine, Lippincott Williams and Wilkins Incorporated, January 2004. For details regarding copyright as it applies to this page, please visit the page entitled Site Terms of Use and Aspects of Copyright on this site.
This website was created for the benefit of the world's largest knee-injury community, Bob's ACL WWWBoard (also known as the Kneeboard), accessible to everyone at http://factotem.org.
Documents posted on this site serve merely as a virtual library, and are intended solely for purposes of making access to high-quality peer-reviewed medical-journal articles convenient for all users of the Kneeboard. Knee-injury patients are hereby encouraged to discuss this material with their respective medical teams.
Click here to return to the Main Entrance Page of the Knee Library.
Looking for the Main Index Page of Bob's ACL WWWBoard? Click here!
To find recent postings on Bob's ACL WWWBoard, use the Search Engine.
To find older postings on Bob's ACL WWWBoard, use the On-Line Archive.
Site Terms of Use and Aspects of Copyright