RE: Pelvis - quilty of causing LBP
I have read, EXPATIENTS' posts and replys with great interest and am certain that I have a similar problem. Anteriorly Rotated Left Illiac Bone. This has almost certainly caused me endless back and diskrelated problems. I have also been looking at the Richard DonTigney self help excercises. I am a little confused and would appreciate some advice.Whenworking through the DonTigney excercises, it is indicated that both SIJ are corrected. But if only one SIJ is causing the problem shouldn't that SIJ alone be corrected, instead of both?
Please advise:eek:
BERNI
RE: Pelvis - quilty of causing LBP
DonTigny excercises can give some help, but not for all. Manipulative treatment is sometimes needed. Some old osteopathians could know how to help...
RE: Pelvis - quilty of causing LBP
Dontignys theory is that most SIJD are on both sides - often one side more that the other. he states that you can't get a full correction without doing both sides.
check out the kalindra website - it has a forum and mr dontigny himself answers lots of posts...
where abouts in the uk do you live? dontingy is coming to the uk very soon to do a workshop
carefull when finding someone to treat you - many use the side lying technique where they twist you should one way and hip the other. you usally get a loud clunk
dontogny states thta if you have SIJD it can make the problem worse as it stretches the ligaments around the joint which may already be loose. i can vouch for this as my right si was damaged using this technique
the SI joint is greatly under recoginised as thecause of back problems
RE: Pelvis - quilty of causing LBP
ORIGINAL: iant
Dontignys theory is that most SIJD are on both sides - often one side more that the other. he states that you can't get a full correction without doing both sides.
And as I have interviewed tens of patients who have been doing his exercises for months, many have got worse. My explanation on that is that if you have only other SIJ dislocated you can cet help form DonTignys excercises. But if you have both SIJs dislocated your situation can get worse because with DonTignys excercises you are twistin your pelvis even more mispalced... That is why about 70% of patients get help from his excersise and the rest gets worse. Those 30% have got help from manipulative treatment...
ORIGINAL: iant
check out the kalindra website - it has a forum and mr dontigny himself answers lots of posts...
I am very familiar to that place...
ORIGINAL: iant
carefull when finding someone to treat you - many use the side lying technique where they twist you should one way and hip the other. you usally get a loud clunk
I totally agree. That technique is used by chiropractors, osteopathians and many others. It only opens the lock that results from misplaced joint. But many times it will get locked again soon after that treatment. Opening the "lock" is not enough. You need to balance the pelvis from other problems too.
But with DonTignys excercises only few patients will get SIJs corrected. Most of the patients will only get some stretching to muscles and result of that isa relief to pains. Most pains are from muscles and stretching helps...
ORIGINAL: iant
the SI joint is greatly under recoginised as thecause of back problems
If only people like you would be more active and write more about it...
RE: Pelvis - quilty of causing LBP
Expatient,
My post was directed to the previous post berni - the kalindra site is a great resource. Your right Dontignys methods are NOT the only way to correct SIJD. In your view is it possible to have a posterior rotation of the ilium on the sacrum or is this a secondary sublaxtion at S1 as Dontingy states after the primary anterior rotation at S3?
Do you believe that a anterior rotation is the only possible type of SIJD or do you disagree with Dontigny on this?
I enjoy reading your debates on forums all over the net and am shocked that there is still a great number of medical professionals who do not believe SIJD exists or the SIJ accually does move at all.
I am a regular poster on a distance running injury forum and am amazed at the amount of people who are describing SIJD but not being treated for it ie the classic leg length dispreancy being treated by a heal raise and just adding to the problem. Luckily many phyios in the uk are starting to look at the pelvis in the primary assessment although many of not educated how to treat it unless they go on to post graduate studies in biomechaincs and manual therapy
What are your views on prolotherapy to help strengthen up ligaments around the SI joint that have become chronically slack as a result of SIJD or over manipulation?
Thanks
ian
RE: Pelvis - quilty of causing LBP
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:
- 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.
RE: Pelvis - quilty of causing LBP
ORIGINAL: iant
Do you believe that a anterior rotation is the only possible type of SIJD or do you disagree with Dontigny on this?
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...
ORIGINAL: iant
I enjoy reading your debates on forums all over the net and am shocked that there is still a great number of medical professionals who do not believe SIJD exists or the SIJ accually does move at all.
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...
ORIGINAL: iant
I am a regular poster on a distance running injury forum and am amazed at the amount of people who are describing SIJD but not being treated for it ie the classic leg length dispreancy being treated by a heal raise and just adding to the problem.
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.
ORIGINAL: iant
Luckily many phyios in the uk are starting to look at the pelvis in the primary assessment although many of not educated how to treat it unless they go on to post graduate studies in biomechaincs and manual therapy
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...
ORIGINAL: iant
What are your views on prolotherapy to help strengthen up ligaments around the SI joint that have become chronically slack as a result of SIJD or over manipulation?
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!
RE: Pelvis - quilty of causing LBP
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?
RE: Pelvis - quilty of causing LBP
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
RE: Pelvis - quilty of causing LBP
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
RE: Pelvis - quilty of causing LBP
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 [url]anti-chiropracics forum[/url]. 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...
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.
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.
I have never sit like that.
Which leg gets shorter if one sits more often with left leg grossed over right?
But can it be right to use high velocity thrusts month after month ?
Why? I don't.
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).
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?