Pelvis - quilty of causing LBP

[jojo k]

all such an obvious pattern pain BUT STILL ITS MISSED ALL THE TIME!

even muscles in the shoulder and neck have origins around the SI joint hence they go into spasm when the SIJ is injured/dysfunctional. no wonder so many people with lower bacl problems go onto to develop neck and shoulder problems. DONT TREAT THE NECK, CORRECT THE SIJD AND THEN RE-ASSESS!!!!!

[link=http://www.sportsinjuryclinic.net/cybertherapist/back/buttocks/sacroiliac.htm]http://www.sportsinjuryclinic.net/cybertherapist/back/buttocks/sacroiliac.htm[/link]

Symptoms include:
[ul][*]Pain located either to the left or right of your lower back. The pain can range from an ache to a sharp pain which can restrict movement.[*]The pain may radiate out into your buttocks and low back and will often radiate to the front into the groin. Occasionally it is responsible for pain in the testicles among males.[*]Occasionally there may be referred pain into the lower limb which can be mistaken for sciatica.[*]Classic symptoms are difficulty turning over in bed, struggling to put on shoes and socks and pain getting your legs in and out of the car.[*]Stiffness in the lower back when getting up after sitting for long periods and when getting up from bed in the morning.[*]Aching to one side of your lower back when driving long distances. [/ul]

 

[Ellaine Louise]

[/size]
Well how can you separate which one is at hand: Let's say leftilium seems to bemore anteriorly rotated than right ilium. But you can as well explanethat right ilium is more posteriorly rotated than left ilium. So how to decide which one is the correct diagnosis and which one is just a result from other problemif you only compare them to each others? Do you follow the pain? Check the leg legths? How do you know? And if you check that while patient is standing the result may be different whe he/she is lying on bed, and it can change again if he/se is lying on back or stomack side.

I do not know what is THE answer to your question. I just know it is done wrong by most experts... My opinion is that most often it is rotated anteriorly and the pain is on other side. Sometimes it is rotated anteriorly and pain can be anywhere. Some have both anteriorly rotated but other more than other... I quess posterior rotation is possible, but most of the times it is a result of anteriorly rotated other ilium. Posteriorly rotatedone ilium is quite rare, I believe so. I haven't met anyone yet and others I have met over 200. And they have got help from correcting a diagnosed problem. So the diagnose most likely was correct becausecorrectingit vanished pains and thewhole posture improved...


I lost 15 years of my life because medical doctors don't believe on it even when diagnosing it with forward flexion test is documented (quite poorly) on the procedure how to diagnose low back pain patients... But doctors just seem to ignore that part.

I have beenthrown out from many forums because I have tried to question what the expertsthink they know...


It is perhaps the most commonly misdiagnosed and misunderstood problem of mankind. Millions of people suffer from it, but doctors think it does not exist.



Darren Higgins from UK has visited Finland at least 2 times and our magazine for PT have wrote a small text of what he has been teaching to PTs in here. It sounds great! But why can't I find any writings of Darren Higgins? They wrote he had been teaching here that cause of most problems (I meanfunctional skeletal broblems and pains)is not where the pain is. And he mentions that SIJ pain is one of them: the reason for SIJ pain is in 70% on the other side as malfunction of other SIJ. But on that article was nothing else about what other problems that malfunctioning SIJ can cause...


I quess itcould be a great treatment. But most oftem it is performed on the side where the pain is. So as Darren Higgins says: in most cases to the wrong side!

 

[NitroorsE]

Toni
Again thank you for your reply
I have had a search for Darren Higgins on the web and can not find any of his research. It looks like he was trained in Austrailia and now practicing in the UK - do you have any of his writings from when he came over to Finland?
I have recently found a physio who is quite experienced in treating SIDJ about 40 min drive from me. Unlike Dontingy he believes in form and force closure but and uses muscle energy techniques to treat anterior rotation by rotating the ilum posteriorly on the sacrum without using any forceful techniques. He places an empathsis on the soft tissues that control the joints movement also.
For example if the joint is injured through a fall or hypermobile through general hypermobility (over manipulation in many cases) then you can correct the joint as much as you like BUT the chances are in will revert back to its normal position. This is why I believe its very important to consider the muscles and ligaments surrounding the joint - if they are weak this needs to be addressed. This is wehre I beleive many professionals fail along with using inappropriate techniques to manipulate the joint. If the joint is injured or weak then the classic forms of manipulation will just add to that instability although there is often short term pain relief.
I read one story of a patient receiving approx 130 manipulations on the SI joint by the same "manipulator". Initally the patient would gain relief but pain would return after a few days. Over the course of treatment the peridor of relef gradually reduced as did the time that the patient could hold a correction. What really worries me was at what point the practitionaire was going to realise that the problem was instability fo the joint and that continued manipulation was just adding more instability? I read many stories like this
What are your thoughts on form and force closure?
Its sad to read that many years ago SIJD was thought to be the cause of the majority of back probelsm and even the main cause of disk degeneration but somewhere along the line it was forgot about and disk pathology became the main avenue of investigation - how many people with back and refered pain have any significant findings via MRI scans (the so called gold standard of investigation back pain)? How many DR hand out the "mechanical back" diagnosis when an MRI returns negative findings?
Luckily SIJD is starting to return to the forefront of back problems - although often only after a negative MRI. SIJD is becoming more recognised once more BUT still not many people really know how to treat it. Many of the Dr's who do belelive in it are retired and their methods have been forgotten somewhere down the line which is tragically sad.
Thanks
ian


