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BIG Medical mistake!
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BIG Medical mistake! - May 17, 2006 3:39:00 AM
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expatient
Posts: 17
Joined: May 16, 2006
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Is it??
SIJD - the reason for low back pain, scoliosis, lordosis, lumbar/thorax hypermobility, forward head position, bad posture, headaches, leg length inequality, knee problems, achilles problems and so many others... Very common problem and yet so poorly understod!
(SIJD = sacroiliac joint dysfunction/dislocation/syndrome, rotated pelvis, rotated iliac/innominate, pelvis misalignment, upslip,... A lot of different names to this!)
After years of search I finally found one professional who knew how to cure my back pain: to correct my SIJ. Before him I met tens of others who did it wrong or didn't know anything at all! I spent thousands of dollars during many years for doctors, physical therapists, pictures, exams, test,...
My problem was anteriorly rotated left iliac bone (SIJD), but all the doctors were totally lost, or few of them diagnosed something wrong on right side of my back where the pain was... That is wrong side!!
After I got rid of my back pains (and many other problems too connected to SIJD) I started to search information about SIJ dysfunction and to interview patients who have the same problems I did.
According to many research and studies almost all people have leg length inequality that causes bad posture, scoliosis and other problems. That is because of misalignments in pelvis -> SIJD. When iliac bone is rotated it causes leg shortening, sacrum to lead forward -> lordosis. That leg length inequality causes palvis misalignment. Those all cause problems to spine all the way from lumbar to cervical spine!
Here some references:
Richard DonTigny, PT:
"Eight of ten people in the world will have low back pain at one time or another and I firmly believe that most of it is SIJD.”
http://www.kalindra.com/faq.htm
Wolf Schamberger, M.D.
"Patients presenting for cardiac rehabilitation are no different from the general population in that 80 to 85% are out of alignment."
http://www.cacr.ca/news/1998/9812Schamberger.htm
Maciej Dluski :
“The theory of the YUMEIHO method is grounded on the fact, that over 95% of people have had incorrectly positioned pelvis since their birth. Most often it means, that one ilium is placed higher than the other. The limb on the higher ilium side is comparatively shorter.”
http://www.yumeiho.pl/o_terapii_en.html
Lisa Mancuso, M.D., Hugh S Thompson, M.D, George A. Bitting, M.D.:
"The sacroiliac joint is a commonly overlooked cause of lower back pain. Recent studies have found that Sacroiliac dysfunction was the cause, or a major component, in a high percentage the cases of mechanical back pain. Dysfunction in the sacroiliac joint not only causes back pain but also may mimic pain seen in lumbar disc herniation or a facet joint with pain referred into the buttock and thigh."
http://www.firstchoicehealthcare.com/assets/docs/012405.pdf
Protonics method:
“In a normal person the spine sits on top of a neutrally positioned sacrum (central portion of the pelvis) and has a slight lordosis (arch forward). When the pelvis is anteriorly rotated the sacrum is tipped forward and the rest of the spine has no choice but to follow suit. Rather than fall over forward, the body compensates for this excessive forward tilting of the lower spine by tilting backward at some point higher up the chain. This creates a large increase in the amount of curvature (lordosis and scoliosis) of the lower back. This deep curvature of the back can result in extreme pain and various problems including muscle spasms, pinched nerves, and possibly damage to the intervertebral discs.”
http://www.protonics.com/How%20Pelvic%20Instability%20is%20the%20root%20cause.htm
Greg Spindler:
“One side (usually the left) is rotated forward and then the other side is rotated back. This creates the unstable pelvic condition while under weight-bearing stress. As a result, the sacrum is off-center and tipped which initiates a direction for the scoliotic compensation (the curvature) to begin. The bottom line is, not treating the pelvic area puts limits on relieving scoliosis conditions.”
http://www.gregspindler.com/treatingscoliosis.html
Postural Restoration Institute
“The left pelvis is anteriorly tipped and forwardly rotated. This directional, rotational influence on the low back and spine to the right, mandates compulsive compensatory movement in one or more areas of the trunk, upper extremities and cervical-cranial-mandibular muscle. The greatest impact is on rib alignment and position, therefore influencing breathing patterns and ability. It is very possible that respiratory dysfunctions, associated for example with asthma or daily, occupational, repetitive, work positions, can also influence pelvic balance and lead to a compensatory pattern of an anteriorly tipped and forwardly rotated pelvis on the left.”
http://www.posturalrestoration.com/about/science.html
Richard DonTigny, PT:
"Here is the mind blower. In 1982 the American Academy of Orthopaedic Surgeons met in Toronto specifically to address LBP. They established criteria for testing and for the interpretation of those tests. They assumed that the SIJ was so strong as to be immune to injury through minor trauma and paid scant attention to it. They also reported that 'in spite of thorough examination they could establish a firm diagnosis less than 15% of the time.
