Acute Back Pain (never experienced before)

[Vampire Lord]

what does that prove?

the fact that there is still debate over whether the SI joint has any movement or not is a prime example of how medicial science is lacking in this area.... If there is such a wide lack of understanding of the kinetics of the joint then how do you assess it and treat it?

i spent 6 yrs studying exercise physiology a huge lack of scientifically proven fact. ie still huge debate of whether altitude training improves endurance performance or not. so so many variables

 

[Mary P]

I don't think there is any debate about whether the SI joint has movement. That is the whole point of a joint. If the pelvis was a rigid ring it would fracture if you jumped up and down. The SI joints provide some "suspension" and shock absorption. There is also no doubt that degenerative changes occur and that some people have inflamation of the SI joints. It's called sacroiliitis and can be imaged with isotope scans, CT, MRI, PET scans and plain x-ray and it causes pain. However it doesn't cause pain in the shoulder or the calf so if you had this and someone told you it was your SI joint you have been duped. Presumably money changed hands.
I suggest you read: Why Bogus Therapies Often Seem to Work

 

[tea party]

"It's called sacroiliitis and can be imaged with isotope scans, CT, MRI, PET scans and plain x-ray and it causes pain. However it doesn't cause pain in the shoulder or the calf so if you had this and someone told you it was your SI joint you have been duped. Presumably money changed hands. "


thats just pathetic. sacroilitis is not the only possible problem with the SI joint...

the kinetics of the joint can have an affect all over the place. the lat dorsi, and errec spinea all have insertions around the SI joint. When the joint became unstable those went into spams. I caould have them massaged out all i like but they would just tighten up again. Once the SI was stabalised the muscle spasm went

I don't care if you think i was duped - stabilising the SI joint out an end of years and calf, hamstring and shoulder problems (only took 4 sessions over 5 months). If thats being ripped off then i wish people would rip me off more often! im just very angry that i wasted thousands of pounds on useless scans, injections and other test that the so called cream of the crop threw at me

with this attitide no wonder why there are so many people suffering from long term back problems

 

[Maika H]

I'm glad you are better and I am genuinely interested in how the SI joint was stabilized. What sort of metalwork has been inserted or do you have to wear an external scaffolding screwed into the sacrum and iliac wings?

 

[Steve F]

force and form closure?

 

["Kh a a a a a n n" ! !]

Sorry you will have to explain what this is.
I note from your previous posting you were looking into prolotherapy.
I thought you might have had this done. There is some evidence for this from controlled trials but it works as well with saline as dextrose and no-one knows if there is any advantage in other mixtures. The idea of inducing healing in tendons and ligaments by needling is used in conventional orthopeadics but it is a big intellectual jump to firstly claim that SIJ is the cause of symptoms, that the symptoms are due to hypermobility and that prolotherapy reduces the hypermobility when there is no objective evidence for any of these statements in most people.
Also from you previous postings you say that a fall precipitated the pain. It does seem likely that there was a soft tissue or ligament injury and this would have got better in time. The investigations you had would have been to exclude fracture or tumour not to diagnose the soft tissue injury. In this respect they were useful.

 

[hQT(:]

your just talking rubbish now!

"The investigations you had would have been to exclude fracture or tumour not to diagnose the soft tissue injury. In this respect they were useful."

The MRI and ultra sound scans were to assess any soft tissue injury. EMG test to assess nerve conduction. vascular test to assess local blood, sof tissue compression test, local muscle biopsi pre and post exercise the lot!!! i was a lab rat BUT loved the sport i did so much that wanted to get to the bottom of my problem

Your above statement is just completely arrogant and totally incorrect.

"Also from you previous postings you say that a fall precipitated the pain. It does seem likely that there was a soft tissue or ligament injury and this would have got better in time."

utter tosh

didn't better in 5 yrs. despite extenstive treatment and rest to aid recovery

As i was a serious athlete i had every testing going to try and get to the bottom of it. (read previous post) all came back totally clean. Even had steriod injuections put into the tender points in my calf with no success

A persistant soft tissue calf injury was the problem which came on during prolonged exercise and increased with intensity to the point of total cramp/strain.

there were no obvious signs of soft tissue damage other than mild tenderness on palpation. I could hope on the stop and be fine but after 20 hops i'd be in pain.

finally i went to see a highly regarding physio who has sepnt many post grad yrs studying biomechanics, pelvic and lumbar dysfunction, sports medicine and think he also did a post grad course in manipulation. Many distance runners go to see him and he spent many of his earlier yrs in physio working with gymnast (they need to be hypermobile BUT very strong at the same time)

He looked at all my notes, examinations and preivous treatment. If it was purely a soft tissue injury then it should of healed and there was no obvious signs of soft tissue injury - clinically my calf was perfect other than it hurt after prolonged exercise.