Ps what are your thoughts on pateints whith no difference in alignment between right and left SI but still showing signs and symptoms of SIJD? Is it possible for the SI to be in alignment but just chronically strained/unstable?

 

[godless]

Hi ian and expatient
you both put very interesting points and I myself am concernedby the overuse of high velocity thrusts to deal with SIJD.

Myscope of practice is purley soft tissue work (no HVT)Ifind;-
The problem typically starts with the left hip = pain = weight transference to right hip = right hip pain worse than left. This weight tranferance becomes engrained
into the biomechanics =body cannot now transfer weight equally or back to left hip.Which in turn leads to many many different pain problems.

Myhunch is that (developmental SIJD)begins the day that as children we begin to sit cross legged.Once it becomes an established patternsitting crossed legged for long periods (with the same leg over the other)so begins the rotation of the ilium and the effect on the hip rotator muscles/sacrotuberous ligament.

Regards steve

 

[Sarah ~~x~~]

Thanks for the post Steve
Re HVT. My view if a joints come out of alignment and HTV only temporaraly "readjust" the joint then the problem is instability of the joint which HVT will only make worse and can even create perminant instability. I read paper in the Journal of Orthopeadic Medicine that the classic side lying manipulation technique "opens the joint up" and places great stress on the Long and Short Posterior SI Ligs and if the ligs are already slightly overstretched it cause the ligaments to go slack….
Im reading many posts from pateints all over the world who have had SIJD made worse/perminant by HVT techniques - im one of them! I know that this is not medical evidence BUT if is happening to many people around the world then it can't be discounted as being impossible like many claim it is.
Worrying there are still those sticking to the school of thought that the SI joint can't move at all so is imediately rejected as a possible cause of back problems
Interesting Theoy about the crossed legged - crossing the leg does open the joint up slightly so it could be possible for ligaments to lengthen over time if kept in this position of a reg occasion.
I red an article from Richard Dontigny stating that SIJD was higher in leg used to push down on the accelerator - although do not think this was significantly proven.
Have you read much of Dontignys work? He has a seminar/workshop coming to the uk over the next year. I'll get the details if your interested as will be in london and don't think his workshops will be coming over here much again as hes getting on a bit!
Cheers
ian

 

[Jay John]

Wow! You both write a lot of good thoughts. That is a refreshing change. Usually all "experts" focus on proving SIJD does not exist even thousands of patients in Internet forumsask help after getting that diagnose, usually after years of seeing many different experts...

I quess mostof those diagnoses are based on pain in one or both SIJs. Most of thosediagnosis are wrong! Pain can be anywhere and most often it is far away from SIJ that is causing it!

Pain is only a symptom of misplaced/subluxated/slipped SIJ, as well knows as upslip/malaignment/misalignment/sprain/locked/blocked/... SIJ. Many names for that baby!

But pain is not always where the problem is. Like almost all skeletal problems: If you have tension headache the cause is not in your head. If you have ischias pain in leg, the cause is not in your leg,...

I have met many patients who have no pain at all in SIJ area or sometimes even no pain at all in low back area but perhaps on hip/knee/foot. Even ischias pains, knee bursitis, ankle pains and many others have gone away after correcting SIJ positions.

Now back to your replies:
Darren Higgins have visited herein Finland (at least) twiceas an educatorand both times a national magazine for PTs wrote something about that. And both times very interesting articles conserning SIJ problems. But they are in finnish language... I am very disapointed that nothing written by Darren can be founf from Internet. Those articles were exellent, even they were veryshort and only describing some of histhoughts...

There are techniques for "correcting" SIJD that are not so good. But for some patients they work. For some they make things worse: damaging ligaments? How to tell when it is bad for them?

