Expert: Dr Ron Grassi,DC.,MS.,ACFEI. - 10/21/2009

Question
QUESTION: I am hoping that you can help me.  I am 30 years old and a very active woman, who is in good health.  8 weeks ago I went to a chiropractor looking to ease my low back ache that I developed running.  I was diagnosed about 6 years ago with a degenerative, minimal bulging disc in my L5S1.  The pain that I was experiencing was similar to the pain I experienced 6 years ago.  I explained this to the chiropractor.  He was convinced that my pain was my SI joint on my left side and had nothing to do with my disc.  I didn't have much physical pain to the touch at the time, just a dull ache when sitting and standing for long periods. So, the chiropractor did a side manipulation that was quite forceful for my SI joint.  Immediately after the adjustment I was dizzy and out of sorts.  As the day went on, my SI joint throbbed and I began to feel a light tingle in my left calf  and in the bottom of my foot (same side as the left SI joint that was manipulated).  Not only that, but I my SI joint and sacrum was tender to the touch.  It still hurt to sit and stand.  Walking is okay for short periods of time.  Occasionally, I have intense muscle spasms now in both of my calves.  Believe it or not, I am still experiencing these same symptoms 8 weeks from the initial adjustment.  I did have anther MRI of my lower lumbar only to find out that the disc looks the same as it did 6 years ago.  To top it all off, the left side of my pelvis feels a little higher than the right and seems to stick out further in the back, as I sometimes feel it when I lay flat on the floor.  I have a few questions for you.  When I was manipulated, could the chiro have pinched a nerve?  If so, will this eventually go away on its own?  I haven't been back to a chiro since my original adjustment, as I was and am too scared of making making my symptoms worse.  If I didn't have an SI joint problem to begin with, do I now sound like I have one?  In your professional opinion, will I eventually heal up and how long should that take? Thanks in advance for you advice.

ANSWER: Hi Nicole: The only way to differentially diagnose a true Radiculopathy (radiating nerve pain) is to go to a Neurologist and get an EMG or nerve test. This is similar to testing a wire for its ability to transmit an electrical signal. This tells you where along the Nerve the problem is. If that test is positive, it is Neurogenic referred pain. If it is negative, it is Sclerotogenous referred pain. This means pain from a structure other than a nerve. Like an SI Joint. It does not sound like your disc is the origin of your pain. How are your reflexes. Do you have muscle atrophy right thigh/leg compared to uninvolved side. It sounds like you were not ready for the Adjust ment at that time you had it. It sounds as if you have a musculo-ligamentous sprain/strain. I do not think the Chiro "pinched" a nerve. It takes much more trauma to do that. Your condition is probably self limiting. Will get better on its own in time. But, it sounds very inconvenient and annoying. If I were you. I would go to the Neurologist for the nerve test. Bring your MRI films. He can give you injections of an anti inflammatory and pain meds. to hold you over. You need a back brace. You need back strengthening rehab. exercise (pilates,yoga)  You should really run all this by your Chiro. too. Tell him of your concerns.  Good luck!. Dr Ron Grassi,DC.,MS.Jupiter,Fl. www.DrGrassi.com

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QUESTION: Also, one last question, is it possible for a chiropractor to move the SI joint out of alignment with one forceful side manipulation?  If that was the case, would I still be able to heal up?  How would I know if it was out of alignment? Would there be any distinct symptoms that I could look for?  Thanks again.

ANSWER: Hey Nicole, Dr Ron again: Unequivocally YES.! If you can put it in, you can put it out too. There are many directional force vectors to take into consideration when applying the Manipulation. This is why sometimes it takes a "couple of shots" to get it right. SI adjustments require the most power/force of all the adjustments because of the nature of the joint. You should be completely relaxed before the adjustment. The most extreme way to do this is Manipulation Under Anesthesia. Twilight Sleep, like a colonoscopy. Or, a little piece of tranquilizer before the adjustment as RX by your MD.

Each SI Joint (there are 2) articulate 4 ways in a figure 8 pattern when you walk. One or many of those movements can either be stuck or be very loose and moving too much. That's what the Dr is supposed to recognize and fix.

Weigh yourself on two scales at the same time. If your total weight is 120lbs. You should weigh 60lbs. on the right and 60lbs. on the left. 9 out of 10 times, you weigh more on one side. Let's say you weigh 70lbs. on the right and 50lbs. on the left. You weigh 20lbs more on the right.This means you have a right functional short leg. You adjust that patient on their left side down only. re-measure the leg length and weight. Both will be even.

Now, isn't that simple and scientific?.  THE SHORTER HEAVIER LEG SIDE, IS ALSO THE PAINFUL SI JOINT SIDE.

If you can't get the legs even this way, you go into a heel lift. But,never greater than 12mm.The heel lifts are another story. Tell ya what Nicole. Give this note to your Chiro. I'm a Chiro. instructor so they should be OK with that.

Good Luck. Dr Ron Grassi,DC.,MS.Jupiter,Florida.  www.DrGrassi.com

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QUESTION: I am planning to go to the neurologist on Friday.  Thanks for the advice.  I just thought of another question for you.  Can you explain to me how a chiropractor could damage your SI joint in one side manipulation?  I am actually seeing another chiro now and he is putting me back into alignment.  I am starting to feel a little better, but occasionally, for no reason, I get an electrifying, sharp pain in my SI joint (I have had this since my initial bad adjustment) .  It doesn't radiate or have any connection to my calf.  Could those be pulled or strained ligaments causing that? If so, how long do SI joint ligaments take to heal (considering you are in alignment)? I am just concerned that I am going to have an SI joint dysfunction that will never heal because of my adjustment.  Thanks again for your time.  I really do value and respect your advice.

Answer
Hi Nicole: That is my Nieces' name too!. You STRAIN a muscle/tendon. You SPRAIN a joint. Most of the time it is a combo. sprain/strain. Strains heal. Sprains really do not heal. They just stop hurting. This is why you get so much money in Court for a Whiplash. You Sprain ligaments and joint capsules. That type of tissue in inert or not alive. It does NOT have a blood supply. Therefore, No healing. Once stretched out, permanently stretched out. This is called elastic deformation. You know those plastic rings that hold a six pack together.? If you try to stretch it, at first it's difficult then it just gives way and never goes back like a rubber band would. That's what I'm describing. There are grades of sprains 1>5. 1=minimal sleight. 5=compleat rupture. An Ankle running sprain usually is 1>2. A dislocated shoulder 3>5. To get a 3>5 SI sprain, you have to throw a Grenade at it. The SI joint is that strong. It's almost impossible to cause a 3>5 SI sprain with an adjustment. You could to a neck though.! If your SI is really sprained you will hear it "clunk,clunk" once in a while. The electrical feeling is probably NOT a nerve. It's your brain confusing pain signals. OR , it could be the manifestation of some underlying latent Neurological problem.! Ergo, The Neurologist. Strain/Sprains typically take 3>6 months to resolve.As far as I'm concerned. If the joint stops giveing you problems, your healed. Nicole, remember the leg length thing I told you about. Important in SI cases. Dr Ron. KEEP IN TOUCH.!