Prolotherapy, short for proliferation therapy is a controversial technique that involves a series of injections of an inactive irritant substance into a painful joint, or area where ligaments or tendons insert into bone. The injected substance can be dextrose, phenol, saline solution, glycerol, lidocaine, or even cod liver oil extract. Prolotherapy injections are intended to artificially initiate the natural healing process by causing an influx of fibroblasts that synthesize collagen at the injection site, leading to the formation of new ligament and tendon tissue.
Some of the signs that might benefit from prolotherapy include:
Joint laxity, such as in the shoulder, that does not resolve with standard treatment
Distinct tender points at tendons or ligaments as they attach to the bones
Unresolved, intermittent swelling or fullness involving a joint or muscle
Popping, clicking, grinding, or catching sensations in joints
Temporary benefit from chiropractic manipulation or manual mobilization
Aching or burning pain that is referred into an upper or lower extremity
Recurrent headache, face pain, jaw pain, ear pain
Chest wall pain with tenderness along the rib attachments on the spine or along the sternum
Spine pain that does not respond to surgery, or where there is no definitive diagnosis despite X-rays, MRIs and other tests.
So why is prolotherapy considered “controversial?” Because, according to the federal government (Health Care Financing Administration) there is currently no strong, compelling study that proves prolotherapy can cure cases of soft tissue pain. A “strong” study is one that has at least several hundred test subjects; has a control group (who get a placebo, or fake treatment) and is done in a “double-blind” methodology where the test subject and the administering doctor do not know if the injection is a prolotherapy agent (only a third member of the research study knows). However, there are numerous studies in the literature using smaller test populations (less than a hundred) that support prolotherapy as an effective treatment for pain.
Two RCTs (randomized controlled trials) on osteoarthritis reported decreased pain, increased range of motion, and increased patellofemoral cartilage thickness after prolotherapy
Two RCTs on low back pain reported significant improvements in pain and disability compared with control subjects, whereas 2 did not. All studies had significant methodological limitations.
So, if you have chronic musculoskeletal / joint pain, especially related to trauma, that has not resolved with cortisone injections, chiropractic, physical therapy, personal training, surgery, and time, prolotherapy may be worth investigating. The good thing about it is that it is generally safe.
Inversion therapy tables are see-saw like contraptions designed to use gravity to decompress the spine. They have been around for more than twenty years already, so today’s models offer more in terms of comfort and ease of use. But the principle is the same: use a platform balanced on a horizontal rod, with a mechanism to offer some controlled resistance. You lie face up on the platform (more expensive models allow you to be face down), lock your feet into the foot carriage either by hooking your insteps onto rollers, or wearing gravity boots strapped to the carriage; and raise your arms in varying angles to control the amount of tilt. Arms extended straight above your head result in the maximum angle, usually around 45 degrees. The weight of your torso pulls gently on your spine, and you get some degree of stretch to your back.
So is inversion therapy good for your back? Can it relieve lower back pain? The answer is “yes” for some cases of low back pain. I wrote about how low back pain can come from bulging discs, an acute or chronic low back strain, and even abnormal communication between the brain and the postural muscles. Low back stiffness is usually caused by inactivity, carrying too much abdominal weight, which places too much pressure on the small facet joints in the back of the spine; and basically “turned off” muscles; i.e. poorly conditioned, inactive erector spinae and multifidi muscles that surround the spine. This is common in people who sit more than four hours a day on a regular basis and don’t exercise.
Inversion table therapy should be helpful for some cases of disc bulges and back stiffness. Do not do it for an acute lumbar strain. And if your problem is due to miscommunication between the brain and postural muscles, inversion therapy may offer some relief, but the symptoms will quickly return, as this type of back problem originates in the motor neurons of the brain, not the back muscles.
Before you go out and buy one, realize that you must be able to physically handle being inverted. Although you shouldn’t stay inverted for more than 30 seconds or so, for some people, just a few seconds of being inverted (upside down) can be unpleasant, and dangerous. If you have the following conditions, you should not use inversion therapy for back pain:
metal plates, hardware in spine or lower extremities
history of migraine headaches
eye diseases (especially glaucoma)
history of vertigo, tinnitus, Meniere’s disease
recent surgery to ankles, knees, hips, spine
cardiovascular disease; heart problems
risk factors for stroke
aortic aneuyism
osteoporosis
Basically, aside from back pain, you need to be in fairly good physical shape to do inversion therapy; otherwise the risks exceed the benefit. Ask your doctor if it is OK for you to do it.