I received 3 times a manipulation treatment by an old chiropractor. (He told that about 80% of all people have that lock and it causes troubles to spine, legs and muscles. I agree him!) He opened my SIJ block with chiropractor's technique. It was a success and all my pains were gone. But every time on following night while turning my self while sleeping I felt a click sound in my SIJ area and pains came back. Ofcourse I woke up for that. Something moved?

But thenI went to an other place and got SIJ corrected by a technique more as mobilization that manipulation. And it helped and the correction hold for months!

(here I have to mention that only very few chiropractors know how to treat and open SIJ locks. Most of them don't even believe on that problem as I have found out in Allen Botnick's anti-chiropracics forum. Again they said no SIJD exists)

So I believe every case and body (ligaments) is different and everything is possible. You just have to find a treatment technique that is best for you. I am not sure that mobilisation technique would have alone be the one but after chiropractic treatment it worked.

Chriropactors only open the lock. Usually it is not enough but sometimes it is. Why? I don't know... I have met many patients to whom one treatment is the God's answer to pains for yearsand at the same time some patients have to seek exactly the same help once a month because their SIJ holdsonly few days or couple of weeks. Why?

I have to ask [link=http://www.healthypages.net/forum/showProfile.asp?memid=1774]stephen jeffrey[/link]from his hypothesis: If SIJD is a result of cross legged sitting: so why it comes usually only to one side? And can it come toboth sides? And which side is more common and why?

Sorry now I have to end this message. Please ask again if you still want to hear something from me. I have other forums and many e-mails to respond... I only visit these "foreign" forums when I have time...

 

[jak.]

Hi Expatient,
as we grow into adults and over time the cross legged sitting becomes more favoured to one side only.The muscle shortening of that one side continues the habit untill pain is caused and treatment sought.

If you are hypermobile then crossing of either leg in equall frequency is not uncommon.Its your subconcuose search for stabilty (caused by shortened muscles and weak core) which can even lead to the foot of the crossed leg then hooking underneath the calf muscle of the other leg (the double wrap round and increased likelyhood of scoliosis).

You are absolutely right when you say everyone is different and responces to treatment vary from person to person. But can it be right to use high velocity thrusts month after month ?

SIJD may evolve from many different causes, the above theory is only offered as to explain why it may be so commonly evident in low back pain.

Regards steve
PS Thanks Ian I will PM you shortly, sorry its taken so long.

 

[emma(:]

I have never sit like that.
Which leg gets shorter if one sits more often with left leg grossed over right?


Why? I don't.

 

[just one thing]

I've posted this elsewhere, but it's worth repeating here, there seems to be a bit of a campaign on these boards about SIJD at the moment, it is NOT the be all and end all of mechanical pain, and beware of any practitioner who thinks that it (or any other problem) is. It can be used as a differential diagnosis in many many cases, and may be part of teh cause, but using it a diagnosis#1 for every patient means you've got a lazy therapist. It comes under the quote in my signature

As a chiropractor, I would be amazed at any colleague who doesn't know about this, but probably calls it something entirely different. I for one, have never (that I can recall) used that set of initials, so wouldn't immediately know what they were if someone came to me with that as a previous diagnosis.
I would also query the validity of the link I followed ("this is SIJD"), it's an article on one person's oppinion, and is very subjective.

I assume that when you are talking about "doctors" you're meaning GPs, who tend to know little about biomechanical medicine, as it doesn't fit with their training, until relatively recently there was debate (in orthodox medicine) as to whether the SI joint was even a mobile joint (as opposed to a fused suture).

 

[Kev]

Thanks for the post

Im a nat standard distance runner and have came across many many athletes and freidn who have had "complex" long term biomechanical injuries relating back to the SIJoint. In my experience of on a day to day basis speaking to injured athletes it would seem that problems with the SI joint have often been overlooked - in some cases for many yrs.

By no means am i saying the SI joint is the cause of all back problems BUT i've seen many many people frustrated for many many yrs because of a lack of understanding of this type of problem " it should not move" its impossible to become unstable etc etc

in my experience of distance running and spending time with many injured athletes it does seem to be more common BUT distance runners are probably not a good representation of the general population!

any thoughts on this?

 

[An internet weirdo]

It looks like you're talking about the problem I mentioned in the final paragraph.
I believe that Gray's anatomy only acknowledged that the SI joint was a mobile structure, as opposed to a fused structure in the late 80's / early 90's (any anatomists out there care to correct me?) so any Dr's educated up to that time would be of that opinion.

