Sacroiliac

hi alo

thanks so much for your time.

well you bring up some interesting points there. actually i had reflected on some of these points myself...remembering back to the beginning ...

1. after the accident i had terrible rib pain on the right .. couldn't sleep on that side, and i couldn't lift my right shoulder. that rib pain lasted for about 6 weeks or so. after about 3 weeks, i started to run again .. despite the rib pain. i ran for a couple of weeks up and down hills without noticing much pain until i moved closer to the lake in lausanne and starting running flat along the lake. i remember it was the first run along the lake ... flat, that the knee pain kicked in like there was no tomorrow. i did wonder during that time if this poking of my approx 3rd of 4th rib into my sternum and spine would and the right rib pain could have set up something in my pelvis. after about one year, the popping went away in my thorax and just cronic pain in thorax and neck remained.

the reason i thought this rib gig wasn't the cause of my pelvic problems is that i'd taken three other falls when i lived in colorado and france ... two snowboarding and one with a heavy backpack where i slipped on the ice. but that was years before and those three rib incidence healed without giving me grief. so i just thought this 4 rib incident would be the same. i didn't realise the pocking of my ribs into my spine until several months after the accident. also... "the malalignment syndrome" talks about the reorientation of the ribs in that exact area as a results of a pelvic misalignment. also after the accident i remember thinking that i left leg felt shorter. apart from the other original pain after the accident, the other thing i did notice was pain in the top right of my hip, which was taken away by a physio with some resistance to teh muscle ...i'm guessing the TFL was where the pain was coming from.

2. after manipulation, the orientation does stay in it's new position. actually what i notice is that after the manipulation, it takes a day or so for the joint to settle to its new orientation, which is not the same as the previous orientation. however, over time, i think the ligaments and muscle have become compromised and i haven't been playing around with hte joints as much lately (for about a month) so i can't say what they do these days. i got scared when my SI joints started to hurt ... quite alot at one point. now i feel alot of referred pain to where i think is my right glut medius. also, my left knee has started to give me grief again .. but i've been through periods of almost a year without any knee pain. i know that due to the misalignment, both knees have tears in them, but the patella cartilage is wearing more of the left... and has since the accident ... also i think my quad is tighter on the left ... which would make sense re: the patella wearing.

3. thanx for that reference. i should check it out. "the malalignment syndrome" shows that you can see structural differences after adjustment. sorry i don't know what "XR with RSA" means :-) i don't profess to be an expert :-)

4. MC also examined and messed about with my thorax. actually so did the physios in december... mobilizing my spine with their thumbs and rotating my torson. he confirmed that my right side of my ribs sit higher and are more bunched together. BH also saw that but said she corrected that. one thing i do notice since 9 months is that my right rib/lats area isn't as tight as it was. last year, that right side area was tight, tight, tight. before the accident i had no scholiosis (i have xrays from a few years before), i was buff. however, last year on a set of xrays i got done here i see a scholiosis has been set up. actually after the accident i had an xray a couple of times of my spine but an absent minded (speaking from experience with her) doctor's secretary in switzerland left those two sets of xrays by her rubbish bin and the cleaner threw them out, never to be seen again despite my best efforts to try to get them back/find them, so i don't have those iterum period xrays and i was pretty clueless at the time, and so don't remember trying to examine those xrays myself. however, my SI joints have been moved so much since then and i want no more xrays (one doctor told me i'd been over-radiated), so i don't know how this "Functional scholiosis" is going now.

yes, i've examined these muscles closely in my cadaver and anatomy books... that's why i started to focus on the muscles above my pelvis which attach to the pelvis and my core muscles. you sound like you've got a good grip on that stuff.

5. thanx for the tips there. i need to read more about how muscles react to misalignment and when they are placed under constant tension or a lack of tension, which can be the case when face with changes in surrounding bones and muscles.

i've become a bit like my own guinea pig lately. so i'd be all up for getting knocked out in the name of nutting out this probem :-)

thanx a mil for your insight. i'm a bit like sarah ... very appreciative. i can't imagine i'd be as enthusiastic as you if my life didn't depend upon it.

