Dynamic Chiropractic - September 23, 1996, Volume 14, Issue 20

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Book Review

Title:Spine: State of the Art Reviews, Vol. 9, No 2 1995
Prolotherapy in the Lumbar Spine and Pelvis
Editor:Thomas A. Dorman, MD
Publisher:Hanley & Belfus, Inc.210 South 13th Street
Philadephia, PA 19107
Tele: (215) 546-7293
Publication:Hardcover, 524 pages
Category:Doctor and student education

This book revisits prolotherapy as a treatment option for low back pain. This treatment option has been called sclerotherapy in the past. In this work the authors present an updated view of this controversial treatment. Whether you believe or disbelieve in prolotherapy as a viable method of treating low back pain, this book contains information of use to our profession.

The introduction by Vert Mooney, MD, tells the story of how one traditional orthopedic surgeon had his eyes opened to nontraditional conservative methods which were successful when traditional approaches failed. The successive chapters review the osseus and soft tissue anatomy of the spine. They go beyond a simple review of the structures to give a new insight into how soft tissues support the spine and the storage of elastic energy in the myofascial tissues.

Several chapter authors discuss the mechanics of the sacroiliac joint, beginning with the "accepted fact" of the immobility of this joint being one of the more significant errors made by the traditional medical community. The more current concepts of the pelvis as a functional, and potential dysfunctional, unit is discussed. The involvement of the sacroiliac joints in functional leg length inequality is presented as a result of "entrapment" which can be corrected by manipulation.

A discussion of the effect of proper pedal foundation and its effect on certain types of pelvic pain is found in one chapter. An interesting discussion of the new concepts in pelvic function and the relationship it has to lower extremity mechanics is included. Later chapters discuss the transfer of the load through the pelvis and the effect of counternutation of the SI joints on the connective tissues.

There is a chapter dedicated to imaging of the low back. It points out the advantages of the newer imaging techniques, yet acknowledges the inability to visualize ligamentous laxity clearly.

Clinical findings in the low back are discussed, including the concepts of referred pain, sclerotomal pain and postural decompensation. A discussion is also included of the importance of postural evaluation and how dysfunction of the soft tissues from gravitational strain can cause postural changes and other symptomatic findings.

The final chapter reviews the status of prolotherapy. The clinical indications for and the expected effects of prolotherapy are presented, and several case outcomes.

Overall the quality is good. There is some inconsistency among the chapter authors regarding the quality of the charts and illustrations. There is new terminology introduced by some authors, a glossary would have been a pleasant addition allowing the reader to review the definition of a term quickly after its introduction.

Although the title would suggest a book entirely dedicated to prolotherapy, this short work presents a great deal of current information on the function and dysfunction of the pelvis. This updated and well-referenced information can be and should be used by the chiropractic profession.

Dr. Stephen Savoie Rating: 8.5 out of 10