Now, for those who meet the physical criteria. As in anything new, start slowly. Get used to your machine– how it feels, how responsive it is to your movements. Know how long you can be inverted before you start feeling dizzy. The proper way to do it is to start with small angles first, maintaining the position for a minute or so. Attempt steeper angles, but in small increments. You will find that the steeper you go, the less time you are able to hold the position, due to blood pressure increasing in the head from the effects of gravity. Take your time. Do not attempt a 45 degree incline your first day. You don’t even have to go that far, ever, as long as you can get a good stretch to your low back.
As you get comfortable with your inversion therapy table, you can do some gentle and slow spinal twists as you are inverted. Just rock your upper torso and shoulders from side to side. You may hear some pops as some vertebral facet joints decompress. The popping sound is just air pockets shifting in the joint capsules as the space increases from the stretching.
Lastly, adhere to this tip, which most people forget when doing inversion therapy: concentrate on relaxing your spinal muscles. In fact, before you start your inversion therapy session, close your eyes and take three, deep breaths through your nose, and slowly exhale through your mouth. Focus on your diaphragm expanding, drawing in the air, then relaxing it as you exhale. If you are tensed up, your back muscles will NOT allow the table to decompress your spinal joints. Back muscles are strong and can easily prevent the spine from elongating if they are under contraction. Remember, the goal of inversion therapy is to target the spinal discs and facet joints, not the back muscles themselves. The spine is where most of the symptoms of back pain and stiffness originate.
There are many brands of inversion tables, and varying degrees of quality. The basic ones are rated to about 250 pounds max (person’s weight). The Teeter Power VI Inversion Table with Gravity Lock Ratchet table is a higher-end table that doesn’t require you to raise your arms in order to tilt the table. A motorized inversion table may offer better traction to the lumbar spine, as the act of raising the arms contracts the back muscles which is definitely undesired when attempting to stretch the spine. And if money is not an issue, you may consider the Teeter DFM – Decompression and Functional Movement Table, a commercial-grade table designed with input from doctors and therapists. This table can be used in the prone (face down) OR supine (face up) position, and offers progressive decompression therapy.
My advice is if you are a chronic back pain sufferer, go with a higher end machine because you will be using it a lot. That way, you can rest assured that you’ll be getting a sturdier machine with better construction that will last longer. The cheaper models still can do a decent job, but they are made of weaker material and tend to be more “rickety” as they are held together by bolts and thinner metal tubing.
The short answer to the first question is “yes” if the bulge is not severe and the body still has in place the mechanisms to keep the disc living and healthy (see below).
The other answer to the first question is “no” if the disc bulge is the result of breakdown of the nutrient-delivery mechanism to the disc. If this is the case, it is a matter of time before the disc totally degenerates. Physical therapy, chiropractic, spinal decompression and exercises can slow it down, but one cannot do these things indefinitely and often enough to stop the progression.
It’s important to know that your spinal discs are mostly avascular; meaning, don’t have a direct blood supply. Discs get their nutrients (water, oxygen, glucose, minerals, vitamins) via slow absorption from the capillaries directly underneath the vertebral end plates. At the end of the day, your discs flatten from the effects of gravity. As you sleep, they soak up fluids and expand, so that by the time you wake up in the morning you are at least 5 mm taller than when you first went to bed. This is called the diurnal cycle of fluid movement in and out of the disc and is the major means of nutrient delivery.
At the center of the disc is the nucleus, which has tiny cells that make the proteoglycan molecules responsible for attracting and holding onto water. This maintains a hydrostatic pressure that allows the disc to bear about 80% of the weight applied to its spinal level. These cells, similar to chondrocytes that make collagen in the joints, are the most active when the pressure in the disc is about 3 atmospheres. If the pressure is higher (obese individuals, those who carry heavy weight frequently at work) or lower, the cells make less of these molecules, putting the disc at greater risk of drying out. Injuries to the internal part of the disc or vertebral bodies can increase the volume of the nucleus, drastically reducing its hydrostatic pressure and slowing down proteoglycan synthesis. This is one of the pathways of degenerative disc disease, or DDD as the posterior (facet) joints, which are not designed for bearing much weight take on the responsibility of the disc and quickly wear down, forming the familiar osteophytes (bone spurs) seen on X-ray and MRI studies.
