Question
QUESTION: Dear Dr. Kulla,

I has my first chiropractor visit 12 weeks ago.  I went to see a chiro because I had flared my degenerative disc in L5S1 up from running.  (I was diagnosed 6 years ago with a degenerative disc, but haven't had any problems since).  The symptoms that I experienced was an annoying ache with prolonged sitting and driving.  After performing various tests, the chiro determined it was my left SI joint and manipulated it via side posture manipulation.  The adjustment was very forceful.  I felt dizzy for 24 hours and  experienced an achy burn in the SI joint.  Over the course of the week following the adjustment, I could not get comfortable standing, sitting, or laying on my back, had extreme lower back stiffness and  the achy, burning sensation was constant in my joint.  Needless to say, I never went back to the chiro and tried to heal up on my own.  That didn't happen.  After 6 weeks of being in constant discomfort and visiting many back specialists, who confirmed through a new MRI that my disc remained the same, I decided to go to another chiropractor.  I have gone once a week for about 5 weeks.  I have definitely improved a little.  I can walk and stand without pain, the back stiffness is almost gone, the tenderness around he joint is gone and I can sleep on my stomach, which I couldn't before.  After last week's visit the chiro told me that I have good joint mobility and no soft tissue damage.  He then said that he would need to see me at 3 week intervals.  I am excited that he thinks I can heal, but am a little nervous that I won't ever heal up.  I still experience a lot of pain when sitting and when laying flat on my back and I still have an achy, burning sensation in the SI joint. I have a few questions for you.  One, how long does it take for an SI joint to heal up completely at the stage that I am in?  I am stretching, walking, icing and heating to help with the healing process.  My pelvis looks a little rotated to me.  Initially, after the first, bad adjustment, the right hip bone stuck out in the front and it felt like bones were sticking out in the back on the left side.  After addressing this with the new chiro,  now, the right hip bone sticks out in the front more than the left when standing, but the left hip bone sticks out slightly more when laying flat on my back.  There is no feeling that bones are jetting out the back, which is good.  In your experience, is anyone's pelvis perfectly aligned and will that prevent my left SI joint from fully healing?  Thanks again for all of your time.  I am anxiously awaiting your response.

ANSWER: nicole,
well, that is a heavily weighted question. i will do my best.
first off, the first chiro you went to (was only once? ) correct? if that is the case, many patients get worse before they get better. so, in my eyes you didn't give him a chance to correct the problem especially if you have a degenerative disc. A Deg. disc takes many years to progress to that stage. to think that it will heal in a week or in 1 , 2, or 3 adjustments is just not going to happen. You may have a SI joint out of place due to the compensation for that deg. disc., that is hard to determine without seeing you myself. I would say that the cause of the ache in your lower back is the deg. disc itself (regardless of your si joint being out of place) I would not see a patient in my office once a week with a deg disc (more like 3 times first week , 2 times a week for a few weeks then 1 x a week for a few weeks)this will speed up your recovery time much faster then going 1x a week for several weeks. this is why you are still struggling with this problem. you need to understand that symptoms come long after you have had the problem, so theoretically , you have had this disc problem for many years it just took running to aggravate it or make it symptomatic.