Hi...

...before i forget, XR=X-Rays and RSA = Roentgen Stereophotogrammetric Analysis which is basically sticking small balls of metal into your ilia +/- sacrum then taking XR - it allows very small changes in movement to be assessed in 3D.

I do believe that you now have a significant SIJ issue but i always come back to the question..."who is driving the bus?"...the associated changes in your SIJ may well be from habitual postures driven by other processes.

I have not read the malalignment syndrome. However, i am personally not a fan of the term...but i do appreciate the sentiment - it is often easier for someone to understand that something is "out" than to go through the multitude of possible variations that could be causing the problem. My new assistant is going through the process of me asking her what the possible structures are - she is "muscle" trained so i am working hard to get her to see other structures. Physios, Chiros and osteos tend to be joint focused but we need to keep in mind all the systems that can cause dysfunction.

TO be honest, there aren't many physios that know how to fix motor control problems of the thorax (ribs and T/S). I try to do as many LJ Lee courses as i can on the subject because she is the world's foremost expert at thorax rehab.

Anyway, more information is good whenever you can...I jsut wanted to ask again...you did not have back pain for some time after the accident - it was leg and rib pains?

hi alo

thanx for your information, comments and questions ...

hmmm, well now i have a significant SIJ problem if i didn't have before, that's for sure! i should also mention that since about 6 weeks, i also have this sciatic type pain on the right side which started from too much manip (i think) on the right side .... when i lye on my stomach and lift my right leg up using my gluts, without knee bent, i have too much pain from bum to back of knee along lateral hamstring. when i bend right knee 90 degrees into air and lift right leg (lying on stomach), the pain is nowhere near as sharp.

i had so much pain in the rib area and spine area for 6 weeks after the accident, but it was something i had felt before with rib pain ... you know how it is. but after the rib pain subsided, i had a very sharp poking of my 3rd,4th rib into my spine and sternum ... like the rib had been moved out of place. well what i would do is ... the rib would be poking into my sternum and so i'd pull my shoulders back to relieve the pressure and it would then poke into my spine .... so yes, that was very localized back pain. it was predominately on the right side of the thoracic vertibrae at the 3rd and 4th rib connections and on the left and right side of the sternum at the 3rd sternal costal cartilage. an MRI of my sternal costal cartilage about a year after the accident showed that my sternal costal cartilage was inflammed (most of it, not just at the place where i felt pain) .... i was convinced it was a symptom of a change in the biomechanics of the skeleton and associated muscular response ... the doctors suggested this rediculous arthritis thing... i also had the sensation of having a short left leg and this knee pain ... which i also notice when i tried to run on flat ground about ... 5 weeks after the accident (because the 3 weeks after the accident, my running was being done up and down hills where i didn't notice anything wrong with my knees).

also, the scholiosis last year was showing that from L5 to about L1 there was a slight curve which made the spine sit on the right side of normal spinal centerline, then the curvature reversed and there was a kink at i think around T10/T9 which sat on the left side of my normal centerline spine position. from about T11 to T4 my spinous processes were bent to the left (like the spine was twisted). then there was another kink on the right side of my neutral spine position at about T1/C7. the physios in december and MC were pushing on those spinous processes to kind of move them back. but i don't know ... i wasn't sure that twisting could be fixed without correcting the orientation of iliums/sacrum. but then what do i know ...

oh and one other big thing ... since a long time, i notice that if i lye on my back and lift my left leg up in the air and then throw it over my right leg, so i'm twisting my spine .. you know what i mean ??? ... well my flexibility is alot less when my left leg is over my right (hence twisting my pelvis clockwise with respect to my head) than it is when i turn my pelvis anticlockwise with respect to my head (throwing my right leg over my left). i figure it's a combination of muscle and spine biomechanical changes which cause this...obivously...