He did a very detailed assessment. My motor control around the trunk and pelvis was very poor. He carried out extensive motion test on my SI joint (it takes a very skilled professional to do this). I have excessive anterior pelvis tilt on both sides, and thorugh he motion best he concluding that my SI were very hypermobile and quite unstable - my muscles around the joint were working on over drive to stabalise the joint but were quite weak. He applied force closure to my joint to and then reassessed.

His theory was that my pelvis was unstable and this put a great deal of stress at the bottom of my calfs and ankles. The pelvis is the base of stability dueing the stance phase of the running action. In very basic biomech language when your foot hits the ground the muscle around the pelvis force the joint shut and stabalise (its the shock absortion point of the body is it not where upwwards and downwards forces meet)

if the pelivs is not doing its job to stabalise then it places great stress on the lower limbs - the kinetic chain. As i ran more and more my calfs would get overstressed due ot the lack of support from above (the theory)

He was very honest and told me there was no magical cure for this and it would take a lot of hard work on my point as stablaising a weak joint can take a long time. His plan was to put me on a extensive core stability program to make my pelivs and SI joint strong enough to cope with the forces that i wanted to put my body through.

Its not just as simple of going down the gym and stregthening up. I need to educate my key stabalising muscles to regain their motor control statically, then with small ranges of movement and then moving onto more functional movements. (ilsolate and THEN integrate was the appoach)

He wanted to see me every 4-6 weeks as i was coming from a long distance and would give me enough exercises to move me on to the next level if i could not make it up to see him (hardly the rip off merchant you suggest). He would assess joint movement at each session, assess how i was stablising during certain movements and actions and MOST IMPORTANTLY assess the stae of my symptoms as this was the key to whether what we were doing was working or not (if it was not he would re-evaluate)

Each month i was getting better, the exercise were getting easier i could do more advance exericse that i could not of dreamt of doing before and MOST IMPORTANTLY i could do training before my calfs would strain. I was up to running 5 times a week for 30-40 mins after 2 months!!!!!!! before i could run 2-3 times per week for 10-20 mins and calves would be a mess in between.

Other the next few motnhs we progressed more and more and he worked at loosening my pirifomis which was quite tight and could of been irritaing my sciatic nerve. He only ever touched my calfs a few times as no matter how many time i'd had them worked on before they would be screwed again within a few days or weeks


"I note from your previous posting you were looking into prolotherapy.
I thought you might have had this done."

No my phsyio said while it has worked for people it should not be used until all other non invasive measure have been used to stabalise things. Infact he said it might work but as the reason why your joint is under stress is because the key stabalisnf muscles are weak and coupled with yrs of stressing the joint (60-80 miles per week running late teens) the ligaments can weaken. Givene sufficient support the can full recover was his answer so no prolo for me thanks.)


The end story was a few yrs back i was totally sorted and calves recovered 100% after 5-6 yrs of being screwed.

Until 8 months ago i was fine. until i started getting a few lower back problems. I'd been back up to running 80 miles a week again and had forgot the most important thing for a distance runner (ther CORE is the centre of stability!) and i'd got lazy with doing my stregthening exercise as so constantly training like an animal. I should of gone straight back to my physio but had moved down to south surrey and hes a long way away. WEnt to a local phsyio who was pretty naff to be honets. Then went to chiro and osteo who between them manipulationed the living hell out of my lower back. and i started to develop constant back pain and lots of joint clicking (of course i was hypermobile and then just made it worse).

I have lots of muscle tension in my lwoer back BUT my ligaments of quite weak (my msucle go into spamp to protect the joint which make it seem tight) They thought the approach was to beat the hell out of my back - IDIOTS!!!

Have since had MRI scan (perfect) an epidural + facet injections - did nothing

Then i found a v experience orthpeadic dr who found out exactly what my problem was - i was hypermobile at L4,L5 and both SIU's they were clicking about like naything and causing constand muscle cramping. When my Joint clicks my whole back right upto my neck would clench up. He used to work very closely with Dr. James Cyriax who i understand is the einstine of orthopeadic medicine. This guy though that hypermobility was a majot cuase of back pain as ligaments can get stressed and weaken after many yrs of abuse and poor posture.