second: you can never heal a degenerative disc back to its normal state. It's impossible once it deteriorates, that is permanent. That is why I stress spinal hygiene to all my patients and recommend a periodic visit to a chiropractor (depending on the stage of degeneration they are in) when you are NOT in pain. Similar to you going to the dentist for a cleaning twice a year without tooth pain. Your teeth just chew food and your spine controls all functions of all organ systems and muscular systems too. Many don't take this into consideration or just don't understand how the body works.
now in regards to your pelvis being out of alignment changing based on standing versus lying down. That is also a very difficult question to answer without seeing you. I would definitely check your muscles, specifically your iliopsoas muscle. You very well may be compensating for another problem. Do you have scoliosis? do you have a short leg? did he take an x ray? why is that disc degenerative? did you have an old accident or where you a track and field athlete? these are all important when diagnosing and getting to the root problem, so this doesn't reoccur.
i wish i could help you more but there are many questions unanswered here.
another thing to try is to take nutraceuticals to speed up soft tissue healing like gotu kola, manganese and there are a few others too.
let me know if you have more questions. when you see your chiropractor ask him to check your psoas muscle, then get back to me. there is only one way (area)to release that muscle and you will be able to tell if he knows what he is doing. if he releases it in the front by contacting you near the ASIS or in lay person terms (just above your hip where it meets your stomach) and it will be painful and very tight. this muscle is the only muscle that actually connects onto the side or lateral aspect of your disc. It is HUGE and very often missed by doctors. good luck!



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

QUESTION: Thanks for your quick and thorough response.  I really appreciate your time and effort.  I have a few answers to some of your questions.  First of all, the chiro did not take Xrays as I had them done from an MD after the first chiro adjustment.  They were normal. No one has ever mentioned scoliosis, so I would assume that I don't have it.  My leg length is checked before each adjustment and I do not have a leg that is significantly longer than the other.   I grew up playing soccer, but have never been in an accident.  The new chiro did check my psoas muscle and has performed that release technique while I was laying on my back.  It didn't really hurt.  So, I am not really sure what I should do.  Should I talk with my chiro about seeing me more frequently?  I do want to get better, but unfortunately don't have much experience with chiropractic care. to know if something is normal or not (in terms of visits).  Now I know you haven't seen me, but based on my initial question, does it sound like I can get better on the schedule that I am on?  One other thing to mention . . . when I had my first thorough exam with the new chiropractor, he also performed various tests and concluded that my problem was my SI joint. Assuming that my problem is my SI joint, how long do they take to heal up?  How about degenerative discs?  I am in the beginning stage of degenerative disc disease, as I still have a good amount of cushion.  Thanks again for your time.  i can't tell you enough how much I appreciate your answers.

ANSWER: first if you had an xray done somewhere else, were you standing? or lying down?
who read the xray and said it was normal? Was it an MD or radiologist?
If it was an MD or radiologist that doesn't surprise me one bit. they look for pathology, that's it. they have no clue what a subluxation is or what it looks like on film. You should get your actual film, not a report from them. Bring them to your chiropractor, if you haven't already done so.
good your DC checked your psoas. the leg length test your chiropractor does is one type of leg check meant to check Si joint, not meant to actually read the length of your of your femur, tibia/fibula, etc.. the only true leg length measurement (in my opinion) down to the millimeter is by x ray.

you should see him as often as he recommends. If you are nutrient deficient then you will heal slow , very slow. If this is the case then you should see him at least twice a week for a few weeks. If you want to prevent that disc from deteriorating further, then you need to take care of your spine so when you get older you will not have problems. Understand, chiropractic should be looked as a prevention to spinal decay as you age. It's your spine you have only one! you have plenty of teeth (which can be replaced) and one spine that is permanent and once it deteriorates it is irreversible. Chiropractic is part of my healthcare regimen (not every week) i go before i have pain i go when i have tension or tightness that's when i know i need a spinal tune up/checkup. After all, it is your spine the master controller(nervous system) of ALL your bodily function.

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

QUESTION: Have you ever heard of the K laser?  What are your thoughts on having a chiro use the laser on your lower back and si joint to reduce inflammation?

Answer
i use cold laser or LLLT (low level laser therapy) in my office for over a year and it is EXTREMELY effective. I do not know what k laser is , but i assume its justthe name brand of his/her laser. I highly recommend using that. you will recover much faster. rememebr the laser works best when you follow up on a daily basis or at least every other day (minimum), it will reduce inflammation very quickly.
to learn more about cold laser go to :
http://www.synergywellnessny.com/templates20/custom-content/coldlaser