VERY long chronic backstory - lots of damage from successive mva’s. Recent flair has lead to an isolated dx of major inflammation of ligaments associated with L4/5-SI. Doc wants to do either therapy to help get under control. Has anyone had either procedure? Please share your experiences. Right now I am not to ride which is not good for the other associated issues with my injuries.
I’m definitely taking a pass on both.
Here’s the best explanation I’ve seen re: PRP, and while written about horses, the research cited is in human medicine: http://www.doctorramey.com/platelet-rich-plasma-prp/
Prolotherapy works on the same theory as pin-firing, and not only sounds damned painful, with many unkind side effects, I’ve seen it described as “utter quackery” many places. Playing with that right next to your spinal cord? :eek: The following Wiki entry is relatively even-handed, but still calls it basically experimental: https://en.wikipedia.org/wiki/Prolotherapy
Today we have many unproven (non evidence-based, placebo at best) “therapies” inching their way into the mainstream under the guise of “integrative” medicine, where mainstream allopathic medicine doesn’t happen to have a quick, easy, miracle cure. Since nobody wants to hear that Nature has to do the healing, and that takes time, commercially sanctioned quackery is now the rage. “Dry needling,” cranio-sacral therapy, and myofascial release are similar delusions. At the very LEAST, there should be biological plausibility as to physical pathways by which these things could work–not just beliefs about “energy” couched in pseudoscientific terminology and woo-woo sincerity.
Personally, I won’t pay for something KNOWN to do nothing as per randomized controlled trials, but that choice is of course up to you.
Soft-tissue injuries, in man or beast, take a damned LONNNNNGGGG time to heal; ask me how I know! 
Rest and NSAIDS as needed are pretty much the gold standard, but yeah, you’re on “stall rest” for the duration. But at least you can read a good book while keeping your money in your pocket! No sense being butt-sore AND broke, right? Best of luck!
What are next steps if PRP or prolotherapy don’t work?
If you’ve got the dollars to spend, PRP is a worthwhile dart at the board. I had PRP in both hip joints in January or so, I guess it was. It was effective at eliminating the pain the the right, and it’s still going there, I suppose. The right hip hasn’t been particularly troublesome lately. The left hip–which is my worse–improved for about 8 weeks, and then the pain returned. Sad for me.
Do note that PRP effing HURT for several days following the injections. I could barely walk. So line up the appropriate pain meds to get you through that if you chose to go that route.
PRP may not be proven in trials, but it does work for some. When you’re in pain and facing serious surgery or–even worse–no further options at all to treat your pain, it is certainly worth a go.
[QUOTE=Lady Eboshi;8771673]
Since nobody wants to hear that Nature has to do the healing, and that takes time, commercially sanctioned quackery is now the rage. “Dry needling,” cranio-sacral therapy, and myofascial release are similar delusions.[/QUOTE]
I can’t speak for all of the above but just because you don’t believe in them doesn’t mean that the appropriate modality for an individual doesn’t work.
I have have myofascial release as treatment for extensive scar tissue for a few years (usually once/twice month). Yes, it does make a difference for me. Natural “healing” for me has meant extensive scar tissue (and in my case, some of that scarring is well over 50 years old so I don’t think nature is going to make it “better”). MFR does help break it down and loosen it up.
I realize that perhaps the only positive evidence is anecdotal rather than “science” but that does’t mean, IMO, that it doesn’t work.
You don’t have to pay to get it if you don’t believe in it.
[QUOTE=Where’sMyWhite;8771864]
I can’t speak for all of the above but just because you don’t believe in them doesn’t mean that the appropriate modality for an individual doesn’t work.
I have have myofascial release as treatment for extensive scar tissue for a few years (usually once/twice month). Yes, it does make a difference for me. Natural “healing” for me has meant extensive scar tissue (and in my case, some of that scarring is well over 50 years old so I don’t think nature is going to make it “better”). MFR does help break it down and loosen it up.
I realize that perhaps the only positive evidence is anecdotal rather than “science” but that does’t mean, IMO, that it doesn’t work.
You don’t have to pay to get it if you don’t believe in it.[/QUOTE]
Hey, glad it worked for you!