the other issue is this ... with all this manip and prolonged bad alignment, i can't help thinking that some of the ligaments and soft tissues have remodelled to kind of set this bad orientation... i hope i'm wrong. but what i think is important is to understand how the muscles react to prolonged tensile stresses over time, which they are sujected to when there is a structural misalignment or muscular thing going on in nearby tissue ... or when they are forced to recruit for an area that they don't normally need to recruit for. for example .. looking at the other extreme, we see that when the muscles are no longer in a structural configuration which they are used to operating in, they waste .... like what happened to my right glut max at the end of last year after the exessive anterior rotation of my right ilium. i think it's regained some of its bulk again now ... but i know i recruit my hamstrings before my gluts when i think it should be the other way around...when lifting my legs when i lie on my stomach. but anyway, that's getting off the point... so i'm wondering if and how, just hte muscle (not considering ligaments for the moment) changes in structure due to prolonged periods of say being in spasm ... you know, sometimes for years. and hte same can be said for ligaments and extracellular matrix. i know that extracellular matrix remodelling .. the structure of the remodelled matrix is affected by the force on the surrounding matrix (and hence the fibroblast cells) during remodelling by fibroblasts. so, i think it's important to know how long (and short) muscles change in structure over time, if any, in order to figure out how to help them return to their original structure and ability to funciton. i know that might sound confusing. maybe i haven't explained it well enough. anyways, do you know any books about how muscles and other soft tissue respond to prolonged periods of tensile force or spasm? i mean, we know that in cartilage, it responds to modified loading patterns by breaking down over time ... which is a bummer!

hi again

i just wanted to bring up another point.... although BH picked up an anterior fixation of the left side of my sacrum which usually and was accompanied by the posterior rotation from december (although she said it happens anyway with an anterior fixation) and an upslip, which was hte case, all muscles of the left remain tight, tight, tight. especially hams, quad, ITB, and sore abductors. i think that now, since last november, there's this problem on the right ... of a weird and long right leg, which i now consider my primary problem ... thanks to mr. 30 years experience chiro and physios in december/april .... so i think that perhaps, the long right leg is keeping the left leg muscles tight... or changes have occurred in the left leg muscles and ITB tendon during the year (since seeing the same chiro earlier last july when all this muscular spasming on left kicked in) which make it difficult, despite correction of left SIJ and best efforts with heat, massage, stretching and pilates, to release them. or, it could be a combination of muscle changes (if that occurs) and long right leg.

when people check my leg length lying down these days, they don't see the right side long but it feels long to walk on.

Hi sijproblems.

wow - that's lots of good info.

i will use point form as i find it easier...

1. I am hoping to challenge the idea that the problem is solely in the SIJ/pelvis area. Your history SCREAMS thoracic spine involvement. However, i take your point about the soft tissue changes after all these years but let me relate a story i have told before elsewhere on this forum...(sorry if you have read it before)...

This lady had something like 12 years of chronic back pain. Had great physios treating her. Had difficult standing up straight for 5 mins after rising every day. For over 12 years! She got assaulted by a patient who threw an outdoor setting bench onto her (pysch ward patient). Anyway, her FF was to the knees only with pain limitation - again for 12 years.

Literally 1 treatment restored her ROM to touching her toes. That one case had made me rethink the whole adaptive change concept which you outline above - real changes are possible quickly. Literally mins. I had 2 physios who were witnesses to the assessment and treatment (i was being assessed at the time).

2. You are spot on with the whole biomechanical change thing. A torsion in the pelvis (or thorax) will create lots of strain on those cartilage joints.

3. scoliosis and short leg feeling etc...tough to judge on that one. I certainly don't believe pushing around on the spinous processes will change that. You are an engineer, do the maths! We might be able to put ?kg of force through a short lever arm (maybe 3cm) - would that counteract the torque of your whole body weight and the tension developed in the tissues?? i doubt it.

I would prefer to work out if your scoliosis is structural (due to the bones) or postural (due to the muscles). Most people have a scoliosis without any problems. It is usually postural and responds well to exercise.

4. twisting the body - the main rotation of the spine comes from the T/S. You only get 3deg from each lumbar vertebrae and maybe 5deg from the pelvis if you add the 2deg each way. Another reason why i was thinking T/S.

