Realistic recovery expectations low back pain and unstable SI Joint

Hi all

I am presently in Physical therapy for chronic low back pain. The pain has been constant for 2 year 7 months with about 2 days with a pain level less than 2. I also have numbness in my right foot.The diagnosis changes with the therapist or doctor however, the majority agree that my SI joint is unstable. Some believe that the transitional vertibrea is the root of the problem.
I have been in PT for 14 months now and am on my 5th therapist. My first therapist told me that the issue would be resolved and I would be back to my usual self in 6 weeks. This therapist was the first to note the unstable SI joint. Treatment consisted of mobilization of the joint and then aggressive stretching of the psoas muscles and strengthening the glutes, and the core muscles, and stopping all walking, cycling until the pain was gone. At about 6 weeks I re-injured my back doing one of the exercises that the therapist gave to me. In retrospect I should have refused to do the exercise since my si joint was still not stable at the time. With this injury the doctor dropped me to lifting no more than 10 lbs from waist high - I am still at this level today. At 10 weeks I was starting to really feel the lack of exercise so I started walking again. At 5 months I started cycling against the therapists recommendations. I started looking for another PT at 6 months. Their favorite comment was just 6 more weeks. My pain level did drop from a 6.5 out of 10 to a 4.5 out of ten. We also tried a SI Joint belt which made the pain in the SI joint go away however It increased the pain in the low back area. The numbness in my foot also increased while wearing the SI joint belt. The second recommended a heel lift which only increased my pain levels. I stayed with this PT for a month. The third PT wanted to repeat what the second therapist tried so I dropped them after one visit although they thought that I might have joint hypermobility syndrome. I scored 4 out of 9 on the Beighton score. The 4th PT recognized the si joint as being unstable. He took a mobilize and no stretch approach with light exercise, however he took me off the bike again. After 10 weeks with no improvement I found another therapist who also believes the SI joint to be the problem. He has a different method of correction and has given me self-correction exercises that are more effective than previous self-correction exercises though the SI joint still goes out to the point where I cannot self-correct within a weeks time. I have also seen a massage therapist, and an occupational therapist who specializes in Feldenkrais.

My doctor who also believes my SI joint is unstable wants me to see another specialist. The last two specialists basically told me to carry on, and that there really is not a reason for my pain - Just sciatic inflammation without a specific cause. I also have a severely degenerated disk at the L6, S1 level with facet joint arthritis, and retrothisis at the same level. The transitional vertabrea is also partially scralized on the left. I have alway been very active with cycling being my preferred mode of exercise. I have not been on my bike for 7 months now. The other component that is hard to deal with is watching the muscles just disappear. Since starting PT 14 months ago I have lost about 25 lbs most of it muscle.

The si joint is hypermobile on the right side. At various times I have had a anterior rotation and a posterior rotation. An inflare and outflare. A left short leg and a right short leg, as well as a sacral rotation to the right and the left.

So my question is how long is reasonable to continue to seek help? I have had to pay for most of my treatments out of pocket because of very high deductible insurance plan and my money has basically run out. An at this time I really don't feel like I am getting my money's worth.

If you were in my shoes what else would you try? How do you deal with doctors and PTs that express contradictory beliefs?

Is it possible for the sciatic nerve to be inflamed for no apparent cause?

Thanks for any answers. At this time I really don't know what else I can do.

JR

Hey JR I was reading your post of 8-2008 on this forum and it sounds like I've got the identical SI joint problems....if your still out there I'd like to talk to ya about it....oj

Hi there jr_really,

I don't really have any answers for you but i know how you feel. Sacroilliac joints seem to be very hard to treat.

As for cycling- have you tried a recumberant bike? If not for riding on the road then just for training (e.g. at a gym if you go to one)? At least you might be able to get some good exercise that way.

In my personal experience i have found walking helpful for correcting SI problems however this may not relate to your situation. I'm sure you can tell what aggravates your problem.

Only suggestion i have at the moment is try to find someone who is doing research like at a uni or something. If someone is doing a study on low back pain they probably would be grateful for volunteer participants and they are probably challenging common treatments and beliefs. Perhaps you might find a professor or someone in a uni who has done research already and is a specialist in this area and can help you

Hi there ... i dont know what to say regarding your problem... please consult a doctor who is researching on this topic....i wish for your well being soon...

Hey JR - just read your blog as I've got the same and had pretty much the same experiences.
A year ago I twisted out of a position and really hurt my lower back. I initially went to my GP who told me I had pulled a muscle and prescribed me some muscle relaxants. I was still suffering so I went to a chiropratic clinic. I spend hundreds, gave up running and pole fitness (as this always agrevated my back), however I was still getting a bad back periodically. I decided not to go back and subsequently tried sports masssage therapy. He gave started with deep tissue massage followed by use of a TENS machine. At first I thought I was onto a winner, he but after a few weeks the pain returned, it was also costing me a fortune. So, I stopped that. The pain got so bad that I returned to my GP, he referred me to an Osteopath. I've only had one visit so far (as it's NHS, at least he's not in it for taking my money!!). He's pretty confident that I have an SI joint injury and started by giving my acupuncture. This did nothing to ease the pain (he wasn't sure it would do but has to do it as process of elimination). The next step is for me to have an MRI scan and it's highly likely that I will need a steriod injection in my back. Have you been offered anything like this?? It may be worth investigating.
I hope thing work out for you.