The Importance of an Accurate Diagnosis

All too common is the frustration of a patient who seems to be on an endless search for relief from their pain. A recent caller to our radio show was enduring this very experience. He had right hip pain for about a year and a half without a clear idea of what the cause was. He had gone to several clinicians and was finally diagnosed with a tear in one of his gluteal (buttock) muscles. He went on to say that one suggested prolotherapy treatment. He then asked me if I knew anything about this procedure. It so happens that I know a great deal about prolotherapy, having been formally trained to perform the procedure by the physician who pioneered it in the United States. My wife and I have also been recipients of prolotherapy as patients.

Prolotherapy is primarily used to treat ligament instability, or ligaments that have been “over-stretched”. The primary function of our ligaments is to keep joints “in place”. Prolotherapy involves injecting the ligament with an agent that irritates it in order to cause inflammation. This then leads to the formation of scar tissue. So you are intentionally scarring the ligament, in order to make it “tighter”. This procedure can be extremely valuable, if it is needed. However, it is invasive, expensive, and not very pleasant to go through. I had anywhere from 20 to 50 injections per treatment session, which are done once a month for six to nine months. Therefore all other treatment options should be exhausted first.

Joints are held in place by tight ligaments and strong muscles. If the ligaments are no longer “tight”, then you need to strengthen the muscles around them. This almost always leads to healing of the injured area with no invasive procedures required. There are very specific exercises that can be done in order to accomplish this. They vary according to the injured area.

Furthermore, in the gluteal muscle, where our caller had been injured, there is a gluteal nerve running near the muscle. It is quite possible that their pain had been coming from a gluteal nerve entrapment syndrome. This is treatable without prolotherapy. So the logical step-by-step approach that we take is as follows: Treat any injury to the muscle, release any entrapped nerve, strengthen the muscle for at least six months, and then only consider prolotherapy if an over-stretched ligament remains and continues to cause at least moderate symptoms.

Our caller was very encouraged by this information. He made a final comment about medical practitioners tending to have “tunnel vision” and not seeing “all the treatment options”. This is an issue we work very hard to avoid at Medig. Although doctors have high integrity, and are really trying to help, sometimes they are limited by the perspective from which they have been trained. Medicine has become so complicated that it impossible for one person to be an expert at everything. This is why at Medig we provide a multidisciplinary approach to the diagnosis and treatment of injuries. We have many types of specialists under roof who coordinate their expertise under the direction of our MDs. This perspective ensures you the highest likelihood of an accurate diagnosis and effective specific treatment.

A Better Way to Get Better,
Adrian Lewis
Adrian Lewis, MD