T Nation

Prolotherapy for SI Joint


I have been suffering from a hypermobile left Sacroiliac Joint that resulted from a back injury that I incurred in June of this year. Performing lifts such as squats and deadlifts, even with light loads (<50%) causes issues. I think it's possible that my injury caused damage to a sacroiliac ligament, and that the ligament is either weak or "loose," causing misalignment (especially when put under load), inflammation, and moderate pain.

I have been doing a lot of corrective work on my posture and biomechanics for over a year as a result of previous injuries. I am also performing soft tissue work on a daily basis. Despite being consistent in addressing my mechanics and tissue quality, my issues are persisting ever since the onset of injury seven months ago (although moderately improved).

I am wondering if prolotherapy would be an appropriate method to use in order to stimulate tissue healing. Does anyone have any experience with prolotherapy? I'm especially curious about the use of prolotherapy on the SI joint and other non-synovial joints.


I've worked with several athletes who have done prolotherapy specifically for SI joint issues. I saw mixed results - some had great outcomes and others didn't see much help from the shots. One big thing though is to find out what exactly is causing the hypermobility in your SI joint (if that is indeed the case). Is it the SI ligament itself, surrounding musculature, an issue with your pubic symphysis, etc.? Generally, if my memory serves me correctly, the common injection sites were both SI joints at the PSIS and then other injections were used based on the individual's specific issues. I do remember other injection sites being the adductor magnus and pubic symphysis as well.

Just make sure that you do indeed have hypermobility at the SI joint occurring and find out what is causing the hypermobility before going and getting injections.


Hi LH.

Thanks for the response. A lot of my conclusions (such as the fact that my SI joint is hypermobile, that the hypermobility is what is causing ligament damage, and that the damaged ligament is correlated with increased hypermobility) are really based on what I perceive when I train. I base my hypothesis of hypermobility on the fact that activities that cause "pulling apart" of the SI joint (such as hanging upside down) generally cause increased pain, while activities that involve compression of the SI joint (such as bearing an overhead load) do not. Do you know of a more accurate way to test whether my SI joint is hypermobile, hypomobile, or neither?

To give you a little more information about my current situation, I'll go into a little more detail of the chronology of recent events:
About five weeks ago, I had a mild to moderate re-injury my SI Joint. I performed light deadlifts (~30% of my previous 1RM) and squats with a band around my knees. Both lifts aggravated my SI Joint, which I thought was hypomobile at the time, and I decided to hang upside down and forcefully flex and extend my hips, which led to an acute pulling sensation in my SI Joint region.

Less than four weeks ago, I realized that my right (non-dominant) leg was constantly in an adducted and externally rotated position, which likely caused imbalanced forces on my hips (this may have contributed to the initial injury and the re-injury). This postural imbalance existed for a long time, and I have only been addressing it since the beginning of January. I have been able to perform lower body lifts with both feet being approximately symmetrical. This has caused a moderate reduction in SI Joint pain while performing "motor learning" training for lower body exercises, but some pain still persists.

During my "motor learning" training, I occasionally feel that I acutely overload my SI Joint. I am very conservative with my loading strategy (I begin all lower body lifts with a 15 pound bar and add ten pounds every other set, and I increase the weight until I perform a set that feels worse than the previous set), and I am extremely aware of biomechanics. Aside from my inversion-related injury, I have never felt significant acute pain while training, but it occasionally occurs within the hour after training and mild pain may last several days in more extreme cases. Is this degree of overload acceptable and conducive to healing, or might I be doing more harm than good?

Do you think it would be wise of me to re-evaluate my training strategy or loading methods before considering prolotherapy?