What they did not seem to realize is that when you use their recommended tests and interpret those test in the recommended manner that you will be compelled to miss the diagnosis over 85% of the time! It's not that they are not an intelligent group, but they just have not considered all of the evidence.“
http://www.kalindra.com/critical.pdf
http://www.spineandsacroiliac.com/images/effect.pdf
http://www.spineandsacroiliac.com/sacrodysfunction.html
http://www.healing.org/only-3.html
http://www.kalindra.com/derosa_montreal.pdf
http://www.kalindra.com/rounds.pdf
And I have collected a lot more great links:
http://personal.inet.fi/koti/faro/Selkasivut/Linkkeja.html#eng
This is a common mistake the professionals do: They follow the pain!! That is wrong!
Physical Therapy volume 79 · number 12 · december 1999
http://www.Ptjournal.Org/ptjournal/december1999/v79n12p1134.Cfm
Research report: Measurement of sacroiliac joint dysfunction: a multicenter intertester reliability study
Janet K Freburger and Daniel L Riddle
“for example, a patient with symptoms in the region of the right sij, with a right asis lower than the left asis and a right psis higher than the left psis, would have an anteriorly rotated innomimate on the right. Conversely, a patient with symptoms in the region of the left sij, with a right asis lower than the left asis and a right psis higher than the left psis, would be described as having a posteriorly rotated innominate on the left.“
That last sentence is wrong! If right PSIS is higher it is dislocated ie. in dysfunction regardless where the pain is! But it must not be measured when patient is standing. I have seen patients who have right PSIS higher when standing and left PSIS higher when lying. Because iliac rotation effects to the functional length of a leg, PSISs must be palpated while lying.
Here is other similar:
Physical Therapy . Volume 82 . Number 8 . August 2002
Evaluation of the presence of sacroiliac joint region dysfunction
using a combination of tests: a multicenter intertester
http://www.Udel.Edu/pt/manal/spinecourse/sijlab/riddled.Pdf
Reliability study
Daniel L Riddle, Janet K Freburger, North American Orthopaedic Rehabilitation Research Network
According to table 3:
1. Standing flexion test: my left SIJ lifted, so it was hypermobile!
This test alone should give enough evidence that it was left SIJ dysfunction!
2. Prone knee flexion test: I had the pain on right side and right leg was longer, so this test gives the wrong diagnosis to me: posteriorly rotated right iliac. Wrong!
3. Supine long sitting test: again I had the pain on right side and right leg was longer, so this test gives the wrong diagnosis to me: posteriorly rotated right iliac. Wrong!
4. Sitting PSIS test: this is the worst! I had pain on right side and left PSIS was higher. According to this test I had posteriorly rotated right iliac. Totally wrong result!
And this is why I had wrong diagnosises and bad treatments for many years. It took 10 years to find a professional who knew how to do it wright! All the other PTs and chiropractors did it wrong like in that paper.
The pain is usually on the other side than the reason. That is where the mistake is made! Left SIJ dysfunction -> pain on the right side!
This is why the manual treatment is not helping most of the patients... They do it to the wrong side. They try to dislocate the healthy SIJ!
My opinion is that there is no such thing as posteriorly rotated iliac. It is (always) a misdiagnose because the pain is very often on the other side than the cause. Iliac might seem to be posteriorly rotated. Same thing with legs: One leg seems to be different length that the other leg with almost all the people.
If SIJ is hypermobile it is so because it is dislocated. If PSIS is higher on the other side it is so because iliac has rotated (dislocated) anteriorly on that side, no matter where the pain is! But it must be checked while patient is lying, not standing!
That is why they say right SIJ is usually the problem. That is not true! The pain is usually on the right side! But the reason for pain is on the other side. When left SIJ comes out - the left leg gets shorter - and all the body weight is carried on right side of the pelvis. That’s why it hurts there!
I believe it is so. I have seen and interviewed about 100 back pain patients who have got help same way I did. First some of them got diagnose to wrong side from chiropractors. So those chiros tried to dislocate their healthy SI!!
