Samuel G Oltman, ND, RMSK
Low back pain is complex and multifactorial. It requires an equally multifactorial approach to get you back to pain-free movement. For most people, the plan will undoubtedly include exercise in some form and will most likely not include surgery. So what’s in between? How should you navigate the available treatments and healthcare providers to not only feel better sooner, but also stay better long term?
Movement is Medicine
Exercise and movement are non-negotiable. This can be exercise in a routine sense (walking, swimming, biking, strength training, yoga, etc) and/or in a structured physical therapy setting that is focused on specific movement patterns. This also includes chiropractic and osteopathic manipulation to move spinal segments and increase blood flow. The evidence is very clear that any form of movement is helpful for low back pain and must be done regularly (1). Oftentimes the low back pain is what is preventing movement in the first place– how do you break the cycle?
MFAT: Addressing Arthritis
Facet arthritis, or “facet arthrosis”, is one key component of addressing all the causes of low back pain. The facet joints in the low back are what allow for the movement between vertebrae (flexion, twisting, etc) and they can become arthritic just like any other joint. PRP and MFAT therapy address the inflammation and degeneration of arthritis directly. The facet joints are located in the back of the spine and can be directly visualized and injected under ultrasound guidance. Studies have shown that MFAT injections around the facet joints can result in sustained improvements up to 5 years after the procedure (2).
Prolotherapy: Instability and Discs
Most people have some idea of the discs in their back and often blame them for the pain they experience. While disc degeneration is common, the incidence of disc-induced low back is much lower (3). Disc degeneration is highly associated with spinal instability (4). This is commonly understood as disc degeneration causing instability but there’s very little evidence for this. Clinically what I often see is that instability causes disc degeneration and treating the instability helps relieve the disc pain. This can be done very effectively with prolotherapy and PRP to the supportive ligaments of the low back (5).
PRP Muscle Regeneration
Multifidi muscles are small stabilizing muscles on the back of your vertebrae that aid in posture and small movements. In cases of chronic low back pain they can shrink and turn into fat tissue, known as “multifidi atrophy”. This can be corrected with PRP injections and is part of a complete approach when treating the low back (6).
SI Joint Laxity
Excessive movement of the sacroiliac (SI) joint is a common cause of low back and pelvic pain. Generally, strengthening of the glutes and associated muscles is the first step when SI issues are correctly diagnosed but what if the muscles are reacting to a problem that is fundamentally a ligament issue? Muscles become tight and painful around an area they are compensating for, like when ligaments aren’t holding the SI joint together in a stable position. Regenerative medicine can strengthen ligaments and stabilize the SI joint, allowing the muscles to relax and function properly (7).
Like with virtually every other condition where cortisone is often recommended, cortisone can (but not always) help with low back pain in the short term if the cause is inflammation of a joint or nerve. Short term pain relief is a legitimate concern, as I’ve outlined here. But most people I treat are concerned with long term healing and restoration of function. Which brings us back up to the top of the article with movement and therapies that address specific tissue damage.
Surgery can feel like a miracle when it’s truly needed and it’s done correctly. The trouble is that many people think that after PT fails, surgery and/or pain medications are the only option. Low back surgery success rates are as low at 55% and the downside can be enormous (8). Some reviews have shown that low back fusion is no better than a structured PT program (9). Repeat low back surgery success rates drop dramatically with each attempt. If you’ve had low back surgery already, regenerative injection therapy may still be a good option for you. Surgery should be considered only as a last result and is not the step to take after PT and ibuprofen don’t solve the problem.
Complex Problems Require Elegant Solutions
I never tell my low back pain patients that regenerative injections are a stand alone therapy. They are always in conjunction with other measures and are best utilized within a holistic framework of movement, metabolic health, and tissue healing. Cascade Regenerative Medicine is dedicated to treating YOU in your entirety, and regenerative medicine can be an important part. We address the gap between physical therapy and surgery. Gain the edge you need to get over the hump and live without back pain, see what regenerative medicine can do for you.
Suri P, Boyko EJ, Goldberg J, Forsberg CW, Jarvik JG. Longitudinal associations between incident lumbar spine MRI findings and chronic low back pain or radicular symptoms: retrospective analysis of data from the longitudinal assessment of imaging and disability of the back (Laidback). BMC Musculoskelet Disord. 2014;15:152.
Hussein M, Hussein T. Effect of autologous platelet leukocyte rich plasma injections on atrophied lumbar multifidus muscle in low back pain patients with monosegmental degenerative disc disease. SICOT J. 2:12.