An alternative to steroid for lower back pain

One of the most common causes a low back pain specialist will see in their office is the pain caused by the sacroiliac joint (SI). The sacroiliac joints connect the spine and the hips at the sacrum. The sacrum is a triangular shaped bone at the bottom of your spine. It sits between the iliac bones, your “right and left hips”, to complete the pelvis.

Holding the pelvis or pelvic girdle together is a network of ligaments and tendons. When these ligaments and tendons become weakened or lax, sacroiliac joint pain occurs.

Many doctors who practice Prolotherapy have long known that suppression of pain symptoms is not the answer to chronic lower back pain. Rather, rebuilding the weakened ligaments and tendons causing the sacroiliac pain is the better choice for long term relief and alleviation of lower back pain.

Steroids or more commonly referred to as cortisone do not serve this function. Cortisone does not heal, rebuild, or strengthen tissue. Contrarily, it has been shown in the medical literature to weaken ligaments and tendons in long-term usage by suppressing circulation to the afflicted area.

Then why use them?

Temporary suppression of pain. Cortisione however is not a pain-killer. It is an anti-inflammatory. It works by reducing inflammation at the site of the injury, reducing swelling and tenderness. It does so by suppressing circulation to the injury. No circulation, no inflammation.

Prolotherapy is an injection technique as opposite to cortisone as can be. Prolotherapy introduces dextrose (a very small amount of sugar) into the pelvic area through injection to stimulate immune response. What Prolotherapy does is not suppress inflammation, but rather accelerates it to a level where healing can occur. The accelerated inflammation brings immune cells such as fibroblasts to rebuild collagen and lay down a new collagen matrix over the weakened, damaged ligaments and tendons. Prolotherapy reduces pain by strengthening the connective tissue that holds the pelvic, groin, hip region together.

Typically a few injections are needed during a few visits to stabilize the area and bring pain relief through healing.

Recent research appearing in the Journal of Alterantive and Complementary Medicine clearly states “prolotherapy provided significant relief of sacroiliac joint pain, and its effects lasted longer than those of steroid injections “ (1)

(1) J Altern Complement Med. 2010 Dec;16(12):1285-90.

At our clinic, Darrow Sports and Wellness Institute, we don’t like to offer cortisone but sometimes, in extreme chronic injury, cortisone, used one time is a very good diagnostic test to see where the pain generator is, and at the same time quiet the pain. The next step is to use Prolotherapy to rejuvenate the tissue and end the pain. Prolotherapy treatments for the athlete are typically given once a week over a 4 – 6 week period.

Marc Darrow, MD is board certified in Physical Medicine and Rehabilitation, and is an Assistant Clinical Professor at the UCLA School of Medicine. He specializes in Prolotherapy which is the natural stimulation of the body to produce collagen and heal overuse or other injuries.

Questions? Call his office 310-231-7000 or email