However, it has been explained extensively to me that the placebo effect is very, very strong with much variation between individuals. The stronger the belief or faith that something’s going to “work,” the more likely you’ll interpret the results that way. What is actually doing the job, however, is not the technical treatment modality, but he act of treatment itself. This has been proven many times by double-blind studies of sham acupuncture, even sham surgeries.
Many times, many MANY times, improvement is attributed to the “treatment,” when in point of fact the thing was just getting around to improving on its own.
Low back pain is a classic example. But this is why the plural of “anecdotes” is not “data,” as Deltawave used to say on COTH.
For my money, if you have to “believe” in it for it to work, it’s not a “thing.” I need to see reasonable proof and biological plausibility before submitting to some form of manhandling or invasive procedure.
Or, to put it another way, I’ve seen “Dr. Green” cure more equine lamenesses than all vets I’ve known put together. So I’ll be “patient” and let Nature work, too. I haven’t noticed any of the poor COTH’ers on the hip-pain thread seeing much relief AT ALL from the myriad “therapeutic” tortures to which they’ve submitted!
I get the placebo effect. Having said that, when one has no idea how the modality is supposed to work or what effect it is supposed to have, how can things improve? Or, when one tries the modality with complete skepticism, as I did both both MFR and dry needling, that one worked (MFR) and one did not (dry needling)???
I’d also like an explanation of how 50+ year old scar tissue (or even 4 year old scar tissue) is going to “get better” (i.e., become “softer” and less binding/restrictive) on its own???
I do get frustrated that for some, for a modality to work, it must be proven scientifically or it must be placebo/belief rather than just maybe because we don’t understand everything about how the body works, maybe some modalities are just flat out difficult to test and placebo maybe has nothing to do with it.
My 2 cents for all they are worth
MFR (myofascial release) works well for me, too!
PS. I was also pretty skeptical about Feldenkrais and despite not understanding how it works and being skeptical that it could make a difference, for me it did…
Not sure how you could get a meaningful scientific study on some of this modalities as their impact/influence on someone is not really quantifiable as well as every single body is different…
Lady E, you’ve posted this several times: http://dralisongrimaldi.com/resources/lateral-hip-pain-mechanisms-and-management/
Can you please point me to multiple, peer-reviewed studies that prove this treatment is effective? No? Oh, it must not work.
There is SO much we don’t understand about pain. SO MUCH. It is unfair, and, frankly, offensive for you to say that the only way these “alternative” therapies work is the placebo effect and insinuate that anyone who finds relief must be getting it because of that effect. I think we understand that you’re not supportive. Fine, you don’t have to go get dry needled. Or have PRP. Or go for Myofacial Release. Or try Kinesio Taping. But these things WORK for some people. Why?? Dunno. Maybe we’ll find out once we learn more about pain.
^^ +1
I had prolotherapy on my hypermobile SI (from a injury) almost 10 years ago.
It helped, but what has helped me the most is is acupuncture from a licensed sports medicine acupuncturist.
Simkie, heaven knows I am no therapist but I have gotten the impression from things I’ve heard (my therapist, discussions on sports coverage on TV) that the kinesio tape can both help “support” as well as “activate” muscles in the same way that a therapist can gently “prod” a muscle to get it to activate (the latter I’ve actually personally experienced).
My gold standard for kinesio tape is it must do “something” as I see pro bicycle riders with usually their knees taped (although sometimes it is other things… quads, arms) during races. I’m not thinking there is much “placebo” going on when those guys are driving their legs pretty hard for hours at a time 
I’ve also used kinesio tape on my one knee occasionally when it is bothering me and it does seem to help “stabilize” it. Maybe placebo but again, I was/am a skeptic so not sure if I am skeptical of a modality that I would get any placebo effect.
Mostly what you said. I’m okay if someone doesn’t believe a modality will work because it isn’t backed up by scientific study but don’t look down on those who do choose to use an alternative modality. There is so much about the body we don’t understand that some things… who knows why they work, but for some individuals they do
WMW, I tossed taping in there because DAMNED if I wasn’t dubious about it myself. A piece of very light tape? How on earth is that going to help at all? But I humored my PT and he taped me up and wow. WOW. Made a huge difference for me.