5. muscle imbalance and remodelling and response to stress. The body is an amazing machine. Like the story above, i have seen things that theoretically shouldn't happen. I like to find the areas of stress and fix them because then the muscles and other tissues will settle down.

6. Feeling the right leg long and seeing no change in leg length in lying down do not create a confusing situation - it just means that in lying down your legs are not much different in *apparent* length and when you walk, you *feel* the right leg is longer.

I have changed gait and apparent leg length discrepancy by joint means (manipulation of "stuck joints"), by muscle changes (stretches, soft tissue releases), my motor control changes (coordination exercises then reasses) and with visceral releases (changing the fascial pull on bony structures).

in summary, I like to keep it functional... any other ideas out there?

Hi everyone.

First of all I want to wish good luck to everyone with SIJ problems. I suffer from it too and I know how bad the pain is!

It all started from a fall on the coccyx 5 years ago. The pain was increasing by the minute. I seeked help with doctors, physios, massage therapist, Rolfers, acunpunctors, chiros etc.

I went through x-rays, scans, MRI and nuclear medecine nothing showed on the tests.

I met a sports doctor back in 2005, he assumed I injured ligaments in my right sijoint. I stress the fact that he said that I probably injured ligaments. He couldn't tell from a firm point because the tests he did didn't show anything, but the symptoms I had were pointing him towards the ligaments injury.

Those symptoms were and still are: feeling of short leg on right side, numbness in right foot sometimes in both (increased when I do cardio), a lot of coughing, light headed and vision of silver spot (like when you get up too fast), cramps in the abdomen and lower back, muscles pulling and tightness in lower back ,abdomen, legs and calfs, weird taste in the mouth, unable to sleep or stay in the same position for long periods, extreme fatigue, and the major one: pain around L5, sacrum and hip on the right side. If I touch my lower back towards L5 and my sacrum I can feel lumps, the Rolfer could undo them and it would bring my back to normal but it wouldn't hold. The doctor, also added that I would be hungry and would have to eat more than usual as the body required a lot of energy to heal this kind of injury.

He advised me to go to the gym and do as much cardio as I could. Ligaments are supposed to be healed by cardio workouts in order to stretch them back into place.

So I went to the gym, for 2 years I did a weight training program 5 days a week and cardio program 6 or 7 days a week. There is no words to explain the energy it took to do so, all the while working full time as a sales rep. on the road.

The doctor mentionned that I would go through the following phases:
1- improvement in my condition as I worked out
2- the lack of sleep would increase especially towards the end of the healing process
3- about half way into the healing process I would reached a point where I would no longer be able to workout due to the fact that my body would be too tired to recover normally -- I reached that point 2 years into the training in the summer of 2007
4- after that resting period I would have to go back to the gym to finish the process otherwise my condition would stay the same i.e with no more improvements
5- the remaining sensations and pains should go away as I keep working out.

I went through all these painfull steps and I was able to get back in the gym in August 2008 to start my cardio workouts and in September 2008 I started my weight training on top of the cardio. I don't work at the moment, because this is taking all of my attention and energy.

I am wondering if anyone out here experienced the same thing?

At this point, I still feel the pain and the numbness in my foot, but it is totally different then what it used to be. I see and feel improvements, but it is a very slow process. I still can not sleep well, I either can't fall asleep or I wake up 4-5 times a night. This is due to my back going into an active state. I can feel and hear the ligaments or tissues trying to get back into place, it comes with hot flashes or chills. If it happens during the night it wakes me up and must eat in order to go back to asleep, if it happens during the day I have to lie down and rest or sleep (if I can) and eat as soon as I wake up.

From all the specialists I have seen, the Rolfer acknowledged that something was wrong with my ligaments, but his treatments didn't work, all the physios couldn't figure out what was the root of the problem and kept working on muscles, 1 ostheopath acknowledge that something was wrong on my right side, but couldn't find anything else to help me, all acunpunctors found something on my right side but couldn't find anything to help me. All doctors I have seen except for the above mentionned, said that it was impossible that it could be my ligaments and didn't know what was wrong and wrote it off as a psychosomatic problem. Frustration frustation let me tell you.

