Expert: Dr. Victor Dolan, DC, DACBSP - 4/21/2008

Question
Hi.I am currently in the care of a chiropractor for SI joint pain, sciatica and just found out that I had a twisted coccyx. I had seen a chiro previously and was feeling better until he did a manual adjustment for my cocyx. I had so much pain after that, I did not return. I had problems on and off in the last year and a half since I was diagnosed with a herniated L4 and L5. I have even went for physical theraphy for my back issues and ended up in more pain. I have been really good with my posture and feel that most of my pain is still coming from my SI issues. Also I had a hip scope about three years ago that I am still rehabbing. It came to my attention that my left side was still considerable weak and causing over compensation issues. I am finally able to add leg lifts into my rehab for my VMO'S. I am hoping now that because I am now strenghtening my left leg it will help to alleviate some of the over compensation issues I am dealing with on my right. I have not been given any exercises for my instabilities of the back and was wondering what your advice was. I have now been seeing my new chiro for over a month for three visits a week and I still have the hip locking up on me when standing from a seated positions. I am a little concern that maybe I am lagging some what behind because I am not getting a rehab protocal for me to use at home. I hurt my back after doing a yoga class. I overstretched. Sloan

Answer
Hello Sloan.  Sorry to hear of your protracted pain.

I am not totally clear on your question.

Twisted Coccyx.  This hurt so much AFTER manipulation that you stopped going to that chiropractor.  Is this still the cause of your back pains?  Has this 'healed' and your complaints are NOT related to this twisted coccyx?  If the pain(s) are related to the twisted coccyx, then (I'm sorry to say) you need that coccyx 'untwisted' or re-manipulated.  You would need to ask your DC if he/she does any coccyx maneuvers.  Personally, I do not do coccyx work.  Usually the coccyx is well-protected between the buttocks that problems are rare there.  Treatment is difficult and a touchy subject- being placed where it is.  Ask your DC- do they do it?, if not get the name of a DC that does manipulate the coccyx bone.  You could go for an adjustment or a few, and return to your original DC if you are happy with him/her.

Herniated L4  AND L5, so we have two discs (not just one disc at L4/L5) that are in a problem.  SI joint problems, and a hip joint problem.  Difficult to differentiate all of these.  ALL of them could be problematic concurrently, or any combination of one or two or all of them,,,, with radiating pain confusing the issue.  Your DC should perform a complete evaluation of each separate area and decide which area contributes what to your current complaints.  Unfortunately your health insurance may not cover all of the examination required, may not cover all of the testing required: perhaps EMG/NCV, additional MRIs.

Hip 'locking up', when was your most recent xray, ct or mri?  any anatomical reason for this 'locking up'?

You mention VMOs as a muscular involvement.  Your Psoas muscles (and iliopsoas) muscles should also be evaluated.

You seem to have many problems going on.  Find the best Doctor of Chiropractic that you can.  Have as complete an examination, history and testing regimen as you can.  Treat the priority areas.  It will take TIME and patience on your part.

To help yourself heal, avoid activities that aggravate your complaints, exercise as instructed.  YES get a home rehab protocol.  Live an anti-inflammatory lifestyle (no smoking, no alcohol, avoid processed foods, sugar, flour, salt).  Supplement with anti-inflammatory vitamins/ minerals, and joint supporting supplements.
Vitamin C with bioflavonoids, Glucosamine, Chondroitin, MSM, even SAMe, Calcium, magnesium, Omega 3 EFA's, enzymes.

This sounds very compicated, with your whole lower torso in problems, hips, SI joints, lumbars, coccyx.  Only your treating health professional can evaluate, prioritize and treat.  Hope this discussion is of help and gives a little more info.

Good luck, and I wish you Good Health, Naturally!

Victor Dolan, DC DACBSP
http://www.DocDolan.net