Manual Therapy and Prolotherapy for Spondylolisthesis: A Patient’s Story.

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I recently received an email from a patient expressing gratitude for the role I played in his recovery story. I asked him to share his story for other patients facing the same questions he had regarding the use of of prolotherapy for a dynamic spondylolisthesis, whether he could return to high level activity without a fusion, and what kind of recovery timeline he could expect.
Here’s is some background. The patient had initially contacted me from out of state after reading a post I made on SI joint dysfunction and the up and down stream effects that segmental instability in the lumbar spine can have on regional mechanics. We spoke and he ended up consulting with me on his case. At this point he had not been moving in the right direction despite visits with two MDs, two PTs, and a DC in his home state over the course of a year. I worked with him on and off over the first year because he was living outside of Washington. When he was in state I provided manual therapy and later consulting on a home exercise program from a far. After about 6 months he moved back to Washington and I was able to provide more focused treatment and coordination of care. In short after 17 visits of PT (over 2 years) and prolotherapy this patient no longer suffers from chronic lower back pain and he avoided a lumbar fusion surgery!
Here is what he had to share about his story.

“My pain started when I was 22 as an ache throughout the left buttock. At the time I had been doing lots of running / sprinting in playing ultimate frisbee as well as Olympic lifts. Physical therapists determined that my sacroiliac joint was out of place, so I went to a chiropractor who mobilized the joint. Immediately after that, my pain took on a sharper, burning sensation and moved to focus around the sacroiliac joint specifically. At this point, it became clear to my doctors that the pain was referred from my grade 1 spondylolisthesis.

The pain remained this way for a year and a half and was not responsive to various treatments including physical therapy, extensive rest, massage, and back bracing. Then I started physical therapy with Mitch, at which point the pain began to gradually decrease over the course of a year. However, I still had pain walking and was unable to perform any athletic activities besides biking. This led me to seek prolotherapy from Dr. Musnick. By manual tests, the prolotherapy injections significantly stabilized my spondylolisthesis but did not have an immediate effect on pain.

In an attempt to dampen any nerve irritation that may be causing the pain, I received anti-inflammatory injections into the epidural space (which would relieve nerve root pain) and later the facet joints (to relieve pain caused by the irritation of local nerves). Neither decreased pain.
About 3 months after these injections, I began rock climbing, which did not trigger further symptoms. Three months after that, the pain remained but had become less activated by exercise. The pain has continued to lessen and become less sensitive to exercise since then, and I am now able to run and play team sports.”
I want to acknowledge Dr. Virtaj Singh with Seattle Spine and Sport Medicine for the role he played in this case as well as Dr. David Musnick who provided the prolotherapy treatments as well as consultation regarding the use of the prolotherapy for a dynamic spondylolisthesis.
Mitch Owens MsPT, COMT