Question
QUESTION: I have suffered with upper back/rib pain for a few years and have been seeing an osteopath once a month who helps with the pain etc. recently i was unable to make my appointment and i attended at a Physical Therapists office who lives near me for a treatment.  He used massage on the area and did some sort of manipulation to the ribs which was not like the osteopath and kind of messy and awkward, he then manipulated my pelvis, this was very uncomfortable and sore.  I went home to bed and the next morning began to have watery diarhea, i presumed i had food posoining or a bug, the next day i began to have extreme sharp/shock pains in my abdomen and pelvis and in my back where the ribs had been worked on, lots of gas and pain and discomfort when needing a bowel movement after 10 days of these symptoms i ended up in hospital, i was in hospital for 9 days where they did bloods, urine, stool samples, left side colonoscopy, endoscopy, abdominal and pelvic ultrasound and abdominal xray and thorasic xray.  Nothing showed up!  The diarhea has cleared up but i am still in extreme pain, my pelvis feels like it is having electric shocks, especially bad when sitting and moving certain ways, my lower left back and hip are also very sore and lots of cracking and shock pains down ribs, into chest and in middle of abdomen.  I told the dr's in the hospital about the PT treatment but they did not think this could affect the bowel in such a way.  I would like some advise information about this situation, is it possible for such a treatment to cuase these symtoms, could the pelvic manipulation have damaged nerves or ligaments in my pelvis and be causing these horrible pains?  What can i do?  I have made an appointment with the osteopath i had originally seen for rib pain but i am quite scared now to go ahead with any type of treatment as i am in so much pain but can not bare the thought of the original symptoms coming back again.  Any help would be much appreciated.

ANSWER: Dear Barbara,

This is a very tough question.  I know that it was not directed to me specifically, but I found it in the "question pool", so if you don't mind, I will take the time to give you an opinion.

Please be aware that any opinion is just that. It does not out-rank any opinion of any attending physician or therapist.

First of all... physical therapists do not get extensive training in spinal manipulation. Don't get me wrong... I love physical therapists and they do amazing work, but manipulation as performed at an osteopathic doctor or chiropractic doctor's office is quite unique.  I wouldn't go to a dentist if I needed gall bladder surgery, regardless of how good the dentist is.

I am glad that you underwent such a complete examination at the hospital. It is good to rule out any pathology or disease that could be causing your symptoms.  That was a wise choice.

One test that was missing from what you told me was the spinal MRI... If, by chance, your symptoms are related to neurological irritation due to spinal problems, x-rays would never show this. Only an MRI can show disc involvement and nerve entrapment due to disc problems or spinal degenerative problems.

Nerves that exit the mid back and lower back can affect digestion.

If I were you, I would go back to the osteopath that you trust. Tell him your story, and tell him of your fears of returning.  Osteopathic doctors are well trained in diagnostics and they are open to the concepts of joint problems and how they can cause other issues (like chiropractors in this regard).  I bet that he can help you.

I understand your frustration and fear, but ignoring it is not going to do you any good.

I hope that this gives you some ideas and some hope.

Sincerely,

Keith Biggs, DC
http://www.eastmesachiropractor.com

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

QUESTION: Thankyou very much for your help and information, I have been back to my GP this week and she has referred me for an mri of my spine and pelvis, so hopefully this will give some more information, i only wish i had been referred weeks ago for these tests, i have been taking muscle relaxants and lying on the hard floor a lot of the time and seems to have helped an awful lot.  do you think at this stage anything will show up on the mri if im healing and taking it easy or will there still be evidence of what started this? When i have more results i will definately go back to my osteopath for a consultation as i never had any problems with her treatment and found a lot of relief from my rib pain after treatment. Is it possible for the MRI of the spine to give any information about the problems i have been having with pain and clicking in ribs for the last few years?? I asked my GP to refer me for mri of ribcage while i was getting the Sorry for so many questions and thanks again.

Answer
Dear Barbara,

If you have disc problems in your spine, the MRI will likely see it. You might be feeling some better, but this only means that the inflammatory stage of your problem is easing up.  Please remember, MRI's are typically done in preparation for surgery. I would only consider surgery as a last resort since it is risky and can cause additional problems. Surgery will never make you grow a new disc, it will only cut out the bad ones.

Clicking in the rib cage could also be a sign of degenerative changes in the spine.  MRI may or may not show a reason for this.

Most osteopathic doctors are also medical doctors... Your osteopath is NOT your primary care physician?  What is her specialty?  Most are general practitioners as well...

Keith Biggs, DC
http://www.eastmesachiropractor.com