Here are the basic risk factors for developing DDD/ bulging discs:
1) History of Structural Damage to the Disc or Vertebra
Single event trauma to the spine resulting in damage to the vertebral end plates . An example would be a parachuter landing hard on the ground on his feet. This can cause a small injury, or even a significant compression fracture to the bony end plates– the surfaces to which the disc attaches. This is bad news, because nutrients to the disc (blood, oxygen, glucose) traverse through these end plates from the top and bottom of the disc. If it is damaged, the area calcifies and “shuts the gate,” depriving the disc of critical nutrients needed to stay healthy. This sets the stage for a slow procession of degeneration over the years which will have phases of back pain, stiffness, disc bulging, stenosis, and in severe cases leg pain, leg weakness and altered sensation.
Repetitive, axial loads to the spine. An axial force is one that travels straight down the spine, while standing. If you are in a job that requires frequent heavy lifting, especially above the shoulders; or requires you to carry 50 or more pounds of gear most of the day, you are placing axial loads on your spine. Similar to #1, it can slowly damage the vertebral end plates and damage the nutrient delivery system to the disc.
2) Hereditary Factors – there are respected studies that strongly suggest a genetic component to DDD. One study showed that there is a 50% greater chance of developing severe disc degeneration in the relatives of past disc surgery patients. Another study found mutations in the genes responsible for the synthesis of proteoglycan molecules, which are responsible for water retention in the disc. If the disc cannot attract and hold onto water, it cannot maintain its hydrostatic pressure. As a result, it loses its ability to distribute weight and slowly dessicates (dries out).
3) Occupation. This is pretty obvious. Those who work with heavy machinery or require heavy lifting are more prone to developing bulging discs.
4) Smoking. Smoking damages the fine blood vessels that the disc depends on to deliver nutrients. It also generates a lot of free radicals, which can damage the disc further. Some surgeons require patients to be “smoke-free” for at least three months prior to surgery.
So, here are the lessons to take here. First, if you have a parent who suffers from bulging discs and degeneration, realize that you have a 50% greater chance of developing them on your own. You may have a mutant gene that is making defective collagen in your disc, making it a ticking time bomb ready to go off in the near future. Your best bet is to minimize the expression of this gene, and a good way to do it is to eat as healthy as you can; ditch the toxins (smoking, excessive alcohol and sugar); avoid getting overweight, and maintain positive thoughts (may affect gene expression to your benefit).
Secondly, avoid unnecessary axial forces to your spine. Stay away from things that involve hard landings on your feet, and don’t lift weights in a way that places pressure to your lower back.
When you think of a scorpion, the first thing that comes to mind is that scary, nasty poisonous tail. You really don’t want to have one of these things napping in your shoe.
But, looks like the nightmarish creature may be offering pain sufferers some hope in the future. There is ongoing research into the pain-reducing effects of scorpion venom, and it looks promising. This is a subject of great interest, as popular opiate-based pain medications like morphine and codeine have undesirable side effects; notably addiction and withdrawal symptoms.
Scorpion venom interacts with sodium channels in muscles and nerves, which are involved in the transmission of pain signals to the brain. Prof. Michael Gurevitz of Tel Aviv University’s Department of Plant Sciences is investigating new ways for developing a novel painkiller based on natural compounds found in the venom. According to Dr. Guervitz, these compounds have gone through millions of years of evolution and some show high efficacy and specificity for certain components of the body with no side effects. His research team is trying to understand how toxins in the venom interact with sodium channels at the molecular level, and whether or not they can be modified to make them specific to certain sodium channels associated with pain.
If successfully developed, this new class of drugs could be useful against serious burns and cuts, as well as in the military and in the aftermath of earthquakes and natural disasters, according to Dr. Guervitz.
I hope that the good doctor finds success with his research. Although this blog is about overcoming pain without the use of drugs (exercises, diet strategies, natural supplements, psychological techniques, lifestyle changes, manual therapy) there are those who simply need some form of quick and powerful pain blocking in order to live a normal life. If scorpion venom can help some people achieve this, it could mean a lot to those suffering from intractable pain. Bee venom apparently has some success in reducing arthritic pain; perhaps scorpion venom, being more potent, can some day be a more potent, safer pain killer alternative.
Have you been told by your doctor that you have a bulging disc in your spine? Then read on, and make sure to watch the video a few paragraphs down.
First of all, understand the following as it pertains to disc, or disk bulges:
1. Bulging discs can only be diagnosed from an MRI (magnetic resonance imaging) study, not an x-ray study. If a doctor told you that you have a bulging disc just by looking at your x-ray, find another doctor fast.