Out of interest, how would you know that a chronic, complex biomechanical problem came from the SI joint then spread, rather than somewhere else, then spread to the SI joint?
I agree that it's overlooked in orthodox medicine, but I'd be shocked if it's overlooked by chiropractors/osteopaths; in fact, in my experience, it's over-diagnosed by lazy practitioners, who simple give that as the diagnosis for everything (I've worked for one, and locumed for others). That is bad diagnostics.

As for your final comment, yes, you would expect long distance runners to have a higher than average incidence of SI joint problems, purely by the nature of what they do (requiring high mobility in the joint, and then adding a lot of repeated, heavy impact loading)

 

[Mr.Pants!]

I can see you guys are professionals or patients - I agree that there still exist professionals who are either lazy or arrogant and that I also came across a respected orthopedic specialist in a pro sports injury clinic that was adamant it was not possible to injure an SI ligament - well that experience has provoked me to write this long but perhaps entertaining post !!!

I am aski instructor by the way !!


Do not give too much credibility to people who do not recognise that their own knowledge is limited.....especially when they are giving you advice about your health !!!


I am staggered by the attitude and arrogance of some doctors and physiotherapists (and even professional national sports team medical advisors - for example look at the reaction by the US Ski Team medics when Bode Miller, Eric Schlopy, Bryon Friedman all had prolotherapy and rave about it's success !) who dismiss certain treatments and ideas simply because they do not know anything about them. The one's I am thinking about use their own lack of knowledge as an argument as to why something cannot possibly exist or work. They know who they are, don' they ??

I find their arrogance mind boggling - their arrogance is only exceeded by their ignorance - beware !

I am particularly referring to conversations I have had about the treatment called Prolotherapy or Sclerosant therapy.

I have spent 3 years researching the treatment and during that time have been treated with astounding and rapid success - and I speak from experience of talking with many medically qualified people and patients ......but I know I can only be sure of what I have experienced..not what I have been told, read...or not read for that matter !

In my experience the most arrogant and dismissive "qualified" people with whom I have had conversations have been General Practitioners and Physiotherapists - these are people who hold a position of respect in society and to whom people look to for advice about their health. Ironically, they are the "medical" staff who require and go through a much shorter training than the doctors that I know who administer prolotherapy. They have considerably less (if any at all) experience in diagnosing and treating musculo-skeletal issues. Many GP's spend most of their time dealing with headaches, earaches, flu, period pains, depression, pregnant 15 year olds etc etc etc...they probably get to see an MRI scan once a year...if at all...and may not have a clue what they are even looking at - some admit this of course but many do not !

So when a physio (with their 2-4 yrs training under their belt) or a GP (with their 5-6 year training) , tells you that something is impossible just because they have not been taught about it (or because no drug company has sponsored it !!!)..question why some orthopaedic surgeons - who have taken possibly 14 years to get to the point where they can start to practice independently - who have had the same training as the GPs and physios at the beginning of their career, then studied much further for much longer, then specialised and focused in particular injuries and conditions FULL TIME...who then also often go on to study and qualify as Osteopaths....a further 4-5 years ( so now we have approximately 20 years of study and hands on experience in specific medicine and LIFE)...just ask yourself who is likely to have the greater knowledge...and strangely, the people to which I am now referring are open minded and curious.

Maybe the above-mentioned arrogant sceptics do not know that (and I quote..) "the American Association of Orthopedic Medicine
AAOM) promotes Orthopaedic Medicine by teaching doctors integrative diagnosis techniques and comprehensive/ integrative nonsurgical treatment methods including proliferant injections (prolotherapy), steroid injections, fluoroscopic spinal interventions, osteopathic manual medicine, therapeutic exercise and interventions with various pharmaceuticals/nutriceuticals/ herbal/ homeopathic based treatments."......well maybe these sceptical GPs and physios should be questioning why they have not read about it..why they have not informed themselves of what treatments are successful at treating their potential patients...why they have NOT
kept up with their own profession...mmm ??? Think about it !


The problem in finding a prolotherapist is that there are very very few of them. This is because the skill set and legal qualification required is much greater than just becoming a "doctor" or just an "osteopath" and certainly much greater than just a "physiotherapist"....after all...on paper...a physiotherapist when compared to the doctors that I know who perform prolotherapy..is like comparing the mechanic at your local
Ford garage with Ernst Fuhrmann, the man who designed the incredible, world beating Porsche type 547, 4 cam roller bearing engine for the Porsche 550 Spyder in 1954 - you get my point ??? One knows what goes on..the other needs to be told what to change and how !!

Okay - I know you are not all like that...and apologise to those who are not but choose to be offended......but I bet you know many who are !!