He was an advocate of Prolotherapy BUT i was very weary of this so did not take that approach. As soon as he said hypermobility/instability i knew where to go!!! Back to my old physio. He could not believe the state i was in and was very angry that i had been advise to have so much manipulation (if i went back to the same people they would still do the same thing as thats all they have in their tool box). If manipulation is all these guys can do then tehy are just total quacks. Don't get me wrong there are some v good chiros and osteos out their who use a range of treatment but all the ones i went to see only wanted to manipulate depsite me telling them how bad it had made me!!!!

Anyway now im back on the core stability program with my old physio althought this time its a lot hahder was i have a back back which makes it quote difficult to do many of the required exercises. HE is very careful on what we do as he said many of the strengthening exercises given out of back problems are too advance in the early stages of treament.

after 3 months of this im about 70 fixed in general life ie i can sit down for an hr without being in constant pain. He thinks it will take me a while longer as i really have to stregthen up all the key stabalises in my pelvis AND lower back with v slow progression BUT while i continue to improve no need to try experiemental proceedures like prolo - only as a last resort!

In his opinion a great deal of back pain starts off with poor muscular stabalisation and thats where problems start off.....

As for biomechanics i wont bother going there as clearly your lacking in this area.....

 

[Pompal 09.]

Thank you for your detailed post. I don't mean to belittle you as you have obviously thought deeply about this but I have to admit that it is largely gibberish to me. I have a First Class degree in Human Anatomy as well as the anatomy I learnt as a medical student and I have spend my entire working week for the last 15 years looking at SI joints and the lower back and I have to say that I don't recognise most of the pseudoscience you have spouted.
Maybe some of it is true and maybe it isn't but without proof (rather than testimonials) this is not science or ethical medical treatment. If it helps you then fine- at the end of the day it doesn't really matter why it helps, just that it does but as a trained scientist I can't assume what worked for you will work for someone else since the diagnosis is unprovable and the effect of treatment unmeasurable.
Surely if SIJ instability was so important it would be very easy for someone to knock up a wooden gig so that the degree of instability could be measured, either in the office or even in the MRI scanner. The truth is that the people who are so keen on the diagnosis have no interest in developing a reproducible test because it would blow their cover.
BTW when you said the condition was cured by force and form closure I thought you were taking the p155 as this is a term used in robotics.
Anyway, thanks for the discussion I have found it enlightening.

 

[luvmfabt]

Its a great shame that you have such a prestigious academic background but yet have such a narrow minded view on what are basic and quite universally accepted biomechanics. I find that quite tragic actually....

the diagnosis/treatment of SI joint problems still remains controversal due its complex anatomy and biomechanics. There is a lack of consistently reliable clinical tests and imaging studies! it is only in recent history that movement at the sacroiliac joint has been recognised and as a result the importance of the movement is often neglected.

A highly detailed understanding of the soft tissue structures surrounding the SI and the role they have in maintaining the joint's stability is essential. From the sounds of things you forgot to read this chapter in your medical text book all those yrs ago

Force and Force closure is something studied by in detail by a biomechanist called Andre Vleeming and expanded on by many others. This research is published in many medical journals - you should read up on it. Form closure is the stability provided by the anatomical stucture of the joint - you may hear this being described "mountain and valley" configuration. Force closure is the ability of the muscular system to contract to prevent excessive movement in the joint. - maybe someone reading could give a more detailed explanation of this for us.

As for your "wooden gig" i recalled a few studies measuring which measured the ascending and desending forces placed on the joint. Also a device measured the motion of the joint while only certain muscle were contractded to assess the role they had to play in maintaining the stability of the joint/force clsure. I think some of this might of been in used Vleemings research but then again it could be a load of crap.


For now all of the highly dedication athletics, footballers, cyclist etc that they have been con into believing that the long term injuries they had anything to do with the stablity of the SIJ and pelvis + along with them all the orthopeadic dr, biomechanists, sports med Drs, physios who treat these issues on a day to day basis that they are con artists and are misleading all the patients that they help with this problem.

OPEN YOUR MIND!