2. A certain amount of disc bulging is normal, or typical in the population. The primary function of a spinal disc is to assist the spinal column in supporting the weight of the body. Since it is viscoelastic (can change shape, due to its fluid behavior), a disc will naturally bulge outwards when standing, like pressing down on a donut. If you had your MRI in the late afternoon, gravity will have acted on your discs for many hours already (unless you were lying down the whole day, which is obviously unlikely), and will show discs with slight bulging, even when you are recumbent (most MRI machines are recumbent; i.e. the patient lies down during the study).
3. What really matters is if there is injury to the disc, and whether or not it is obstructing nerve tissue in any way.
The architecture of a disk can be imagined as a slice of an onion, but with a jelly center, encased tightly by a vertebra above and below. If an injury event causes that jelly center to punch through successive rings in a focalized (as opposed to broad) spot, but the last couple of rings remain intact, you have a disc protrusion. If the jelly punches all the way through the outer ring and is still connected to the disc, it is called a disc prolapse. If the jelly center punches through the outer ring and breaks off and settles in the spinal canal, it is called a sequestered disc.
These can be painful, as there is internal injury to the disc and the protrusion can potentially press against an exiting nerve root or spinal cord, depending where it is located. Pressure to an exiting nerve root in the lower spine most often causes same side leg pain, numbness and/or weakness. Disc prolapses and sequestered discs are usually addressed via spinal decompression surgery or discectomy (total or partial removal of disc); disc bulges are usually first handled conservatively via manual therapy and exercises.
A disc injury can also not involve bulging. An annular tear or fissure is when the rings of the disc separate circumferentially (along the perimeter), instead of split radially (outwards from center). These can be equally painful, as they are deep and difficult to heal.
If you have a disc bulge, there is still hope for recovery without surgery. It all depends on your body’s ability to heal itself. In this sense, those who have a greater chance of recovering from a bothersome disc bulge have an otherwise healthy spine: no to minimal arthritic changes, good bone density, healthy ligaments and tendons (basically, younger patients) good spinal flexibility, well-conditioned spinal musculature, and not overweight.
Here is a video of stretches/ maneuvers you can do that may help reduce the size of a disc bulge before it progresses to a surgical case. Warning, do not attempt to do these exercises if they cause a significant, sharp increase in pain. Do them slowly and pay attention to the changes in pain characteristics during the exercise. If you notice reduced pain with a certain movement, then continue.
1. Place yourself on movement restrictions for at least a few months: no heavy lifting, no jumping, no prolonged sitting, no frequent bending at the waist.
2. Eat a healthy diet consisting of plants and animals only; i.e. minimize processed food including grain foods. Flood your body with the necessary vitamins, minerals, and anti-oxidants to give it a boost as it attempts to repair your bulging disc.
3. Lose the weight, if you you are overweight. This alone will take significant pressure off of your injured disc. Eating a protein and good fat based diet along with lots of plants is a natural, healthy way to drop the pounds without having to rely on exercise too much.
4. Stretch your back frequently. Lie on your back, knees bent with feet on the floor. Take a deep breath in and gently and slowly arch your lower back as your stomach rises; exhale and flatten your back against the floor; repeat 10 times 4x/day.
Another exercise you can do is lie on your back and hold both knees tightly to your chest. Try to shape your spine in an egg-shaped curve, especially the lower spine. Hold for 20 seconds; repeat five times. Alternatively, you can get a large exercise ball (Swedish exercise ball) and lie on top of it, with your lower back at the very top. The curvature of the ball will slightly traction apart the disc.
5. Ask your doctor if you are a candidate for using an inversion therapy table. Last May, I wrote an extensive post about when to use an inversion therapy table for back pain. While this can stretch the spinal discs using gravity, it is not for everyone.
As your pain decreases, it usually means that the bulge is decreasing in size. At this point, you can do light back extensions: stand with feet 6″ apart. Place both palms behind your hips, and gently arch your back. Hold for ten seconds; repeat five times, several times a day.
Alternatively, lie on your stomach. Make a triangle with your hands (hands open, touch index and thumb fingertips together) and place under your chest. Push up (extend your elbows) and arch your lower back, while arching your neck back as well (this is called the cobra position in yoga). When you do lower back extensions, the backs of the vertebra pinch together and force the bulge towards the center of the disc.
Remember to do these exercises slowly with good form and control; remember to breathe. If any of them cause an increase in pain, it means you are not ready for them quite yet, and discontinue.
