Expert: Gerald Anzalone, D.C. - 1/13/2010

Question
I was diagnosed with a "sprained sacrum" after a slight accident in June 2009. My sacrum was tilted outward at the top. I went to a local chiropractor for help that same month. My treatment was where he put my right leg over the other and rotated my lower body to the left, and then rotated my upper portion in the other direction. Then he forced the weight of his upper body down onto my right hip and upper thigh. He did this 2 times lightly and the third time was with great force. This caused immediate excruciating pain. He had me stand up which intensified the pain. I was eventually able to walk out of his office with a cane but remained in horrific pain until I had physical therapy starting in July 2009 which corrected the initial issue with my sacrum.

The 3 physical therapists that I saw found my pelvis was tilted/rotated upward and outward on my right and the left side was tilted/rotated down and backwards. Please note that my pelvis was NOT tilted/rotated previous to the chiropractic 'adjustment'. My balance is now definitely "off" and my legs do not point completely forward, they point slightly to the right side. Physical therapy has helped a little, however my pelvis seems to be quite mobile.

I had been active, healthy, and very fit, but I am now quite disabled from this for the past 7 months. I'm not sure what to do now. Would a reverse of the initial chiropractic adjustment fix this? Is there something else you can suggest?  

Answer
Pelvic rotation (in any direction) is usually caused by muscle imbalances. Muscle imbalances can result from trauma.

Regardless of which direction or position your pelvis is believed to be malpositioned, it sounds from your description that your actual problem may be a herniated disc at the L5-S1 level causing your excruciating pain.

While spinal manipulation may often be helpful in addressing lumbar spine and pelvic problems, your symptoms appear from your description to be more consistent with a disc herniation than a postural distortion.

I recommend that you see a neurologist, neurosurgeon, or orthopedic spinal surgeon for medical evaluation of your spine to determine if you need an MRI scan to rule out disc herniation. Minimally, it sounds like you probably need medication for the pain, inflammation, and muscle spasms that are likely present.

In the absence of a disc lesion, you might be better off pursuing physical therapy (which typically focuses on rehabilitative exercise). However, it is important to note that there are many spinal manipulation approaches that are used in chiropractic (and other manual therapy professions), and not all of them involve thrusting manipulations. A chiropractor who utilizes another approach may be able help. These manual techniques may include drop work, in which the patient lays prone an the treatment table and sections of the table are cocked, allowing the chiropractor to perform a gentle downward manipulation utilizing the speed of the drop rather than using a more dynamic thrusting maneuver, soft tissue manipulation, or spinal joint mobilization.

I hope that this helps to answer your question.