Prolotherapy: An Alternative Therapy for Lower Back Pain in Athletes

Recently in our practice, we have been seeing a lot of athletes including Olympians and Olympic-hopefuls with low back pain. They come from a variety of sports including pole vaulting, skiing, running, volleyball, baseball, wrestling, and many others.

Poor running form is the number one reason these athletes get low back pain. Good form means the abdominal muscles are engaged, the pelvis is level and the torso is tall. Proper running form also involves landing on the midfoot to the balls of the feet and not on the heels.

Fast runners have a slight forward body lean while keeping the ankle/knee and shoulder joint in alignment. Poorer runners have a bend at the knee and land on the heel. For the elite athlete it is generally because of the great forces they place on their pelvis during training. It doesn’t mean they did something wrong, only that they are maximizing their training. And sometimes you maximize it too much and an injury occurs.

When an athlete injures the lower back it is almost always a sacroiliac injury. Typically the athlete will say one side hurts more than another, so that is the primary sacroiliac joint that is injured. This is why it is the most common joint manipulated by chiropractors. Since the injury is to the sacroiliac ligaments, Prolotherapy is the option that makes the most sense, in my opinion, since it has the potential to stimulate the ligaments to repair and strengthen.

Manipulating the sacroiliac joint will move the joint and does carry the risk of sacroiliac ligament injury if done too aggressively or too often. I call this over-manipulation syndrome. It is common for me to see athletes who have received hundreds of manipulations of their lower backs.

Realize if an athlete has an acute low back pain injury and it is not significantly better by five manipulations, another course of action should be sought. The course of action we recommend is Prolotherapy.

Prolotherapy for low back pain in the athlete typically involves Prolotherapy to the sacroiliac ligaments. This can be repeated weekly as needed. Generally just one to three visits are needed. For more chronic cases three to six visits. Athletes love Prolotherapy because they can get right back to training after the Prolotherapy typically.

For the athlete who has centralized low back pain, the vertebral attachments of lumbar vertebrae 3 down to the sacrum are treated also with Prolotherapy. Generally these are injured by a hyperflexion torque on the lumbar spine (compared to a hyperflexion and rotation injury of the pelvis that would injure the sacroiliac joint). Again for acute lumbar disc injuries typically one to three sessions of Prolotherapy are required and for chronic conditions three to six visits. The athlete can resume exercising generally two days after Prolotherapy, though we have plenty of athletes who resume activities the next day. About which sporting activities and how vigorous the training can be is discussed at the first visit.