A recent study in The Journal of Bone and Joint Surgery showed that people who had mild to moderate knee osteoarthritis and were depressed rated their pain as severe, the level which others in the study who had x-ray documented advanced osteoarthritis reported.
I’ve always believed that there is a “mind-body” connection, and this is yet another study that supports this. The thoughts that you allow to enter your mind can have a definite effect on your physiology, whether it be blood pressure, heart rate, respiration rate, digestion, strength, immune response, or pain. Check out this cancer treatment center’s use of visual and music therapy to help with treatment.
Jon T. Giles, MD, an assistant professor of medicine at Columbia University and rheumatologist at New York Presbyterian Hospital in New York City, says this study adds further weight to the existing medical literature highlighting the effect of psychosocial issues on pain responses.
“Painful sensations are relayed through the brain in a very complex way, and can be modulated up or down,” he says. With stress, poor sleep, anxiety and depression, which are known to influence pain levels, “stimuli feel more painful than they would in someone without the adverse psychosocial factors. This probably explains in part why the largest effect of depression in the study was seen in those without much OA to see on X-rays.”
The study recommends that patients fitting this profile get psychiatric evaluation and treatment, including anti-depressant drugs, in order to help alleviate their pain.
The study does not outright say that only “clinical” depression can make pain worse. If you have pain, persistent negative thoughts are more likely to make it appear worse than it actually is. Remember, the perception of pain is a complex neurological pathway that is not entirely understood.
I can sympathize with those experiencing chronic pain– it can be a terrible cycle, where the pain itself can push the patient to negative thoughts and depression, embedding it further and further into the body’s central nervous system. Speaking as a human being, and not just a health care provider, I can offer the following suggestions to break the cycle. And I’m sure it’s not all new, but worth repeating here:
1. Don’t hang around negative people. Their negative energy will bring you down. Instead, hang around those with “positive buoyancy,” the ones who can lift you up emotionally. Most small children fit in this group.
2. Similar to #1, avoid negative stimuli in your environment– crime shows, news, reality TV, newspaper headliners, internet news, etc.
3. Find something to keep your mind occupied; something that requires active brain usage (not passive, like watching TV). Social activities that involve interacting and working with other people is a good choice; especially if it is for a good cause. Arts and crafts is another good choice.
4. Get a pet. There’s nothing like a dog who exhibits unconditional, total loyalty to you.
5. Eat only those foods that nourish the body. The nutrient dense foods that occur naturally; i.e. plants and animals are the best for a body experiencing pain: fruits, green leaf plants, sardines, lean meat, nuts. Definitely avoid cigarette smoke, alcohol, corn syrup, sugar, and food preservatives.
6. Get out in the sun. Take of your shirt, expose your trunk to the sun several times throughout the day.
7. Stay active, as much as your pain will allow. Tai chi and yoga are good if your body can’t handle the forces of running , jumping, and lifting weights. Walking briskly is good, too.
8. Get fresh air. Drive to your nearest nature preserve, far enough away from the city and suburbs and get some negative ions (the only good, negative thing if you’re in pain!) and clean oxygen in your lungs.
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Inversion therapy tables are see-saw like contraptions designed to use gravity to decompress the spine. They have been around for more than twenty years already, so today’s models offer more in terms of comfort and ease of use. But the principle is the same: use a platform balanced on a horizontal rod, with a mechanism to offer some controlled resistance. You lie face up on the platform (more expensive models allow you to be face down), lock your feet into the foot carriage either by hooking your insteps onto rollers, or wearing gravity boots strapped to the carriage; and raise your arms in varying angles to control the amount of tilt. Arms extended straight above your head result in the maximum angle, usually around 45 degrees. The weight of your torso pulls gently on your spine, and you get some degree of stretch to your back.
table is a higher-end table that doesn’t require you to raise your arms in order to tilt the table. A motorized inversion table may offer better traction to the lumbar spine, as the act of raising the arms contracts the back muscles which is definitely undesired when attempting to stretch the spine. And if money is not an issue, you may consider the 
, a commercial-grade table designed with input from doctors and therapists. This table can be used in the prone (face down) OR supine (face up) position, and offers progressive decompression therapy.
I’ve been fielding a lot of questions about bulging discs lately. Here are some of the questions I get:
When you think of a scorpion, the first thing that comes to mind is that scary, nasty poisonous tail. You really don’t want to have one of these things napping in your shoe.
