Question
QUESTION: Hi Scott
I have been dealing with constant low back pain for a little more than a year now. After being sick of having medications thrown at me, and no solution on how to fix the pain for good, i decided to start going to see specialists on my own. No one has been able to give me a straight answer on what my issue is - possibly things I was born with but I had a hard time believing that as I am 28 yrs old and have NEVER had any back pain in my entire life, and this just started one day as an annoyance and over a month span it got to the point where i was always in tears.

Just recently started going to a highly regarded Chiropractor in my area about 2 weeks ago. She reviewed my MRI, did a physical exam and determined that my left SI joint was out of place. This sounded like a possibility as my SI joint has been mentioned in the past from some dr's, they just couldnt see what was wrong with it in the MRI, they just knew it didnt look right. I have gone for 2 adjustments so far, going for my 3rd today. I am also going to Physical Therapy at the same time, there was one day where I did both PT and Chiro the same day, but havent done that since.

What i am curious about is that I have had increased discomfort since starting to get the adjustments. Nothing severe, just more annoyance. It almost feels likes its more the muscles around the joint bc the pain is more a throb/burning opposed to the usual sharp pain. I wanted to find out if this is normal for someone who is having a joint manipulated and put back into place, esp if its been out of place for over a year. Could it be the combo of getting the adjustments and doing PT?

My pain management dr isnt a fan of chiropractic care, so I fear that she will tell me to quit if I tell her its making my back flare up. I would like to be able to tell her that i rec'd an unbiased opinion, not from my own chiro, who said I need to stick with it for awhile longer before I notice any results.

Thank you so much for your time.

ANSWER: Jessica,

If it was simply your SI being "out of place" then one adjustment would make it feel better right away.  The SI joint hypothesis is outdated and poorly correlated to pain in most cases.   Also, your pain management doctor could do a "diagnostic block" at the SI to prove or disprove if it is the cause of your pain.   If a diagnostic anesthetic block drops away your pain, then it's the SI.  I'd be more curious if ANYONE did a prone instability test (PIT) on you.   Go to google or google-scholar and search "prone instability test and low back pain."   As for PT's or DC's thinking your SI is out of place, the research shows that the odds of this being accurate are pretty poor.  Everyone's SI's appear misaligned when they lay belly-down the boney knobs are palpated for alignment.  So what!   Odds are you have a lumbar disc problem and nobody has been able to hit a bullseye in getting you fixed.  If you have a (+) PIT, then you must do stability exercises (search "McGill and Stability exercises for lower back"; or ask your PT or DC).  The pain management doctor should ask herself how many epidural steroid injections she does on patients that haven't seen DC's when she knows full well that the research shows that ESI is not very effective long term and the literature supports chiropractic treatment for back pain, both acute and chronic.  Chiropractic care is also very safe.   What's her problem?   Maybe she hasn't met the right chiropractors.   Let me know if this was helpful.

'Best,

Dr. G

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

QUESTION: Thank you Dr G! I may be explaining things wrong with my SI joint "being out of place", but I do know that my DC does think its related to my SI joint. However, I have been told by other Dr's that my pelvis is tilted (probably born with it), and I was also forced to wear special shoes when I was younger due to flat feet - could these things be adding to any underlying back issue I may have? I didnt have an accident or injury - the back pain came on at the end of my mom being in the hospital for 5 months for a head injury and I did hours and hours and hours of sitting, bad posture and bad seating most of the time im sure. Towards the end of the 5 months, it started as a back ache, and turned into a really horrible pain. Could that have done something to my back?

I have had 3 injections during the past year - a facet joint injection, an SI joint injection and an epidural injection. The facet injection didnt do much, just caused some more pain. The SI Joint Injection felt good that day, got a little sore from the inj the next day, and had a little relief for a few days but didnt last really long. I remember with that injection the dr had a hard time getting the needle in the area he wanted, he had to really push it in hard. The epidural injection was the worst - the pain was so bad I went to the ER.

I have had 3 MRIs - My first MRI had a few notes about possible degenerative changes in a few places, but nothing major - from what ive been told thats a pretty general term they give ppl w back pain. My last one was deemed normal- i had it taken after that bad injection so i didnt know if thats what normal meant, that there was no issue from the injection, or if normal meant normal. Shouldnt any disc issues have been picked up on my MRI's?

I am also going to see a physiatrist at a local hospital next week, and recently started seeing a Craniosacral Fascial Therapist. Are these other good options?

Answer
Jessica,

Not all disc issues get picked up on MRI, and not all radiologists describe the findings the same.  There is a notable false-negative rate with MRI (Schneider, M. JMPT 2008?) that is a factor; in other words, there is a problem but the radiologist didn't see it or mention it.  Another problem with MRI is that you are laying flat on your back.  The weight of your torso is taken off your spine, the discs relax, and sometimes everything looks normal.  There are some seated MRI scanners (2 in CT, one in MN, and I don't know where else) that scan lumbar spines just for this reason: seated will put the weight of your torso on your spine and load up the discs, showing bulging and vertebral slippage that often doesn't show when laying supine in the scanner.   Someone has to the the PIT on you!  If it's positive, you need to do stability exercises.  Also, have someone take a close look at your MRI images and see if you have this:  "bone marrow edema in the pars articularis."  They'll know what this means.   Lastly, if you have overpronated arches/ankles, then it is not a bad idea to get arch supports to help line up your legs/femurs/pelvis.  For some people this helps a lot with their backs.  Good pre-fab' (off the shelf) orthotics include ALINE.com and Superfeet.   PowerStep brand is also okay, comfortable, but offers less control of your alignment.   Custom orthotics run from $180-$300.  Don't spend more than $300 on orthotics, especially if pre-fab's will do the trick for about $50.   Get the PIT done and have your DC look it up if he/she isn't familiar with it.

Good luck,

Dr. G