Reason for back pain, ischias, foot pain, ankle pain, stiff back,...

[structural75]

Questionable source of information!

Expatient,

I'm sorry to have to say this, but I just finished reading some of your past posts on other topics and it's become shockingly apparent that you're sources of information are questionable at best. I don't know where you get this stuff from or who your chiropractor is, but you've been severely misled along the way.

In one post you claim carpel tunnel syndrome is caused by nerve impingment in/around the cervicals... that's more accurately related to thoracic outlet syndrome. In another you state that 'tennis elbow' is caused by nerve impingement as well... tennis elbow is the lay term for lateral epicondylitis (inflamation of the tissues at the lateral epicondyle... not nerve impingement.

It sounds as though you're getting a lot of your 'theories' from a chiropractor with questionable intentions and knowledge. Everything revolves around pinched nerves in the spine, subluxations, the atlas, the si joints, etc... .

Again, it's not to diminish the benefit you've received from these approaches.. but you stated earlier that your "scoliosis" was "mild" and "never measured". So it doesn't sound as though you fully understand the severity of some of these peoples cases... Adjusting the si joint, the hip or changing a pelvic tilt is not going to offer much more than symptomatic pain relief for most folks. Chiropractic has value, but in the case of scoliosis if you don't address the connective tissue restrictions that have developed over time to support and conform to the curvature, adjustments will be futile at best. (with the exception of a few).

It sounds as though you have a desire to learn about your body... I would recommend finding some new sources though. It's probably not a good idea to learn from a home video someone posted on the internet.

[expatient]

Expatient,

I'm sorry to have to say this, but I just finished reading some of your past posts on other topics and it's become shockingly apparent that you're sources of information are questionable at best. I don't know where you get this stuff from or who your chiropractor is, but you've been severely misled along the way.

No I don't have a chiropractor. I have seen few but they didn't know how to help me. I got my help from a doctor. And after that I started to look for more information and for more others like me. I have found hundreds of them..

In one post you claim carpel tunnel syndrome is caused by nerve impingment in/around the cervicals... that's more accurately related to thoracic outlet syndrome.

Yes I had diagnosed TOS a while ago. Its gone now.
So what is your theory for carpal tunnel syndrome? It is well known that if nerve is pinched it swallows... And when it swallows the tunnel it goes through gets tight.

In another you state that 'tennis elbow' is caused by nerve impingement as well... tennis elbow is the lay term for lateral epicondylitis (inflamation of the tissues at the lateral epicondyle... not nerve impingement.

Again that is your theory. I have seen and met many who have had tennis elbow and after one proper manipulative treatment the pain was gone. Treatment included sijd correction, opening thorax facet locks and some mobilisation for shoulder.

It sounds as though you're getting a lot of your 'theories' from a chiropractor with questionable intentions and knowledge. Everything revolves around pinched nerves in the spine, subluxations, the atlas, the si joints, etc... .

No chiropractor have helped me. They claim to know something but they can't do much...

Again, it's not to diminish the benefit you've received from these approaches.. but you stated earlier that your "scoliosis" was "mild" and "never measured". So it doesn't sound as though you fully understand the severity of some of these peoples cases...

My scoliosis was mild, but I have met many who were suppose to go to a surgery for their scoliosis. They chose not to go and are very thankful now to did so...

Adjusting the si joint, the hip or changing a pelvic tilt is not going to offer much more than symptomatic pain relief for most folks.

That is true. Many people tried to manipulate my pelvis but it did't help me. So many adjusments are done wrong. That is why many people won't get help. It's because they are adjusted by a poor expert. Only so few really can do the adjustment. Many claim they can... Not every hockey player is a good player even how well they have been trained.

[expatient]

On torsion... a true torsion is more rare than most think. There is usually an upslip, downslip, inflare or outflare... and you can have SIJD without a true torsion... in other words, with one of the aforementioned situations present and no torsion. In fact, the chiropractor that wrote the article you linked me to describes this quite plainly... the innominate slips UP or DOWN.. that is not the same as a torsion or anterior/posterior rotation and they can occur independantly from one another.