I eat very healthy, 3 meals a day, 3 snacks a day (usually raw veggies and nuts) and sometimes eat when I wake up at night. I drink at least 3 liters of water a day. I avoid caffeine, sugar, unhealthy fats and processed food. Put it this way, I can not eat healthier or better, I took nutrition classes and seeked a lot of help, including a biochemist analyse to figure out what were my best options and I stick to it.

I welcome any comments, suggestion and so forth from everyone out here.

Deep down inside, my instincts tells me that I am doing the right thing with the workouts and that I am on the right path, but my mind always wonders. I would feel a load off my shoulders if I could find exactly what I have.

Thanks!
I look forward to your replies
Bikegirl

hi bike girl - OMG i wish i had more compliant patients like yourself!! I don't blame you for feeling frustrated.

Also, i haven't met such a "far-sighted" doctor before...but i think he might have had weeks/months in mind, not years like you have described.

A number of things...

1. something is irritating your autonomic nervous system - all the "wierd" symptoms and pains in your tummy can be from irritation of the sympathetic chain.
2. If you are getting treatment at the pelvis and back and it is not "sticking", then i would look elsewhere - like the hip or L/S or thorax. Hve a look at some anatomy pictures - the muscles that attach down near the coccyx also attach to the ribs and even to the back of the skull!
3. Your exercise programme is too non-specific for my liking. Try to find something more specific - but you will need a thorough assessment
4. You live in Canada - If i were you, and honestly i would do this, i would book a trip to Vancouver to see Diane Lee or LJ Lee and get some seriously decent time with them for a strategic plan - have them assess and diagnose you. Then have them treat you. Then have them teach you the specific exercises you need. Someone else can follow you up but have the people at the top design the strategy.

Perhaps they can recommend someone in Montreal...

Good luck - i don't think you are crazy - i think deep down, the doubts niggle away because your brain is thinking there must be a better way. There probably is...just got to find out how!

Good on you for persisting this long with it as well...

Cheers

Hi alophysio,

Thanks for your reply! Indeed I am known to do whatever it takes to solve something....and don't understand people that don't when it comes to their health!

I also think the doctor meant weeks/months of healing, that's why I am questionning what's going on here.

1- I figured that my nervous system was responsible for the sensations. I am assuming nerves are affected from whatever condition I have.
2- Thanks for that. I forgot to mention that the last physio I saw, performed a lot of manual therapy on me and always worked on my diaphragm, but never looked further. So this is something to keep in mind for the next one.
3-As far as specific exercices, I had a bunch given from all different physio I have seen, they never really worked. I understand that with the weight training program I am is focusing on back and abs muscles, but also on overall body. I always give a chance to new exercices, its only a matter of finding them. Perhaps you might have something to suggest?
4-I did call Diane Lee's clinic for a referal. I also contacted the Federation of Physiocal Therapy of Canada to get more. I was lucky to find someone 15 minutes away from my house. He did his advanced manual therapy course as well as Diane's Lee course, just not sure which one in particular. I am going to see him on Sept. 22nd...I can't wait! I also talked to someone else that confirmed me that the physio I am going to see is very good for this kind of injury.

Thanks for your kind words they are very welcomed on my part.

Now my fingers are crossed!!!!

I will persist until I find the answer no matter what it takes. There is just no way I am living the rest of my life like this...just no way!


Bikegirl

me again,

One thing I didn't mention before is my posture...its very bad. I am called a back hugger, I have a huge arch in my lower back and my tommy sticks out like crazy. I look pregnant (BUT I am not!). Strangers ask me if its going to be a boy or a girl. I can tell it is not fat, so I really wonder if it is muscles, ligaments or caused my the sacrum or something else.

I also can not tighten my stomach muscles, it just won't go in. It is important to mention that during my 2 years of training I had a 6 pack stomach.

My last physio worked on the muscles for that arch in the back, nothing was holding for more than a few hours. He disregarded the belly sticking out and only worked on my diaphragm saying that I needed to relearn to tommy breathe instead of breathing from the chest. I try to make him understand that I was chest breathing because the tommy breathing took so much energy since everything was stuck down there. I had to sit down and really think about it, it wasn't a stress response or anything like that. I was so short of breath from everything being stuck that my body naturally managed to breathe from the chest.