I expect that once we more know about pain, we’ll be able to produce studies that show a repeatable, predictable positive effect…but we need a better idea about what kind of pain–and what kind of people–to target.
WMW, I tossed taping in there because DAMNED if I wasn’t dubious about it myself. A piece of very light tape? How on earth is that going to help at all? But I humored my PT and he taped me up and wow. WOW. Made a huge difference for me.
I expect that once we more know about pain, we’ll be able to produce studies that show a repeatable, predictable, positive effect…but we need a better idea about what kind of pain–and what kind of people–to target.
[QUOTE=Simkie;8771690]
What are next steps if PRP or prolotherapy don’t work?
If you’ve got the dollars to spend, PRP is a worthwhile dart at the board. I had PRP in both hip joints in January or so, I guess it was. It was effective at eliminating the pain the the right, and it’s still going there, I suppose. The right hip hasn’t been particularly troublesome lately. The left hip–which is my worse–improved for about 8 weeks, and then the pain returned. Sad for me.
Do note that PRP effing HURT for several days following the injections. I could barely walk. So line up the appropriate pain meds to get you through that if you chose to go that route.
PRP may not be proven in trials, but it does work for some. When you’re in pain and facing serious surgery or–even worse–no further options at all to treat your pain, it is certainly worth a go.[/QUOTE]
I am not sure Simkie. This is an old injury. Pain management is a continuous effort. Would you do it again?
Thank you to everyone who took time to respond. This is an old established injury that will continue to break down and degrade as the aging process rolls on. The window for healing and soft tissue remodeling closed 14+ years ago. I am not sure what I did to flare the ligaments this time. Pain mgmt is an ongoing issue, as is doing everything possible to remain mobile as possible. I know surgery is in my future for the bones/disk issues. I know there is considerable arthritis. Was the inflammation worth the relief?
[QUOTE=Bearskin;8774175]
I am not sure Simkie. This is an old injury. Pain management is a continuous effort. Would you do it again?[/QUOTE]
I would do it again, and am considering it before we move. Just be sure to have pain meds in place beforehand, or a plan to handle it if you get that sort of reaction. I don’t know if what I went through is normal or not?
I got more pain relief out of the PRP than pretty much anything to date. I felt really great when it was working, and it did calm down the right hip pretty significantly, for a much longer duration than the left.
If you are guarded about going into something like this…have you had blocks into the area in question? Do they help?
If they can’t block your pain via injection with lidocaine or ropivacaine (ropi is my FAVORITE–I would be GOLDEN if they could just do a slow, constant drip into the joint :lol:) then I’d think you’re unlikely to get any relief from PRP or prolo. If you’ve not had blocks to isolate where your pain is coming from, it might not be a terrible idea to start there, especially since PRP isn’t exactly cheap and most insurance companies don’t cover it at all.
A friend of mine has very chronic SI issues. She did both PRP and prolotherapy at a well-respected university hospital. Had to do at least 2 rounds of prolotherapy. She had such bad pain and spasms she could barely move. She reported that it was very painful. She is doing a bit better now in conjunction with her usual PT, chiro, dry needling, acupuncture, massage, and rest (a biggie, because she is terrible about being overtrained). Overall, she isn’t sure the injections really worked, but at that point, she had trouble even sitting in a chair. I think she was just expecting a much larger improvement on the pain scale than she got, and it took time.
And a musing question for Lady Eboshi.
For these many “alternative” therapies that you feel have only placebo effect, how would you construct a quantitative test that would meet your criteria to prove these alternative therapies can make a difference?
Or should all qualitative therapies be considered placebo in nature and of no real value?
I’m guessing that Lady E would like to see double blinded clinical trials showing consistent, repeatable benefit.
But I hold that we can’t control for all variables until we know more about pain.
You could pull together a group of 1000 random breast cancer patients and give them herceptin. But you’re not going to see consistent, repeatable benefit until you screen your trial participants to those who carry HER-2–but when you do that, the results will be impressive.
Without the knowledge and screening tools to understand how best to use these treatment modalities, we may be including people in trials that definitely will not benefit, much like giving herceptin to someone who is HER-2 negative. It just won’t work. But that sure doesn’t mean the treatment is worthless on everyone.