Yes they slip up but no, they don't slip down. They also rotate and cause functional LLI/LLD that is causing more torsion. If one ilium is rotated and one is not, the pelvis gets torsion. But it can happen that both iliums are upsipped and no torsion exists but extended lordosis and many times later a spondylolisthesis.

It's just as irrational to say that ideopathic scoliosis is caused by one thing. I think there are many causes for ideopathic scoliosis.

Yes, SIJD is just one thing. Others are hip joint subluxations that are very common and often misdiagnosed even from babies.

Just to be clear here, the si joints only have about 4 -5 degrees rotational capacity at best and only a few milimeters if that in translation. (Remember, half of this joint is fibrous meaning that it doesn't slide.

In normal situation things are as you said. But when it is not at it's place (subluxated) it can be hypermobile or opposite way as stuck.

You mean massage therapy? That's one of the brilliant components to this solution for SIJD and scoliosis????

Yes, to treat symptoms but not the cause...

[expatient]

Why wouldn't sijd cause scoliosis in everyone who has it... according to the article you posted, it's very common?

Almost everyone has scoliosis as an adult. In a study of one university in Finland they said 80% of young (17-20years) had some asymmetry in pelvis and spine and 30% of them had chronic pains and over 60% had had back pains sometimes...

One study said almost all league basket ball players had spinal scoliosis of small degrees indicating pelvis misalignments.

[tonibunny]

If most people have these hip/pelvic misalignments, may I ask why just a few people develop large scoliotic curves, whilst others simply have slight curves that are within "normal" range?

[expatient]

If most people have these hip/pelvic misalignments, may I ask why just a few people develop large scoliotic curves, whilst others simply have slight curves that are within "normal" range?

Because some people have worse sijd than others. It is a joint surface that can subluxate any amount from 1mm to tens of mms. And when your pelvis is badly misaligned and rotated you get more scoliosis. You can have S or C curve depending on how much it is subluxated and rotated or perhaps both are subluxated and rotated, but one is more than other.

And because it effects to your feet too, you can have leveled pelvis when standing. But when you lie down you can have pelvis in torsion.

[structural75]

It is a joint surface that can subluxate any amount from 1mm to tens of mms.

In all of my clinical practice, lab disections and reading alike I have never seen this to be anatomically possible. Half the joint is fibrous.. in other words it is held together very, very strongly on the surface of the joint with dense connective tissue. It also contains surface irregularities that inhibit motion beyond a certain point (form closure). To "subluxate" as far as your suggesting would be absolutely debilitating and extraordinarily painful.

You can have S or C curve depending on how much it is subluxated and rotated or perhaps both are subluxated and rotated, but one is more than other.

The jury remains out on the reasoning why some have c curves and some s. But it's safe to say that one influencing factor is the persons autonomic capacity to compensate or overcompensate (which would lead to an s curve). Because there are a lot of people out there with sacropelvic asymmetries and many don't have moderate or severe scoliosis, or any at all.

I do agree that most everyone has some degree of pelvic asymmetry, I don't necessarily believe this is a dysfunctional pattern in and of itself. SIJD usually occurs when one of the two joints becomes more or less mobile than the other, which in turn creates uneven forces and strain in one or both of the joints. Our bodies are inherently ASYMMETRICAL contrary to what we would initially think. This is evident when you look inside at the organs... they are not symmetrical in their development and placement (stomach on one side, liver on the other, one lung larger than the other, heart slightly off center and suspended on a diagonal, etc.). We all develop tendencies from the beginning for right or left handedness, one leg is predominantly postural and one more gestural (you'll see this in dancers who use one leg as their base for support while the other is used for articulate and graceful movements, etc). Asymmetry is not bad if it is countered throughout the body in a functional manner. It is only harmful if dysfunctional countering arises or the system incurs so much asymmetry that it can no longer adapt efficiently.

I think tonibunny's question on why some develop into scoliosis and some don't points directly to the fact that etiology of ideopathic scoliosis is numerous... there is more than one factor at play so with such a wide spectrum of variables as its cause you get a wide spectrum of effects.

Yes they slip up but no, they don't slip down.

Yes, they do slip down.

So what is your theory for carpal tunnel syndrome? It is well known that if nerve is pinched it swallows... And when it swallows the tunnel it goes through gets tight.