To be a good prolotherapist you need to specialise in musculo skeletal issues (so you are probably an osteopath - incidentally prolotherapy was part of the osteopaths training until the 1960's when the law changed so you then had to be a qualified medical doctor to treat people with the long needles used in prolo - so it was dropped from osteo training because they would never be allowed to do it unless they went on to become a doctor..another 5-6 years training...""oh oh..long time before earning any money..I will stick with just being an osteopath thanks")...so in the UK at least, you really have to be a medical doctor legally and in order to have sufficient knowledge in musculo skeletal issues...an osteopath too....this is before you really get any real life hands on experience...at the minimum.

Then to be any good.....you still have to have a great deal of experience even to accurately diagnose the problems...most ligament and tendon issues are not visible even on MRI (in fact especially on an MRI !!!)

You also need to be very sensitive with your hands and have natural skill and a steady hand....very steady hand...and be very confident...have you seen the needles and where they go ?????? Wow ! I have, I felt them, in my case they didn't hurt because I was treated by someone who had been doing this non stop for 35 years, a qualified doctor who then qualified as an osteopath having been treated by one and amazed by the result, then was treated by prolotherapist and further amazed by the result (and remains totally cured of the problem 35 years after the treatment !) - and so studied that technique too.This man has been the president of the British Osteopathic association and an examiner at London College of Osteopathic medicine.

Now..there are at least 2 orthopaedic surgeons that I have spoken with...remember they require much longer training than even my doctor !!...who treat with prolotherapy in place of surgery in many cases, they still research prolotherapy and they TEACH IT !! These surgeons practice at the ROYAL ORTHOPAEDIC HOSPITAL in the UK.....and still I hear some GP s or physio therapists say..."Prolotherapy cannot work because I haven't read about it, I haven't been taught about it so it must be rubbish...." Ie...they know NOTHING about it...but they insist that their own lack of knowledge proves that something doesn't exist !!

Well....what would you think of me if you asked me what I thought about your favourite book and I said - I haven't read it, I don't know anything about it - it's rubbish - would you consider me very credible ?


If anyone is interested I will be happy to tell them my case - and all the very expensive "specialists" I went to see - none of whom could fix me..or in many cases couldn't even see anything wrong despite MRI etc and them being orthopaedic trauma specialists in their own right..but had no knowledge whatsoever of prolotherapy - the treatment that has fully repaired my problem ( these qualified traumatologists and orthopaedic surgeons were very interested to read the information I had discovered and asked me to return to their clinic in Spain after my treatment in the UK to tell them about it - of course I did and they are now looking into it in detail).

I would love to share that story with any of you !

Do your own research - do not believe the first thing you read - do not believe the 100th thing you read - do your own research - talk to as many people as you can - find people with experience not uninformed opinions - find people who have had it and done it - then decide what to do.

Remember when you read an article and it says "experts say this , experts say that "...look up the definition of an expert - my friends from Argentina define an expert as somebody from the next town !!!!!

There is no doubt whatsoever that....

if you have an accurate diagnosis

if the injury is appropriate for prolotherapy - many are !!

if administered by a skilled and experienced therapist who uses the correct solution and gives enoguh treatments spread over the optimum timescale

if the patient follows the therapists advice regarding eg:
non use of antiinflammatories, diet...reduce sugar for example increase vitamin C, correct exercise

if the above situation applies...there is no doubt that prolotherapy is a natural, harmless complete and permament cure that in many cases leave the patient even stronger and mechanically more stable than before their injury.

It is such a shame that there are so few practitioners because 90% of people suffering today with arthritis and arthrosis pain, damaged discs and cartilage, damaged or just old, worn and loose ligaments could have their pain eliminated permanently - and save the NHS enormous amounts of money - the treatment requires skill and training but the material to do it costs nothing...a syringe, needle and simple solution of sugar, water and antisceptic..it takes half an hour and you just wlak straight out...no hospital time !!

Think about it - ask for it - make them make it available !!!

Good luck.

 

[nnqieoyv]

alls i know that SI joint instability was quite common in distance runners in one of the top high performance athletics institutes in the UK (hundreds of athletes living on campus training v hard)

patterns of groin, hamstring and calf injuries were solved by stabiliasing the 1 si and pevlis in general

everyone used to drive down to a v experience physio in northampton to get these issues revolved (took a long time to stabalise the joint in many cases). all the top bods at the institute of sport and british olympic med centre were pretty usch oblivious to these problems.

this was just a small sample of a few hundred athletes so not sure how wide spread these type of problems were

not medical fact i know but it happened

 

[friend to everyone]

"Out of interest, how would you know that a chronic, complex biomechanical problem came from the SI joint then spread, rather than somewhere else, then spread to the SI joint?"

resolving the Si instability resolved the lower limb injuries. can only put 2 and 2 together in this case and have no medical proof that it was the SI causing the problems

 

[Andrea Krawchuk]

Sorry posted twice

 

[Michael Myers]

Hi Ian
is the physio in Northampton a maverick or unorthodox ?
I dont understand if his methods are so successfull why they would not be addopted by other top sports physios?