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Re: BIG Medical mistake! - May 17, 2006 4:43:00 AM
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tr6454
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your first paragraph is correct and is the reason we all view this site, to learn more.
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Terry
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Re: BIG Medical mistake! - May 17, 2006 8:57:00 AM
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OAK
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Thanks for clearing that up. Who knew it was all so simple. :rolleyes:
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Re: BIG Medical mistake! - May 17, 2006 1:54:00 PM
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ginger
Posts: 660
Joined: February 26, 2005
From: Melbourne Victoria
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Seems like an intelligent review of one view about SIJ status. Not mentioned however in all this is the most importantr consideration of all related to this pair of joints, function. No mention about mobility or lack therof, no mention about the single most important reason to have a pair of whopping big joints there in your pelvis. That is , to move. In none of your very interesting considerations is there a substantial amount of interest paid to the fundamental property of joints. Concerns about position, alignement,rotation , upslip, downslip, etc etc , are all missing the point. Make this pair of joints move properly and low back pain can and will be relieved, It occures to me to say that the attentions paid in your aticles to position and alignement , have in part resulted in improvements to movement capability , this being the important element, and position ( 'alignement') is seen to alter as a side product.
Don't stop looking expatient, son't stop asking questions, you seem to be driven ,just grab the wheel and keep going.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: BIG Medical mistake! - May 18, 2006 4:32:00 AM
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dosrinc4
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lots of talk about bony landmark allignement and symmetry none of which has any reliability whatsoever, lots of nevers and always which is never good and will always lead you down the wrong path. Glad you found something that worked for you but remember that is you and the next guy may take something different to succeed
Rick
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Re: BIG Medical mistake! - May 21, 2006 9:04:00 PM
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expatient
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Yes but I have interviewed personally over 40 patients with almost same story as mine. They all had been looking for help many years (many doctors, exams, PTs,..) untill I told them to try that. And they got help! And there are thousands of others who have got help too, some got it long before me...
So you are wrong to say it hasn't any "reliability". It is BIG and conserns many people. About 80% of all people have pelvic alignment problems and almost all have some inequality with their leg length. There are many medical studies about those...
I am sad you disagree...
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Re: BIG Medical mistake! - May 21, 2006 9:39:00 PM
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ginger
Posts: 660
Joined: February 26, 2005
From: Melbourne Victoria
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Dear Mr expatient, great to have you amongst us, we welcome your insights and have collectively a huge resource of understanding and experience to offer . Should you wish to continue to expose your views here however , you must realise that the thoughts and explanations you express are up for all to comment on. Not all will agree with you and many will have an alternate way of explaining the very experiences themselves.
While you seem to have had an epiphany along with the good fortune to find treatment that works, your explanations as to why , is one that many will find disagreement with, myself included.
keep posting.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: BIG Medical mistake! - May 22, 2006 3:31:00 AM
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expatient
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Thanks. I hope to get some opposite comments. It drives me to look more information about this. There is a lot of it...
I try to be more understanding...
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Re: BIG Medical mistake! - May 22, 2006 3:54:00 AM
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expatient
Posts: 17
Joined: May 16, 2006
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SIJD on pregnant women
"One of the most interesting side-effects of a misalignment of the pelvic bones is that anecdotally, it often seems associated with malpositions of the baby" "-There is little scientific data to show that pelvic misalignment is associated with malpositions because traditional medicine does not recognize misalignment as a problem or research it, nor do they take the idea of "pelvic misalignment" seriously."
http://www.plus-size-pregnancy.org/pubicpain.htm
Dr. Robert White
"Infant spines should be checked shortly after birth due to the twisting, pulling, and tugging that does on during the labor process. Their spines are extremely vulnerable and misalignment can result in such problems as colic, re-occurring ear infections, and later hyperactivity."
http://www.tcwellness.com/article.php?id=399
"Low back pain was caused in 78 percent of the women by sacroiliac dysfunction, resulting from the sacroiliac fixation test also know as Piedallu's sign. The patient is examined and one posterior superior spine is lower than the other. "
http://www.kalindra.com/arcadi.pdf
Dr. Cheryl McFarland
"Scientific research shows that SI joint dysfunction is the primary cause of pregnancy-related back pain."
http://www.sptimes.com/2004/10/25/Citrus/Pregnant_women_can_av.shtml
Kenneth D. Erickson, D.C.
