Original article courtesy of Dr.Forest Fobbs at SageMed
A new study in the medical journal, Pain Medicine questions the conventional thought that the discs are the most significant cause of back pain. The researchers state that studies from 20 years ago indicated “between 26% and 42% of chronic low back pain is attributed to internal disc disruption of lumbar intervertebral discs. With few studies since, their concordance with rates in community practice has rarely been addressed.” The researchers questioned these statistics and conducted new tests, revealing the prevalence of discogenic pain was not as prevalent as previously reported. They discovered discs are responsible for pain 21% of the time.(1)
So what is causing back pain 79% of the time?
The majority of patients and physicians believe that their pain has been identified for them when their MRI displays degenerative disc disease or herniated discs. However, 79% of the time, disc degeneration is not the cause of their pain––it is the spinal ligaments–– a “sprain” is generating the pain.
This is difficult for people to understand because they see their MRI with an apparent “obvious” abnormality and – because of it – they carry with them a recommendation for surgery. Once that person has a physical examination and they understand their back pain is based on ligament instability a treatment plan with realistic expectations can be discussed including the use of Platelet Rich Plasma (PRP) and traditional prolotherapy.
Research at the Mayo Clinic recommend that before conventional treatments are initiated for back pain, a thorough examination of the spinal ligaments are needed. Physicians at the Mayo Clinic suggest determining the kinematics (spinal movement), for distinguishing between pathological conditions of spine disorders,which ultimately lead to low back pain. Is it the discs? Is it the ligaments?
The doctors were able to recommend guidelines in monitoring patient movement and especially side to side bending as indications of when discs were the problems and when the spinal ligaments were the problem allowing for more precise treatment strategies. (2)
Is medical research suddenly discovering that the spinal ligaments are important, actually crucial in determining back pain problems?
Listen to the opening of this research review: “As important as the vertebral ligaments are in maintaining the integrity of the spinal column and protecting the contents of the spinal canal, a single detailed review of their anatomy and function is missing in the literature.” (3)
There is a new cluster of research isolating the understanding of spinal ligaments as needed in the healing of degenerative disc disease. In one remarkable new study, doctors suggests that the ligaments may be the key to degenerative disc disease and low back pain.
The researchers suggest that it is hard for doctors and MRIs to figure out the pain sources in low back pain, and that even when people have it, there are no symptoms for it, yet eventually it will develop into worsening low back pain and disc problems.
But, these researchers also say that there are “patterns” of disc degeneration that may provide insight into where the pain is coming from and that by addressing these patterns – further disc degeneration can be managed. What do doctors need to address? SPINAL LIGAMENTS!
What causes ligament instability and disc degeneration?
Repetitive trauma or sudden trauma like whiplash can cause injury to ligaments around the spine. Ligament injuries cause excessive joint mobility, also known as vertebral instability or subluxations. Basically, the bones are moving too much. This excessive motion causes force against the discs in between each vertebral segment. The body then attempts to stabilize the spine by growing excess bone (osteophyte formation), tissue or locking/stiffness. It is the overgrowth of bone and spinal narrowing (spinal stenosis) that causes painful pinched nerves
PRP Prolotherapy for treating spinal instability instead of surgery
Traditional treatments for disc problems include disc surgery or neck surgery that usually involved fusing the ligaments in place. Prolotherapy doctors believe fusion is not the best treatment because it prevents motion of segment and leads to excessive movement and degeneration of the vertebrae above and below the fusion. In their opinion, a better approach is to strengthen the lumbar vertebral ligaments with Prolotherapy and prevent the progressive degeneration of the intervetebral discs that occurs with age.Prolotherapy strengthens the injured ligament causing the spine to stabilize and takes pressure off the disc. When excessive motion stops and instability resolved, back pain and neck pain goes away. A stabilized joint stops disc degeneration.
Research has shown PRP to be effective in treating degenerative disc disease by addressing the problems of spinal ligament instability and by stimulating the regeneration of the discs indirectly (discs were not directly injected but showed increase in disc height) (4) The same research cites that as in any medicine, the sooner you catch the degeneration, the better the results in patients satisfaction with the treatment. PRP is no exception. “The administration of PRP has a protective effect on damaged discs in the acute and delayed injection settings representing clinical treatment with PRP in the early versus late stages of the degenerative process. It appears that earlier intervention in the disease process would be more beneficial than PRP treatment of already severely degenerated discs.” (4)
PRP has been proposed for the repair and regeneration of degenerated discs and results of research presented by international scientists in Milan in August 2015 showed that PRP is able to recover the mechanical properties of denatured discs, thereby providing a promising effective therapeutic modality. (5) As we have seen, PRP indirectly effects disc height and promotes spinal stability.
Will Prolotherapy really help my Spinal Disc Problems?
Patients are often surprised to learn that Prolotherapy can heal most disc problems in neck and back. While doctors talk about Prolotherapy healing joint pain that results from ligament and tendon injuries, most people are unaware that disc problems results from ligament injuries or instability along the spine. So people with degenerative disc disease,herniated discs, bulging discs, bone on bone, etc can all be healed with Prolotherapy. Prolotherapy works to stabilize the ligaments of the spine allowing discs to get back into position and can even create space to a person who has lost space due to one or more degenerated disc.
So when a patient asks if Prolotherapy can help degenerative disc disease, bone-on-bone ligaments or create space in discs, the answer is Yes! Prolotherapy cuts straight to the instability of the spine that plays a big role in the degenerative cascade that can occur along the spine. Typically neck and back pain patients are seen once a month for three to six months.
(1). Verrills P, Nowesenitz G, Barnard A. Prevalence and Characteristics of Discogenic Pain in Tertiary Practice: 223 Consecutive Cases Utilizing Lumbar Discography. Pain Med. 2015 Aug;16(8):1490-9. doi: 10.1111/pme.12809. Epub 2015 Jul 27.
(2). Ellingson AM, Shaw MN, Giambini H, An KN. Comparative role of disc degeneration and ligament failure on functional mechanics of the lumbar spine. Comput Methods Biomech Biomed Engin. 2015 Sep 24:1-10. [Epub ahead of print]
(3) Butt AM, Gill C, Demerdash A, Watanabe K, Loukas M, Rozzelle CJ, Tubbs RS. A comprehensive review of the sub-axial ligaments of the vertebral column: part I anatomy and function. Childs Nerv Syst. 2015 May 1. [Epub ahead of print]
(4) Gullung GB1, Woodall JW, Tucci MA, James J, Black DA, McGuire RA. Platelet-rich plasma effects on degenerative disc disease: analysis of histology and imaging in an animal model. Evid Based Spine Care J. 2011 Nov;2(4):13-8. doi: 10.1055/s-0031-1274752.
(5) Khalaf K, Nikkhoo M, Ya-Wen Kuo, Yu-Chun Hsu, Parnianpour M, Campbell-Kyureghyan N, Haghpanahi M, Jaw-Lin Wang. Recovering the mechanical properties of denatured intervertebral discs through Platelet-Rich Plasma therapy. Conf Proc IEEE Eng Med Biol Soc. 2015 Aug;2015:933-6. doi: 10.1109/EMBC.2015.7318516.