 

[Teftgligree]

"Another slick way for quackery to attract customers is the invented disease. Virtually everyone has symptoms of one sort or another—minor aches or pains, reactions to stress or hormone variations, effects of aging, etc. Labeling these ups and downs of life as symptoms of disease enables the quack to provide "treatment."
Some practitioners claim to detect "deficiencies" (or "imbalances" or "toxins," etc.) before any symptoms appear or before they can be detected by conventional means. Then they can sell you supplements (or balance you, or remove toxins, etc.). And when the terrible consequences they warn about don't develop, they can claim success."
From Quackwatch

 

[ommlxzos]

hi Liza,
if you feel your back is twisted you could have some muscle spasm which is quite literally pulling or twisting your spine out of position . try to visit a remedial massage therapist for their opinion. other stress in your life can make these kind of problem worse.
good luck

david

 

[lhmmhmxq]

"Maybe some of it is true and maybe it isn't but without proof (rather than testimonials) this is not science or ethical medical treatment. If it helps you then fine- at the end of the day it doesn't really matter why it helps, just that it does but as a trained scientist I can't assume what worked for you will work for someone else since the diagnosis is unprovable and the effect of treatment unmeasurable."

so basically what your saying is that anyone who treates you without scientically proving their diagnosis the your being ripped off and sicentifically measuring treatment outcomes then your being ripped off?!

Unfortionaelt most local physio etc don't have this facility to back up their treatment with the science you require.

Next time i go to a physio with a muscle strain i'll demand he provides me with an MRI and ultra sound scan to back up what hes syating. Once its healed i'll demand the same to prove its healed...

 

[kweybpqo]

boy i wish i had time to spell check my posts!

 

[hairbender]

you can always edit them later - and hope you do so before any pedants notice

 

[Taylor099]

We don't fuss too much about typos, BIA, so long as the meaning is clear. We do, however, pay careful attention to the CONTENT of posts!

Holistic

 

[Suzy]

but... but.... pedantry is fun *sulksincornersmilie*

 

[DanFersoo]

Hello - is Paul Grech there ?

i was observing your conversation with Ian T with interest - I thought you might be interested because I have had prolotherapy on the SI ligaments and lower lumbar ligaments on one side. If you are interested - and still reading this post - i will give you more info - if not it's a lot of typing for nothing and seeign as there are very very few prolotherapists....only 2 or 3 that I would trust with such a long needle...I don't want RSI in my wrist from typing because there may be a queue for more prolotherapy ! seriously, what would you like to know ?

 

[Abercromby]

Krunchie I a new to the Forum and have been researching prolotherapy for a back injury, causing sciatic like symptoms. It was initially caused by a fall down two stairs whilst arresting someone. Two persons then landed on me. This was over two years ago and I have been around all types of specialists who promise the word, then try without success. MRI scans are normal but the SI joint is unstable causing the piriformis muscle to cause the pain along the sciatice nerve, Pain is constant right through my buttock, down the back of my leg into my knee then down through my calf to my ankle. I have been discharged from al NHS speciailsts and being medically pensioned from the police as a result. I also have problems with a burning sensation in my right shoulder. Taking so many pain killers and sleeping pills is basically doing my head in. I just wan a normal life back. I am only 34. I have become so unfit and deconditioned which is also getting me down as I can not carry out any fitness. Who is this Doctor you went to and what were the costs involved. Thank you. Lorna

 

[RyanHG]

http://www.drbrianpattinson.co.uk/index.html

i've been to him too. by far the best consultant i've been to with regards to diagnosis by a long long way.

Just for the record despite what some of the educated have stated on here SI joint problems can be quite common and CAN have a knock on elsewhere in the kinetic chain.

Through my experiences of working with sports people from recreational to Olympic standard I can honestly say the SI joint is a common source of pain and biomechanical defect. Just out of interest where abouts are you based?
I know of 3 people who really know the SI joint in this country - im sure there are more but that’s all I've met so far.
I too have hypermobility in both SI's and L4/L5 caused by injury and inappropraite treatment by the so called experts...

I too am considering prolotherapy to help my ligaments recover but am asking all the questions/doing the reseaqrch first before I go for it. I know of a few athletes ( and close friends) who had this proceedure carried out and it worked well BUT they worked with DR who knew the mechanics of the joint well...


Is your pain a sharpe pain or is it more like a constant muscle strain?

 

[bjebtupjibpihaefo]

Absolutely. I've read advocates of prolotherapy berating doctors for being closed-minded and arrogant, but the highly praised prolotherapist I saw was by far the most closed-minded and arrogant therapist I've ever encountered. He basically PRETENDED to diagnose me, but he actually did no such thing. He only had one diagnosis for any back problem. He just went straight to the SL joints and concluded that they were the problem without even bothering to look anywhere else, and despite very specific details of my case which indicated clearly that the problem originated in the thoracic region.

The way he closed his ears to anything he didn't want to hear was so unprofessional that it makes me wonder about other areas of his practise. He works alone. Who sterilises the needles? Are they disposable? There is no-one checking any of this and he took so many shortcuts I wonder how safe his patients are from infection.