Lumbosacral prolotherapy

Abstract

In Yelland’s comments on our paper in Int Musculoskelet Med 2012; 34:7–12, he makes a number of excellent points with which we generally agree; however, we wish to clarify some points and to build on others. We accept the uncertainty of the exact definition of instability but this should not prevent us from agreeing a reasonably uniform client base on whom to try to refine the efficacy of a treatment that seems to work well. Our subjects with lumbar or pelvic pain who had a diminishing response to manipulation were just one subgroup of several described, indeed some had no discernible dysfunction to manipulate. Our patients were all treated on three occasions rather than up to seven times as in Yelland’s cases and whereas he treated only tender entheses, we treat bilateral ligament attachments across affected segments even if there is only unilateral tenderness. We feel as does Yelland that both studies compare favourably with spinal fusion and that our group was also ‘from the difficult end of the spectrum’ – constituting only 5 and 9%, respectively, of our clinics’ patients. With regard to future research we support Yelland’s proposal that an extended series analysed carefully for subgroups is a practical way forward. Both of us have continued to collect the same data since publication and will be able to analyse subgroups further by factors such as ligament group treated (e.g. sacroiliac, iliolumbar, or lumbosacral) sex, age, and length of initial history. Further subgroups would require a considerable amount of work. We favour this approach since we already have the data collection process in place but as Yelland states so clearly in conclusion there is plenty of room for more research in this area.