Question
QUESTION: Hi Doc
About 3 months ago I had a slight pain in my lower back in the SI joint area on the right hand side with pain in the buttock. I would say that the pain was about 3-4 on the pain scale.
I saw a chiropractor who confirmed that it was my sacro iliac joint.
I saw him for about 8 treatments and at each treatment he did an adjustment with me lying on my side and bending the right leg over the left. There was a popping sound but I felt no relief. In fact the pain has gotten worse to about 5-6 with pain in the back of the thigh and intense pain when moving from a seated to a standing position.

I can actually feel the bone sticking out slightly on the lower right hand side (just next to the ilium) more than the left hand side which I presume is the point of the sacrum.

My question is
Is the chiropractor doing the right adjustment for my specific sublaxation or is he not doing the adjustment correctly as I believe that after 8 treatments I would have at least felt a bit of relief?

Should I try another chiropractor and if so, what questions should I be asking to ensure that they know the correct manipulation techniques?

Thanking you in advance for the great work that you guys do!

ANSWER: Mike,

Thanks for your question.

First, increased pain after several conservative therapy sessions means that:

- the technique being applied is inappropriate
- the diagnosis may be inaccurate
- a new approach is needed.

Sacroiliac joint pain may also be confused with:

- lumbar radiculopathy (something wrong with a spinal nerve root)
- lumbar disc herniation
- lumbar facet syndrome (joint pain)
- myofascial problems (trigger points, muscle contraction, piriformis muscle syndrome causing sciatic neuritis, etc)

The literature supports 5 orthopedic tests to confirm S.I. joint pain:

- Sacroiliac distraction
- Thigh thrust
- Gaenslen's test
- Sacroiliac compression
- Sacral thrust

However, this is not to say that another problem masquerading as S.I. joint pain may not be present separate from, or in association with, S.I. joint pain.

I recommend seeing a chiropractor who is versed in the McKenzie system of spinal diagnosis and treatment. This system is well-supported by the evidence to assist the clinician in evaluating between lumbar disc and other problems.

Continued or worsened pain may be an indicator for plain-film radiographs or lumbar MRI. Additional interventions may also include lumbar epidural spinal injections (if herniation is present with inflammatory-producing pain) or sacroiliac joint injections (if the problem is certain to originate in the S.I. joint).

I hope that this helps to answer your question.

---------- FOLLOW-UP ----------

QUESTION: Hi
Thank you for the advice
Regarding adjustments, if the ilium on the right hand side has moved backward slightly and locked in this position, would the "lying on the side and affected leg bent over unaffected leg" be the best adjustment or are there other adjustments that can be used to correct this?

Thanks

Answer
Mike,

Side-posture manipulation as you described above is not the only way to mobilize or manipulate the sacro-iliac joint.

Prone (laying face down) manipulation may be used with table drop technique. In this technique, the pelvic piece is raised and cocked in an upward position, and a light amount of thrust is applied, causing the piece to drop downward. Gravity and the table movement assist in joint manipulation.

Also performed in the prone position is a non-forceful technique, pelvic blocking. Foam wedges are strategically placed under the pelvis to alleviate pain in the sacro-iliac joints. Soft tissue manipulation may then also be applied to the patient as they lay in that position. The idea behind this approach is the use of gravity and positioning to decrease pain.

A variety of exercises also should be performed by the patient. Giving the patient a sheet with a list of generic exercises usually doesn't help. The clinician should evaluate the patient's movement patterns, and observe with the patient's feedback where the greatest restrictions of movement and/or pain occur, and then tailor a set of exercises around the patient's inhibited movement patterns. You should question your clinician about which exercises would best help you. If your clinician appears clueless, you need to find someone who isn't. A physiotherapist would probably be the best bet.

I hope that this helps to answer your question.