"The most common cause of low back pain during pregnancy is a condition known as “sacroiliac joint dysfunction” or “sacroiliac subluxation”. Subluxation is a Latin term meaning “partial dislocation”. "
http://www.doctorken.com/pregnancy.htm
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Re: BIG Medical mistake! - May 22, 2006 8:14:00 AM
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Jeffre
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Ahh yes, plus-sized pregnancy.org. One of the great centers of research of our time. Better be careful, it would be easy to mistake that for a different type of site. You know what I mean.
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"You are as well as your insurance company is willing to allow."
- Dr. Hibbert
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Re: BIG Medical mistake! - May 22, 2006 2:00:00 PM
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ginger
Posts: 660
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From: Melbourne Victoria
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I think you will find that these articles are written by chiropractors expatient, not real doctors of medicine. As such you will find amongst their work an assortment of the wildest and wierdest , along with some that is useful and interesting. You've struck out into the goldmine of confabulation and starry eyed rhetoric.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: BIG Medical mistake! - May 22, 2006 5:54:00 PM
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MPT
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From: Syracuse, New York
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expatient:
As a clinician I strive to have consistent results. Over and over, palpation of bony landmarks has been shown to be unreliable. That means, if I go in and palpate a patient and then someone else does, we are likely to get totally different results. I may even get a totally different result if I go back and palpate the same person. Using an unreliable test will not give me consistent results. Why would I use a test that may give me different results on the same patient?
Even if palpation was reliable there is no evidence that it is a valid test. I have used palpation of the SI joint in the past and have come to the conclusion that it does not in any way affect my ability to help a patient. It does not change how I treat a patient so I no longer do it.
Many of the articles you posted are opinion articles not studies. The opinions of these people are worth no more or no less than the next person. What is needed is a review of the medical studies on the subject. I do not dispute that you and many other people were helped by a certain treatment, however that does not validate the assumption that your pain was due to your SI joint being out of alignment. The SI joint theory is a unproven model that some clinicians use to explain why a treatment works. If you came to someone like me, I may have given you the same exact treatment with a totally different explanation of why it works. (guess what,, you would still be better).
A recent study even suggests that SI jt injection (the current gold standard for identifying SI joint problems) is not specific to the SI joint and not reliable. This does not mean that SI joint injection is not helpful for some patients it simply calls into question if it is really treating the SI joint problem. It also calls into question other studies that base their conclusion on the gold standard of SI joint injection (of course that is only one study).
So to call what happened to you a big medical mistake is unfair to the other practitioners. A person does not make a big medical mistake when they do not base their treatment on unreliable and invalidated examination techniques. Unfortunately, when treating low back problems we do not have an agreed upon best practice and we do not have reliable way to determine which treatments will work on which patients. It sometimes just comes down to trial and error. (we are getting some better ways to match treatment with patients, manipulation CPR).
All of us will have patients who do not respond to our treatment and they may do better with someone else. That is why, no matter how "good" you are, second opinion for your patients is never a bad thing. Maybe the patient will like the other clinician more and that will make the difference between them getting better or not.
Hope this makes some sense. It is kind of late and the screen is starting to look a little blurry.
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Where am I
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Re: BIG Medical mistake! - May 22, 2006 9:24:00 PM
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expatient
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AR15, you are right. Palpation must be done right to get the right diagnosis. But anyway no matter how you do it, if you find differences on them that means something is wrong on pelvis.
Even if they all did it like in figure 2 it will be wrong way because functional leg length difference will effect pelvis posture as they too say on that research.
http://www.pt.ipu.ac.jp/staff/andrew/papers/2000_leg_length_and_pelvis.pdf
Almost all do it wrong. They palpate patient while he is standing and sitting. But on standing there might be right PSIS higher and when sitting left PSIS can be higher because if right leg is functionally longer. Then it will push right iliac higher when standing. And then they decide which side is wrong by asking where the pain is. Pain is usually not there were the problem is.
And those provocation tests mainly measure the pain, not the cause of the pain.
Only reliable postition is to do palpation while the patient is lying and functional leg length difference is not effecting the posture of his pelvis.
I have a lot of experience on different kind of doctors (DC, MD, PT,...) during my 15 years as a chronic low back pain patient with a lot of other symptoms too... finally one knew how to do palpation and how to correct my SI.
Palpation alone doesn't help anyone. And injections are used following the pain. But the pain is usually on the other side than the problem. For me many PTs said the problem is my right SI becaus I said it hurts there, and then they tried to manipulate it. So they tried to dislocate my healthy SI!??! I tried even acupuncture among many others.