My walk is weird too from my right si joint. I feel my right leg being shorter (no one was able to see if it really was shorter or just felt shorter). My shoes wear differently too, my right heel wears a lot more than the left one. On the elliptical machine in the gym I notice my righ foot rotating inwards. I must concentrate to correct it. I really don't know what that means.

Any suggestion?

Thanks
Bikegirl

Hi - the last post was very informative!!

ok, firstly, good luck with that physio - it is ALWAYS good to get multiple people with relationship to each other telling you a physio is good.

With your exercises, sometimes it is not the exercise prescribed but HOW it is DONE that counts. A skilled teacher and a patient client are required.

You back with the arch and the tummy sticking out thing - is it a "hyperlordotic" back?

Another possible casue is that there is something causing your lower back muscles to be overactive or to become short. This can affect your breathing/thorax, L/S, SIJ, hips etc.

If this guy you wil be seeing is any good, he will explain it all to you.

Sounds like you are on a good thing - keep that determination up!!

Cheers :)

Hi again,

yes it is hyperlordotic back, I had forgotten the term.

Yes I understand about the exercices. I will keep looking, trying and hoping to find.

I hope the guy I will be seing will find the cause of those muscles being overactive...or whatever it is. But what can it be? Bones, ligaments, organs?

Thanks

Bikegirl

The leg length thing ...... you can have up to 1cm difference normally due to bone length, having a smaller hemi pelvis, that is know as a true leg length difference. you can also have an apparent leg this is more down to how everything interacts with each other, it can result in a relative difference in how the two halves of you pelvis move(think of it as your sacrum as an axel on a car.... with the two halves of your pelvis on either side. when you do a symetrical movement eg bending forward they should move together, when asymetrically they should move independantly eg walking. some sij problems are due to the fact that they move the wrong way round. ok physios its a simplistic view but bear with me)
when you walk look at are you taking a slightly shorter step with one leg (don't measure listen to your cadence/rhythum which should be even). there should be some stretches that can change this. however, this is a first aid fix to help wiht the discomfort, it won't sort the problem as you still need to find out why this happens

thanks for your post gwynnwallace.

I do have a shorter step on the right side.

I know about the stretches, I have tried them and I stretch on a daily basis for 20 minutes.

I am searching what's going in my SI joint.

hi Bike girl.

just looked at all of your previous posts, looks like you have looked at lots of different things. how about trying something a little different? Get hold of a nijmegen questionaire and fill it in and let me know the score
gwynn

Hi,

My score is 22.

What made you think of tha questionnaire? If I understand correctly this is for a breathing disorder? Can u tell me more about that kind of disorder?

Thanks

Hi Bikegirl, yep its indicative for hyperventilation syndrome. the pass/fail is 23 so as an indicative marker, so you scored below the diagnostic indicator.. However, with a score like yours I would probably look at stuff around you breathing pattern. The basic idea is that diaphragm function is not just important for the gas exchange stuff, but it is very important in maintaining core stability (sorry alophysio!). for example your breathing pattern should change when you are going to lift something, this relies on normal diaphragm movement. The diaphram, pelvic floor muscles et al. should work in an almost orchestra type way to maintain spinal stiffness my maintaing intraabdominal pressure. If you have a stiff thoracic spine/ribs if you use the neck and shoulder muscles for quiet breathing, i.e. they are dominant it cannot do this. have a look at "Hyperventilation and the body" c gilbert in A & E nursing 1999 vol 7 130 to 140 and "understanding breathing" by leon chaitow in massage and bodywork june/july 2007 28 - 40. It might not give you the answer as to what is going wrong with your SIJ, but it might give you a why. Other thing to look for with breathing pattern disorders are frequent sighs, yawns holding your breath, the need to speak quickly inbetween deep audible breaths, inability to breath nasally.

pleasant reding
gwynn

Hi,

Thanks for your post.