It's not my theory, it's just a fact. CTS is entrapment/irritation of the median nerve within the carpel tunnel of the wrist. As the tunnel narrows for a variety of reasons or the tendons passing through undergo repetitive strain they can irritate the nerve causing inflammation and further impingement. This happens at the carpel tunnel though, not in the neck. Yes, other problems up the arm, shoulder and neck can and often do contribute to the problem, but CTS happens specifically in the wrist. Nerve irritation in the neck will not cause the nerve to swell in the wrist.

Quote:
Originally Posted by structural75
In another you state that 'tennis elbow' is caused by nerve impingement as well... tennis elbow is the lay term for lateral epicondylitis (inflamation of the tissues at the lateral epicondyle... not nerve impingement.

Again that is your theory. I have seen and met many who have had tennis elbow and after one proper manipulative treatment the pain was gone. Treatment included sijd correction, opening thorax facet locks and some mobilisation for shoulder.

No, that again is medical fact, as described in many, many medical orthopedic texts.I just gave you the medical terminology for 'tennis elbow'. It can be treated successfully... it's also quite possible that these cases you're referring to were misdiagnosed as tennis elbow when in fact they were nerve impingements at the elbow which would respond immediately to that type of intervention. Treatment of an SIJD will do nothing for tennis elbow... .???

And I agree, no two practitioners are alike.. even though they receive the same reputable training/education. Manual/manipulative therapies of the body are part science and part art. Not everyone has the skill required in their hands to be highly effective in successful treatment. That's the human variable meeting the scientific method. Logic and understanding may be sound but execution of it will vary greatly.

Scoliosis, or any condition for that matter, can't be reduced to one etiology such as SIJD. We see SIJD in structural and congenital cases where the cause is very apparent, so it's very safe to assume that it is also not causing the majority of other cases, but a secondary biomechanical effect. I'm not sure what else to say, ... ?

[expatient]

Yes, they do slip down.

I want to know how do you decide this: For example if you have left ilium higher than right when patient is lying, so how can you tell is the left lifted up or is the right slipped down? How can you tell? Do you follow the pain and diagnose that painful side is the one that has moved?

[structural75]

I don't want to take up other peoples time getting too descript about diagnostics, nor do I feel this is the appropriate place for it... but I can say this.

Down-slips are more rare than up-slips and often walking will correct it on its own. But in those cases where it doesn't self correct, you need to perform a standing stork test and/or forward bend, depending on other factors involved. Also worthy to perform a forward bend in the seated position as this will isolate the pelvis from influence in the legs to a degree. You're testing for si mobility in these test and looking for the restricted/fixated side. Using that info you gather from the standing test, the patient may then lay on the table and you can proceed with further analysis.

For instance, if a standing test reveals an si fixation on the right, then when laying down you determine the right innominate is lower than the left (checking the ischial tuberosities) then you have probably found a down-slip of the right. This is misleading sometimes if the lumbars have a type I curvature in them... one innominate will be drawn higher than the other, but not necessarily due to a fixation at the sij. Also need to consider and rule out any in-flares/out-flares/ and anterior/posterior shears, etc..

Torsions are possible as well but the above situations should be checked first as they are more likely than a torsion.

Hope that helps.

[expatient]

you need to perform a standing stork test and/or forward bend, depending on other factors involved. Also worthy to perform a forward bend in the seated position as this will isolate the pelvis from influence in the legs to a degree. You're testing for si mobility in these test and looking for the restricted/fixated side. Using that info you gather from the standing test, the patient may then lay on the table and you can proceed with further analysis.

If you are are doing flexion tests to someone and you can see left SIPS/PSIS moving more than right. Does it mean right sij is restricted and left side is ok? Or left side is subluxated and right side is ok?

For instance, if a standing test reveals an si fixation on the right, then when laying down you determine the right innominate is lower than the left (checking the ischial tuberosities) then you have probably found a down-slip of the right.