Regards steve

 

[illisareura]

Nope the total opposite.


He very experience in dealing with endurance athletes, dancers and gymnasts where pelvic stability is very important. In fact i only just learnt that he spent his first 5 yrs of private practice working with elite gymnasts and dancers so that pretty much exmplaines why hes v experienced in pelvic and trunk stability - these performers are generally very hypermobile BUT at the same time have very good core strength which can cope with such hypermobility. He trained in physio and then did a post grad course in advance physio at london medical college and then went onto study biomechanics and manual therapy.

Its widely accepted in the world of athletics that many overuse injuries come from pelvic instability - biomechanist, physio's, sports physiologies/scientics have all studied, testing - all been extensively testing from scientifin point of view. just because someone with a first class honours degree has not research this.....

Most physio work from this point of view but he is just better at tackling long term injuries. He will work through every possibility of whats causing/preventing an injury to heal. He will not draw people in by saying i know what the cuase of this problem is and can fix it in a few sessions. The fact is many long term injuries have multiple causes and all need to be addressed for the problem to be fixed. He's very experienced at working like this and just that much better than anyone else i've seen and i've seen some excellent physio's

Rememing that my problem was from running 80 miles a week. If i was the average person i would be fine and calf would not bother me (it only used to come on really bad after 30 mins of faster running but as a distance running i needed to do upto 2 hrs of training a day + i could not do any speed work). All the scans and test by the so called best sports dr's in the county came back clean and one even offered me an expolatory op to try and remove any scar tissue!!!!!! (it makes me sick thinking about it).

Finally the one of the coaches at the endurance centre of excellence in the midlands told me about the guy in northampton and at the time he actually worked for the institute of sport - i was mad that for the past few yrs they and been sending me down to london and up to leeds when the main man was at northampton and used to come up to treat athletes at the high perfroamcne centre where i lived nr (again it makes me really angry).

He did a very detailed examnination .looked at all my scans, test results, previuos treatment etc. He had me going over force plates and doing specific strength endurance tests that had been developed for athletes. He thought there has to be some reason why a calf injury is not fully recvering when there is nothing clinically wrong with it (as proved by scientific tests!)

The major findings he found from the test that my pelvic stability and control was quite poor even for a non sporty person. He talked about the tranfering of forces through the body going the running action and the role that the pelvic played in absorbing this force and transfering force through out the body. for someone who was constatling stressing their body ranges and values form the general population do not apply. Just like an average Haemoglobin blood count could be low for a distance runner (boy how many of us have had that problem being told our test are coming back in within the normal ranges by the local DR's) the having to present clinically proven scientific evidnece that in fact the normal range for an endurance athlkete is much higher!!!!!

He came up with a number of possibilites of what could be stressing my calves and worked through them.

He's very highly regarded within the sports world (and infact by many well known orthopeadic dr's, professors etc)but you get idiots on here who've fallen into the education trap (think that becuase they have a first class degree they know everything) claiming this is pure quackery!!!

whats the world coming to

 

[sephienie]

a couple of case studies from his website. I oike the bit how its important to include the patient in the treatment process

"Back, rib and shoulder pain case study


This case study involves a 28 year old lady (Ms P) who had a 7 year history of right sided pain half way up her back and under the right shoulder blade. The pain was not becoming worse or improving but she recently realised that she was fed up with it and wanted to see if anything could be done.

She described 2 pains:
Pain 1 was a diffuse ache, present most of the time under the shoulder blade. It was aggravated by sustained postures, i.e. sitting or standing for any length of time. Keeping moving or lying down would ease it.
Pain 2 was an intermittent sharp pain approximately 1 inch to the right of her spine. It was a brief pain brought on by twisting, reaching up or lifting.

These pains started 7 years previously after seeing a therapist (not a Physiotherapist) for a lower back problem. That Practitioner had manipulated her spine all the way up quite forcefully and the pain occurred at this point. She had not gone back for a follow up visit.

Ms P was naturally concerned that no such manipulations be performed this time. She was reassured that this would not happen and that I would seek her consent to any treatment after fully explaining the nature and purpose of the treatment.

Past Medical History: nothing relevant.

Medication: only anti-inflammatory tablets as required.

Social History: Teacher. No children. Swims 3 times a week and uses a gym once a week.

