Posted by Madeleine Speed, the Pelvic Partnership, October 2015
You may have heard of Prolotherapy in relation PGP but want to know more about it. Prolotherapy is seen as an approach for a number of pain-related problems, too, such as long-term back pain where it has been used for some time. Prolotherapy is an increasingly used therapy for women with instability associated with PGP. It seems to work well for women whose pelvis can be realigned and pain-free during a physiotherapy or osteopathic session, but as soon as they return to the normal activities of life, the pain and instability returns.
If you have been newly diagnosed as having PGP, there are some key steps that you would benefit from considering first before looking at Prolotherapy. The Pelvic Partnership team suggest that PGP usually responds very well to manual therapy. So it's worth looking for a manual therapist who has experience of PGP as your first step. Manual therapy is a 'hands-on' approach where a manual therapist, such as a physiotherapist, chiropractor or osteopath, examines your pelvis to check how it is functioning and if PGP symptoms are apparent. Once stiff or stuck pelvic joints are identified, the healthcare professional uses various techniques to restore smooth and effective movement again. This may take one or several sessions (everyone is different so generalising can be misleading) but after each you should feel some significant progress such as a reduction in pain or an increase in mobility.
Prolotherapy may be useful if you have longer-term PGP and where pain and instability seem to return almost as soon as you've received a successful treatment session. So if you find that your pelvis cannot seem to stay in position whenever a manual therapist has newly aligned it and you notice that the pain and immobility quickly return as a result, this procedure may be well worth considering. This failure to keep the pelvis in position is often due to a true instability at the pelvic joints where the ligaments have been overstretched. Ligaments are different from muscles, and once overstretched, sometimes cannot return to their normal length.
Prolotherapy works by injecting a sucrose solution into the ligaments, which causes a local inflammatory reaction, which in turn makes the ligaments tighten up. Some patients report this as a painful procedure but most practitioners use sedation before doing the injections which makes it much less uncomfortable. It is usually given as a course of injections, once a month for three months.
Many of the women who have received this treatment are reporting improvements in their symptoms with a reduction in pain and increase in stability. The best results are in women who have had their pelvis realigned just before and after the injections, so the pelvis is in the best possible position for the ligaments to hold and maintain it. If this has not been done, people have reported disappointing results.
Most women who have had good manual therapy find that this alone works for them and they make a full recovery. However, if you have good reason to believe that your pelvis regularly shows an instability at the pelvic joints soon after a successful manual therapy session, then it may well be a procedure worth considering. Prolotherapy is sometimes available on the NHS (but not widely) so there may be a significant cost implication to trying this treatment. It is usually seen as an option to try when other options have failed to maintain an improvement.
We have found some weblinks about Prolotherapy that may be useful to you:
* Image courtesy of Tina Bolton.