I will take a look at the book you suggested even though I believe the breathing problem is a symptom of my Sijoint condition. I don't hold too much importance for my score of 22 and that test as it is very general. Symptoms described on there can apply to many different conditions, I do not think they are very specific. As you said: its indicative for hyperventilation syndrome, to me a syndrome is not a cause but a side effect of something else.

I understand the relation of the diaphragm with muscle balance. It is easy to understand that any muscle working improperly will create all kinds of imbalances in the rest of the body. The hardest part is finding why it creates that and where it is coming from. Most people stop at one symptom and treat that specific area instead of making correlation of it all and understand the full pattern in order to correct the root of it. An Si joint injury creates all kinds of tightness and pain around the body and mimics many other different condition.

Have a good day.
Bikegirl

Try the test for APAS in my area.

It will tell you if you truly have an SI joint problem.

I do not find any test of the supposed stuck or fixated SI joint that hold up to this test.

Best regards,

Neuromuscular

Bikegirl, what happened with the physio you were going to see? I am most interested in what he had to say.

Quote:

---

Originally Posted by sheri

Bikegirl, what happened with the physio you were going to see? I am most interested in what he had to say.

---

Hi Sheri,

The Physio I am seeing first saw:

1- Atrophied multifidus and transverse abdominus
2- atrophied glute med (right side)
3- right foot supination (my big toe wasn't touching the floor)
4- torso rotation due to internal oblique
5- inter-vertabral muscle tension from L5/S1 to cervical vertebrae
6- anterior rotation of pelvis
and more I can't remember exactly

after about 7 months of physio treatment twice a week a lot had improved

I am now seeing him once a week and I have still some stuff to be worked on. We kept finding new things as we were moving along.

Humans are not perfectly symmetrical - the more you look for faults the more you will find and the more money you will be spend trying to fix the unfixable (and most likely not broken anyway).

Thats a long and quite "inflammatory" list of "problems" and a hell of a lot of treatment sessions - I would only hope that the last say 5 months has been focused on using your own body and movements to address them and not thru manual therapy techniques. Best of luck into the future.

What a wise reply that means absolutely nothing!

Your opinion isn't worth much when you give it without knowing the patient history and without having seen the patient.

But anyway!

My comments were not meant to disrespect - and I wholeheartedly apologize if they did. I just get concerned when I see the use of body asymmetries as a justification or rationale for long term manual treatment. There is no evidence to support such an approach.

Regarding "without seeing the patient" comment - this forum, as you can appreciate, does not afford for such luxuries and so many of the comments posted can appear negative and taken out of context but I think most members intentions are in the right place, as were mine. I'll make sure to check my step before getting up on the soap box next time.

I do tend to agree with physiodace. you have a really long history and you likely would gain just as much if not more benefit with say a pilates program for your aforementioned problems (perhaps an orthotic would help with the supinated foot althought that might come right with correct pelvic function) as you would with hands on treatment. you are at a stage where you need to retrain your nervous system to work correctly. hopefully you can manage one supervised pilates session a week or fortnight with unsupervised sessions between, saving either you or your health fund a whole heap of cash!

keep us posted. if you are involved in a pilates program could you please send me some exercises you are doing as i am very interested in pilates for pelvic dysfunction. somewhat of a novice in the area :)

Quote:

---

Originally Posted by Physio Dace

My comments were not meant to disrespect - and I wholeheartedly apologize if they did. I just get concerned when I see the use of body asymmetries as a justification or rationale for long term manual treatment. There is no evidence to support such an approach.

Regarding "without seeing the patient" comment - this forum, as you can appreciate, does not afford for such luxuries and so many of the comments posted can appear negative and taken out of context but I think most members intentions are in the right place, as were mine. I'll make sure to check my step before getting up on the soap box next time.

---

Thanks for this.

You are allowed to be concerned, but I do no think you are right in this case. I don't know in which book it is written that there is no evidence for long term manual therapy, but I can pledge that textbook stories are being written and lived everyday,as I am one.

You are allowed to your own opinion and you are right when you say that you should check your step before getting on the soap box. Your opinion is just wrong in my case, I need the manual therapy.