Initial Thoughts
Due to the cause (being a forceful manipulation) the location, and the nature (description) the sharp pain was likely to be from a joint dysfunction. This is where , for any reason, a joint is not operating as it should. In this instance it was likely to be a spinal facet joint or a costovertebral joint (where the ribs join the spine).

The ache was likely to be muscular or referred pain from the spinal joint.

Initial Examination

This showed no observable scoliosis or other spinal deformity. The muscles to the right of the spine were more tense than they should be and there were a few tender places in them.
Movement testing showed no restrictions in the cervical (neck) and lumbar (lower back) spine movements. Thoracic spine (mid back) movements were painful, especially backward bending, twisting right and side-bending either left or right. The most restricted movement was twisting to the left.

Arm movements caused both pains when nearing full elevation. A deep breath in caused pain 1.

Treatment

Treatment initially was to relax the muscles on the right side of her back. This eased the ache and allowed a more thorough spinal assessment. The further findings were that accessory movements of the 4th, 5th and 6th thoracic vertebrae (T4-6) and the right 5th rib gave pain. Also, T5 was stuck in a right rotated position.

Ms P. was informed of the findings but the vertebra was not directly treated in this first visit due to her previously mentioned concerns. Instead she was taught 2 exercises to try to address the problem. 1 of these was to begin to twist that area to the left.

2nd Visit, 4 Days later.
Ms P. reported an improvement in the ache for a few days after treatment but it had started to come back. The sharp pain hadn’t changed.
On examination: the muscles were again tight on the right side. Once these were relaxed off it was clear that the T5 problem hadn’t changed.

Commonly this is an area that responds well to more forceful manipulative treatments but due to Ms P’s past experience it was decided to use a Muscle Energy Technique (MET) to realign her spine. This is a more gentle technique that uses the patient’s own muscle contractions as the force and usually feels more like a good stretch. The technique was used 3 times, each time allowing a greater degree of left rotation.

A new home exercise was given to increase the amount of stretch incorporating left rotation, side flexion and forward flexion. We discussed the impact of her daily activities and it was discovered that 2 things were probably not helping: sitting on the settee with feet up and looking to the right every evening; and that she also turned to the right at the end of each length when swimming. We agreed that she should avoid these for a short while.

3rd Visit, 1 Week Later.
Ms P was delighted with her progress and both pains were 60-70% better. There was no pain on breathing or reaching up anymore and she described her back as “much freer”. She actually came in requesting the same manipulation that we did last time! After examining the area it was clear that this was still the appropriate treatment but the muscle treatment did not need doing – it had stayed relaxed for the week. The left rotation range was ¾ of what it should be (a good increase from where it had been).
The MET was repeated and left rotation then was equal to that right. Her home exercise was checked to ensure she was doing it correctly.

4th Visit, 1 Week Later.
Ms P reported being “95% or more” better with no ache and had only felt a few hints of pain near the spine. The treatment was repeated a further time and she was checked to make sure no other problems were present. We did not book a further appointment because I expected the remaining discomfort to disappear over the following 2 weeks. She was to rebook if any symptoms remained but has not needed to.

Thoughts.
I feel that there is often too much acceptance of being in pain. This can be due to fear of treatment as in this case. Sometimes people believe they will not get better but they have not explored all the options.
There are usually a few treatment options for any given condition.
As Physiotherapists we feel it is important:
-to look at muscles as well as joints
-to think about the patient’s everyday activities and postures
-to try and include them in the treatment process"
Lower back pain case study

"This is the case study of a 38- year old fit and healthy gentleman, who presented with an acute onset of severe lower back pain, an extremely common injury that will affect approximately 60% of us at one stage or another in our lives.
What follows is a basic account of my management, which demonstrates the importance of a thorough assessment and a close working relationship with local Specialist Surgeons to enable the best outcome possible in the shortest space of time.

Subjective Questioning

Problem: Constant, unremitting lower back pain, with shooting pain into the left leg from buttock to heel. He also reported the presence of pins and needles in his heel.

Aggravating factors: Any static position aggravated his back and leg pain if sustained for over 10-15 minutes.

Easing factors: There was nothing that he could do to ease his symptoms.

24hrs: He reported difficulty sleeping, but no significant difference pattern to his symptoms.

Special Questions to Exclude Serious Pathology: No alterations to bladder and bowel function, no sudden unexplained weight loss, no night-time fever/ malaise, no pins and needles/ numbness in groin region, no significant loss of leg strength.

History of Problem: A sudden unexplained episode of lower back pain and leg pain, that started 8 weeks ago. He reported a history of 1-2 episodes of localised lower back pain and occasional low-grade leg pain, but nothing ever of this magnitude.

