Prolotherapy: Prolotherapy for Sacroiliac Joint Laxity
by Dr. R. C. Sweeting, F.R.C.S.(C), F.R.A.C.S.(ORTH)
I met Dr. R.C. Sweeting at the annual meeting of the American College of
Osteopathic Sclerotherapeutic Pain Management group last year where he was an attendee.
Dr. Sweeting is an orthopaedic surgeon in British Columbia, Canada, with 37 years
experience in the treatment and assessment of various orthopaedic conditions. A special
interest of Dr. Sweeting has been manual musculoskeletal testing and the non-surgical
treatment of low back and pelvic conditions. Over the past 6 years, he has focused on the
treatment of ligamentous laxities with prolotherapy which has been particularly helpful in
non-surgically resolving pelvic instabilities. The following article is an excellent,
concise assessment of the mechanics of sacroiliac joint laxity, Dr. Sweeting's examination
to diagnose this problem, and case reports of treatment using prolotherapy.
—Donna Alderman, DO
 Figure 1. Direction of force during bracing for a collision.
Following Mixter and Barr's description of the herniated lumbar disc and it's
subsequent excision, the possible involvement of the sacroiliac joint as a source of low
back pain has tended to be overlooked. However a review of 1294 patients presenting with
low back pain by Bernard and Kirkaldy-Willis determined that 22.5% of these patients had
symptoms originating in the sacroiliac joint.1 It would seem that interest in
the sacroiliac joint as a source of low back pain would appear to be undergoing a
resurgence with the recognition of ligament strains—generally with a fixed
mal-position after injury or, alternatively, demonstrable instability of the joint. For
the latter, women in their childbearing years would appear to be particularly susceptible
following rear-end motor vehicle collisions.
Mechanism
At the moment of impact in a motor vehicle accident—with the driver sitting and
restrained by seatbelts—the leg muscles contract thus extending the knee in an
attempt to stop the forward momentum of the torso (see Figure 1). The forces then travel
posteriorly along the line of the femur towards the acetabulum resulting in a torsional
moment along with a posterior component being exerted on the sacroiliac joint. This may
well cause partial ruptures in the sacroiliac ligaments.
While the pelvis can be visualized as a box like structure (see Figure 2), it is
believed to structurally function as a bioengineered truss2,3 with compression
forces being transmitted through the bone and joints with the tensile forces being taken
up by the adjacent myofascial tissues. It follows then that, along with damage to the
sacroiliac joint, a number of other structures are likely to be injured—including the
ipselateral ilio-lumbar ligament, the lumbosacral facet, the adjacent myofascial tissues,
as well as the symphysis pubis and, very likely, the opposite sacroiliac joint. These may
all need to be included in any treatment program.
Please refer to the May 2009 issue for the complete text. In the event you need to order a back issue, please click here.
— May 2009
The full article is now available as a PDF and may be
purchased for $5 and downloaded immediately:
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