Expert: John Quackenbush DC - 12/29/2009

Question
QUESTION: Can you explain to me the risks of an aggressive SI joint adjustment?  Besides a severe ligament strain/sprain, can the joint be damaged?  Also, in one side posture manipulation, can the sacrum or pelvis move out of alignment?  I had one si joint manipulation on August 27th and am still not better.  I have been to other chiropractors and pt's and am worried that something is really wrong.  Thanks for your time.

ANSWER: Nicole,

I don't think that the SI Joint was damaged unless you let an 800 lb gorilla adjust you. I say that because I am a pretty big guy and  lot of times when people find out in conversation that I am a Chiropractor I will usually get the comment "I'd be afraid to have you adjust my spine!". Please realize that the adjustment is a natural science and art with the emphasis being on the art of the adjustment for the purpose of this discussion. I as well as any competent chiropractor use more finesse that brute strength when adjusting any joint. The SI joint is usually a very easy joint to manipulate so the Chiropractor would have to put an exceptionally large amount of force to cause damage to the SI Joint, which is nearly impossible to damage the bony portion of the SI Joint. So is it possible? the answer is yes it is possible but not likely. Damage to the soft tissues around the SI Joint or any other joint is more likely to take place. Hopefully this did not take place in your case. I would get a second opinion from a Chiropractor who can physically assess your SI Joint. I realize that you have been to other DCs but was it for the second opinion? If not, inform the second DC what took place so he/she can decide what the course of action should be. I would always (wish or expect any person I adjusted to let me know if they have any side effects so that I could address them. If I was the DC performing the second opinion exam I would want the patient to be straight forward and tell me why they need to have their SI Joint examined. So PLEASE tell the DC of your concerns.

Also you may not be "holding" your adjustment and you may fall into a category known as an adrenal insufficiency. This is caused by the stresses of modern day life and all that goes with it. Usually adrenal problems are picked up by salivary tests. Ask your DC if they do ASI indices by saliva. This would be a good starting point.

I sincerely hope this has been helpful but does not take the place of the second opinion examination that I have suggested herein.

Yours in health,
Dr John Q Quackenbush

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

QUESTION: Thanks for your quick and thorough response.  I am really discouraged as I went to two different DC's for second and third opinions about my situation. One told me that my pain was from the L5S1 disc, as it was degenerative in phase 1 prior to the adjustment and the other said that it was my SI joint, not the disc.  Quite frankly, I am scared to have someone else work on me, as I had a horrible first experience.  I need to find someone I can trust.  

One other question, what about the sacrum?  Is it easy to adjust the sacrum?  I feel like since my original adjustment, my sacrum sticks up on the left side and down on the right.  Finally, what are your feelings about Xrays?  Should a chiropractor take an Xray of you before they begin working on you?  

Thanks again for your time.

ANSWER: Nicole,

I am very sorry to hear of your situation. As in all professions there are those who are good and those who are not. I was assuming that you had a set of x rays taken as the comments made to you from these chiropractors sounded as if they were from a set of X rays. I am appalled if they did not take a set of x rays especially since you went back and complained about a flare up following adjustment. Yes the chiropractor should take x rays before adjusting in most cases and absolutely should take them in your case!!!!There chiropractors who believe x rays are not 100% necessary but I do believe that X rats are necessary.

Degeneration in the first phase is not all that bad. I would admit it would be better if it were not degenerative but a phase one is not that bad. Remember you are allowed to have more than one thing wrong with you at any given time so it is possible you have SI issues and degenerative issues. This all should be considered when working your case up by any healthcare provider.

The "feeling" in your pelvis/sacrum/SI I really can't pin down without physically doing an exam. However this "feeling" is definitely due to bio mechanical fault or subluxation. This will absolutely need to be attended to. You will need to ask your friends and family to refer you to a good chiropractor and get a thorough exam. First check under chiropractors at all experts, then check www.lifechangingcare.com and see if you can't find one that will help you. The bad news is this will probably not go away on it's own and you will need to see a healthcare professional of your choice. If you cannot find one send me another question and I will send you my phone # and we will find you a Chiropractor around your home or within a reasonable amount of distance.

Good luck with your health issues,
Dr John Quackenbush

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

QUESTION: Thanks again for your time and thorough response.  I can't believe that I am going to tell you this, but I have not had any Xrays.  The first chiropractor felt that I was an easy case and made the adjustment, went went terribly wrong (stabbing sensations in the joint, left calf and foot sensations and a protruding bone on the left side around my SI joint).  I was miserable.  The second opinion, who stated that it was my L5S1 disc, did a bunch of various tests on me.  He did not take Xrays of me, as he felt strongly about the SI joint not being able to cause pain.  The third opinion felt my sacrum raised, but does not have Xrays at his sight.  He seemed to think that my MRI after my original adjustment was good enough.  

Needless to say, I didn't go to either doctor.  I went on the suggested website (www.lifechangingcare.com) and found a few chiros in my area.  Do you have any suggestions on how to know if one is good?  I really don't have any friends or family who go to chiropractors and the one recommendation that I received was the man who did my original, bad adjustment.  

I have been going to physical therapy and the therapist says that my leg lengths are normal/the same.  She also feels that my sacrum is raised on the one side.  I know you haven't seen me or evaluated me in person, but if that was my problem, about how many visits to the chiropractor sounds reasonable?  I was just wondering, as I haven't had a great experience and don't know what is acceptable.

Thanks again for your quick response and time.  

Answer
Nicole,

Hello again. I am very glad that you went to www.lifechangingcare.com and found some Chiropractors in your area. I am very sorry for what you have gone through and I feel compelled to apologize for my colleagues but I can't apologize for someone I don't know. With that said every case is unique and different and this is especially true of your case. The amount of response time and especially the protocol of treatment is always customized to match what the patient presents with.If you have found a chiropractor or two and you would like me to call them and make a determination as to which one you should see I am more than willing to do that for you. I have confidence that we will be able to find you a DC that makes sense for your case. I ABSOLUTELY WANT YOU TO UNDERSTAND I DID NOT SAY I WOULD REFER YOU TO A DC THAT HAS A CURE!!I have to state that  because sometimes even the best a certain healthcare provider provides may not cure your health issues. However I feel that the caliber of Chiropractors on this board are more in line with your needs as described.

I wish I could be more direct but again without all the information and an actual physical exam that is the best I can do. I also would follow up with the doctor you/we choose.

I am interested in looking at your MRI results. Can you send them to me through all experts. ( I only need to read the report so you could just retype it.)

If you would like to contact my office my # 623.551.9100 I am unaware of any polices with all experts that would preclude me forwarding an office phone number. I am only doing this to assist you in getting the proper care you need.

Sincerely,

John Q Quackenbush
Chiropractic Physician