Social History: Business man, who was normally very active and enjoyed playing rugby socially and running regularly.

Past Medical History: No medical problems of note.

General health: Good. No cardiovascular nor respiratory problems, no family history of lower back pain, arthritis, diabetes, epilepsy

Drug history: Due to the severity of his symptoms, his GP had prescribed strong pain-killers and muscle relaxants.

Objective Examination

Observation: Unable to maintain any position for longer than 1-2 minutes

Active movements: (Patient performed) Restricted and painful in all planes, especially flexion, which reproduced both back and leg symptoms.

Passive movements: (Physiotherapist performed) severe muscle spasm prevented an accurate assessment of segmental spine movement

Palpation: Local tenderness at the distal two joints of the Lumbar spine (L4/5), with widespread muscular spasm. Palpation of L4/5 elicited left leg symptoms.

Neurological Tests: Reflex testing, sensory and motor testing was normal and symmetrical side to side. There was evidence of significant sciatic nerve irritation when stretched

Analysis of Pathology
His symptoms led me to believe that he had intervertebral disc prolapse at L4/5, causing compression to the sciatic nerve root and leg symptoms. It was likely that his condition would become more serious if it was not managed quickly.

Initial Management
Immediate referral to an Orthopaedic Consultant in Northampton.

Orthopaedic Consultant Assessment
This gentleman was referred to a local Orthopaedic Consultant, who specialises in Spinal injury. Following an MRI our suspicion was confirmed. The scan also identified that a small part of the disc’s contents had leaked out, known as a sequestration. On discussion with the Consultant a surgical procedure was performed to remove part of the disc and stop the compression of the nerve.

Post-Operative Physiotherapy
Following a brief stay in hospital (4 days), the patient was re-referred to the clinic for post-operative care.
We have since been working on the following agreed goals:
1. Restoring full range of movement of spinal joints through local mobilisation, manipulation and active stretching.
2. Developing the strength and co-ordination of the local spinal muscles, which serve to protect the spine from injury. Evidence has proven a link between the education and strengthening of these muscles and a reduction in back pain. It has also been shown that these muscles will deteriorate quickly with pain and following surgery. They are best educated with a gradual specific strengthening program.
3. Restoring normal nerve movement along the length of the sciatic nerve, with nerve mobilisations and local soft tissue techniques.

Following six weeks of Physiotherapy, this gentleman is now resuming a running program and is left with only an occasional mild buttock pain, which I am confident we can eradicate with ongoing treatment.

It is now our plan to introduce sports specific rehab to enable him to resume rugby playing in the near future."

 

[yatakoyfuh]

does a lot of injury prevention of screening of athletes.

Biomechanical Assessments
The Assessment can be described as a Full Service for the musculoskeletal system. It is a snapshot of your body far beyond a basic gym fitness test or running shop treadmill assessment. It is specifically aimed at the athlete but can be adapted to any sport or occupation. We are looking for areas of potential injury - short or long term, as well as areas in which performance can be enhanced with some specific remedial work. This will be discussed in detail and a plan formulated. The work will mostly be in the form of exercise or possibly combined with a treatment programme. To get the most from this procedure it is strongly advised that follow-up visits are organised to check on progress and to adapt the program. The assessment itself will not benefit you--it is the work that is done as a result of it.
The history of this process dates back to the mid '90s. Mark Buckingham was involved in the evolution of the Screening Program for UK Athletics and Phil Pask and Mark also developed the same program for England RFU in the build up to the 1999 World Cup.
The two hour assessment will start with a Musculoskeletal Screening which systematically works through the spinal and limb systems looking for areas of tightness, weakness, hyper and hypo-mobility. Muscle Imbalance, neural tightness and basic control of the joints will be examined. We then move to a progressive Motion Control Assessment from basic standing and walking through to a full Video Gait Analysis and sport specific movement profiling. An Isokinetic Test will be performed on one area of concern to give exceptionally detailed information on that problem.
Following the Assessment your physiotherapist will take you through the findings and discuss a plan of action. The plan of action could take the form of further physiotherapy sessions to work on problems and exercise work to be done by you or under supervision. It may also be decided that further investigations and opinions need to be sought.
The physiotherapy plan of action will be set out in stages with clear entry and exit criteria set for those stages. The first stage will be set in motion on the assessment day and arrangements made to follow-up when appropriate.

 

[stanford.designer]

Hi Ian
this guy really sounds the bisiness, a 2hr assessment should make for little chance of a mis-diagnosis.
Does he have any printable veiws on overuse of HVTs on the SIJ ?

Regards steve