For me this was a bigest medical mistake. My pains started when I was 17yrs old. At age 20 I had chronic pain. Age 22 I started to loose strength from my legs. Then came headackes, migrens, high blood pressure, heart problems, even TOS was diagnosed to me, etc. I lived 10 years on medical pain killers and spent thousands of dollars for doctors, exams, tests, MRIs, X-rays, etc. They found nothing wrong!
I am sure more research is done very soon...
To ginger, I thought MD means medical doctor and PT physical therapist, not a chiropractor...
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Re: BIG Medical mistake! - May 23, 2006 1:37:00 AM
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SJBird55
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From: Michigan
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expatient... AR wrote a very succinct post regarding the status of examination procedures, reliability and validity.
It sounds as though you are definitely passionate about yourself and your experience. But... you are very, very wrong in many of the things that you are posting.
Honestly, it sounds to me as though you had and possibly still have some psychosomatic issues. You've still got issues, and I'm quite sure that "expatient" is probably an inaccurate description for you and that you are probably a "patient" somewhere for something. :)
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Re: BIG Medical mistake! - May 23, 2006 1:49:00 AM
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expatient
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I lost 10 years of my youth. I can't get them back. But I can help others...
Can you say one thing (of those many) that was wrong and why?
Medical experts make mistakes all the time. For me many doctors and PTs said I have to buy a heel lift to compensate my leg lenght inequality. They didn't even check if it was functional inequality... and it was. Almost every time it is! Most PTs haven't even heard that there is such a thing as functional leg length difference...
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Re: BIG Medical mistake! - May 23, 2006 3:01:00 AM
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JSPT
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From: Michigan
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Ok, slow down there, tiger.
"Most PTs haven't even heard that there is such a thing as functional leg length difference..."?
Where on earth is the data you would use to back up such a ludicrous statement? I agree with SJ; it is blatantly obvious that you had much more than a structural anomaly going on at the time of your chronic pain. I do not for one second believe that your functional problems and complaints of pain can all be attributed to one very specific bony malalignment, be it a left on left torsion or whatever else you think the problem was.
Your statement "I lost 10 years of my youth" indicates an intense level of symptom magnification. I know people who were confined to wheelchairs in their mid-teens who do not feel that the last 10 years of their lives have been "lost". The fact that you think your pain stole precious moments from you indicates a strong psychosomatic component.
Please understand that I am not insinuating that your pain was imaginary or was not very strong. My point is that it is likely that your psychological state may have intensified any physical lesions. This makes your pain no less real. But it does mean that a missed diagnosis is probably not the cause of all the problems you have experienced.
Other than very acute injuries, has anyone here treated only a single, very specific lesion and had complete resolution of all symptoms? Now, how many times do you treat general problems (lumbar instability), and see a resolution of a constellation of symptoms?
The bottom line, Expatient, is that you seem to be hung up what you think was the root of all your problmes, a dysfunction which was missed by numerous health care providers until one who was simply "smart enough" finally discovered it. I would postulate that this discovery coincided with you finally having something to pin your pain on, and your body was finally ready to heal.
We're all glad that you are better now, and we have all seen patients misdiagnosed. But I think that at this point, you're holding on to your experience a little to tightly and are not conveying your message in a constructive way.
However, if this is part of the healing process for you, please continue to try to convince all of us that we need to open our eyes. We are a healing and caring bunch, and we would be glad to participate in your continued recovery.
Thank you for input and for sharing your experience with us.
_____________________________
JS
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Re: BIG Medical mistake! - May 23, 2006 10:11:00 AM
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jkmpt
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From: santa barbara ca usa
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I think expatient is another one these guys from chiroweb trying to rattle everyone's chain.
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Re: BIG Medical mistake! - May 23, 2006 1:24:00 PM
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TLB
Posts: 353
Joined: September 13, 2002
From: Arizona
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Agreed, this has become very apparent in the last couple of months. They basically get bored over on the chiro board or run everyone off so they head to RE and stir the pot. Can someone post s/s of a troll so everyone can spot one right away.
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Todd
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Re: BIG Medical mistake! - May 23, 2006 4:11:00 PM
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chiroortho
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No problem Todd. It's easy to recognize a troll.
:)
[IMG]http://www.urbanites.plus.com/troll.gif[/IMG]
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Greg Priest, DC, DABCO
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