Question
first thanks very very much for your long reply. it means alot to me in this day and age that someone would give their valuable time to a stranger. just a 3 quick question thou

if i was to get a mri what exactly should i tell the doctor to take a mri of? and please say it to me using the exact terminology they would use as here in thailand it is very expensive and also dont want to have to do it more than once.

when the mri is complete and probably shows damaged areas is this usefull for any doctor/chiro to go further or is this only to be used for a certain doctor but what is his/her title called?

if a/some igament/s is/are damaged i read some where before that their is some surgery to correct this. something like something is injected into the ligament to make its length longer. is this a good idea?

thanking you in advance.


Followup To
Question -
about the heel lift. yes he did give me a shoe insert as the one side was 6 mm shorter than the other. i had it in for over 3 months it did nothing. by the way i have read part of travel and simmons trigger point manual and that tip is taking straight out of the book. i am sure you know that already thou. i think the chiro was half right about the leg differnce. i think it is not that one leg is shorter than the other as he said but rather that this shorter leg is actually the correct length and that the other leg had its hip pulled up the ql and or other muscles. also when i did look at a technical physical therapy book on ql related problems i did find a photo of a subject who had a ql problem (sorry i can not remember the exact nature of the problem) but funny enough the way the one torso was not symetrical with the other side. a photo to which at times does really remind me of myself. sort of like scloisos but not. of note 2 doctors did think i did have scilios as my spine is curved side to side (not including the natural anterior posterior curve) but the xrays showed that it was not actually scliosos.



perhaps i have many many mucles in the hip area for sure another one is the tfl that have all kinds of pain in them and then also the si joint. but when one physcial therapist did do some teste with me moving my leg it appears that this is also reffered pain. perhaps all these pains are sattellite trigger points from what exactly i dont know? is it possible that a ligament could of been stretched too far ( i am under the immpression that ligaments can not shorten after overstretchd) when the accident happened thus the muscles involved would have to be in constant tension to make up? and are there tests to see if particular ligaments of the hip area are damaged?


also i have noticed that when i do the squat but now with only real light weights that when i quads get down around 120 degress of the knee joint or so that either my knees reaaly curve clockwise or it is the hip turning. it is hard for me to describe in words exactly. and when this does happens it sure makes it harder for me in a bad way. is this ligament damgage or myofascial? or not sure? and could you tell me just what muscle or body part takes over when you do the squat at about 120 degree of the knee joint?

also to mention that the most problem side the right low back region also has that si joint locked from what the chiro did say.

i also do have spina bifida in l5 as seen from the xray. but is it not the case that all nevre problems will show the exact same pain location thus this not being a cause of pain. and further to the point that maybe all the other pains are not caused by nevre damage. although i am thinking about getting an egv test. these egv letters could be wrong but it is a test that is done for about 1 hour that tests to see nerve damage in problem areas. thus i come back to myofascial pain sydrome.


thanking you in advance. thinking positively that your recommendations will provide somewhere to go.

of note i do live in thailand now and it seems to really hard for me in its biggest city bangkok to find any specialist on mnyofascial pain and any doctor to give an exact diagnoses of the problem that they can prove is correct. any ideas of what or how i could find such as person. it just amazing how everyone is some how mystfied as to what it is i have including a chiro i had in here in bangkok from los angeles. a chiro that seems to be really smart and realize that his sessions took over 1 hour something probably not possible in the west with the further costs invovled of running a business in the west. he did not run a revolving door practise.


Answer -
Jii,

Thank you for the detailed explanation of what is going on.  I apologize for the delay in getting to you, but I have been out of town at a conference and have just gotten back to my emails.

Well this is a tough case you have going here.  I think that you have educated yourself very well and just need the right combination of treatment to help.

First I want to answer your questions.

You are on the right track as I feel you are having significant patterns of referred pain. The goal is going to be to address all the aspects of this problem, which I will get to in a moment.

It is very possible that you had ligamentous injury resulting in overstretching of the ligaments.  This will lead to substantial mechanical pressures and myofascial spasms and stretches.  Thus the motor unit of the hip and SI joint are unbalanced.

The best test to determine if there is ligament or other soft tissue damage around the hip is an MRI.

I believe that the situation when you squat is myofascial and mechanical, which may mean that the ligaments are involved.  Normally I would look to the pelvis in this situation as it is the most likely culprit for be torqued or twisted, causing the hip to move in an irregular pattern.  The Quadriceps in the muscle involved with knee extension/flexion and squatting.

Nerve damage will normally display itself in the same pattern, not a migrating one.

Now, I want to let you know what I feel is going on here.

I believe that you have experienced injury to the myofascial and ligamentous complexes of the pelvis, SI joint and hip region.  This has resulted in altered mechanical function and mechanical pressures on the hip, pelvis, SI joint and lower lumbar spine.  This in turn results in further myofascial dysfunction.   A cycle is created which can result in nerve irritation and pressure and obviously, the pain process that you are experiencing.

My recommendation is this: you need to address the mechanical pressures and imbalances and the myofascial component.  Being in Thailand, this may be difficult.  I would recommend that you continue to see the chiropractor for manipulation of the spine, pelvis and hip.  In addition, I recommend that you see an acupuncturist to attempt to balance your energy system, thus relieving myofascial dysfunctions.  You can also see a massage therapist for massage on the involved musculature.

It would be great to have you here as I think I could provide some help through these measures, but I believe that you can find what you need there through chiropractic, acupuncture, and massage.  You need to be stretching daily and be diligent about your care.

Let me know how you are doing.

God Bless,

Dr. Boss

Answer
Jii,

Thank you for the kind words and appreciation.  I do feel that God has put me here to help others and this is one way that I do it.  I do want you to know that I am praying for you and pray that you will find a way to heal this problem.


The MRI should be of the hip and buttock region.  However, I do think you might should try a course of acupuncture and the other treatments I recommended first.  This simply because of the cost of the MRI.  If it doesn't show anything or if it does, I would recommend the same treatment initially.  If this course of treatment fails, then you would move on to a pain management specialist.

There is a treatment here in the US called prolotherapy.  This is where they inject an irritant substance into the ligament and tissue in order to attempt to get the tissue to inflame and then go through the healing process with the hope that it will heal properly.  It has mixed reviews and success.  I have had one patient who has had it and seen some improvement, but it is not widely practiced and used.  You may look it up online.  PROLOTHERAPY

Keep me informed of how it goes and good luck.

Dr. Boss