When many "experts" performed on me that fexion test they diagnosed stiffnes and restriction on right side. On lying my right side was lower. Then they tried to manipulate on my right sij. I was manipulated over 30 times during few years. Not much help. That's why I tried many different experts: PTs, chiropractors, osteopaths, naprapats,... Then I found a doctor of PT who did those same tests and said my left sij was subluxated and moved too much. And that was the reason for right side stiffnes and pain because on that side was longer leg side so that side carried most of the body weigth. Then he pushed my left sij (that was higher) down and all my symptoms were gone: no more back pain, leg weaknes, muscle stiffnes and even my breathing got easier and headache released. All that within few minutes. And all the others were trying to dislocate my right sij???

It's been 2 years now and I am still in perfect shape. And my legs have equal lenths. So the sijd is most often on the short leg side and the pain, stiffnes and restrictions are on longer leg side, that is the healthy side. The cause is not there where the stiffnes and pain is...

What do you think about that? And no, I was not a special case! I have interviewed (during last and this year) over 100 patients who have the same experience. Other side stiff and restricted but the cause was on the other side! They too have been manipulated on wrong side! After correcting the cause (one time was enough for most) from other side they have been without pains! Pains from buttock, groins, low back, upper back, ischias, achilles, knee, hip, legs feet,..

So, for my experience and for many others: down slip is actually an upslip on other side. And most "experts" make the same mistake and treat the same patient over and over again without much help.

Any comments on that?

[zuma]

Publish your findings then dude

[structural75]

Understanding ones individual case on the internet is near impossible... I can't make any claims about what your situation entailed without analyzing it in person... so this is all speculation.

If you are are doing flexion tests to someone and you can see left SIPS/PSIS moving more than right. Does it mean right sij is restricted and left side is ok? Or left side is subluxated and right side is ok?

I don't know what SIPS is? In any case, when the person forward bends your thumbs are placed on the inferior slope of one PSIS and the other thumb is on the midline of the sacrum roughly. If the PSIS thumb moves superior relative to the other thumb on the sacrum during the forward bend then that is the side that is restricted... so if your left PSIS moved superiorly (rides up) during the test, that was the side that is actually restricted. They must be evaluated relative to the sacrum, not each other. It sounds as though the interpretation of the findings was inaccurate.

Down-slips do occur as I mentioned before but they are very rare relative to up-slips. If your left moved up during the test it didn't mean that it was more mobile, it meant it was fixated and being carried along with the movement of the sacrum during the bend rather then allowing the sacrum to articulate smoothly with the ilium.

"Subluxations" is a term I don't care for or believe much in... joints aren't generally 'in place' or 'out of place'. They have a dynamic range of motion unique to each of them... when this motion is inhibited or the joint is fixated in a certain position within that range then you get the problems that we call "subluxations". If a joint is "moving too much" relative to it's neighbors/counterparts it is not a "subluxation", but it's certainly a recipe for problems.

And your right, the sight of pain is not always the cause of the problem... pain should never dictate where you work in that manner. I don't treat people according to where their pain is... that is symptomatic work, not a causal approach.

[expatient]

I don't know what SIPS is?

Let me help you...
PSIS Posterior Superior Iliac Spine
SIPS Spina Iliaca Postero Superiore

In any case, when the person forward bends your thumbs are placed on the inferior slope of one PSIS and the other thumb is on the midline of the sacrum roughly. If the PSIS thumb moves superior relative to the other thumb on the sacrum during the forward bend then that is the side that is restricted... so if your left PSIS moved superiorly (rides up) during the test, that was the side that is actually restricted. They must be evaluated relative to the sacrum, not each other. It sounds as though the interpretation of the findings was inaccurate.

Sounds good. So why that one that moves more is called restricted?

Down-slips do occur as I mentioned before but they are very rare relative to up-slips. If your left moved up during the test it didn't mean that it was more mobile, it meant it was fixated and being carried along with the movement of the sacrum during the bend rather then allowing the sacrum to articulate smoothly with the ilium.

I believe you. Sounds logical.

"Subluxations" is a term I don't care for or believe much in... joints aren't generally 'in place' or 'out of place'. They have a dynamic range of motion unique to each of them... when this motion is inhibited or the joint is fixated in a certain position within that range then you get the problems that we call "subluxations". If a joint is "moving too much" relative to it's neighbors/counterparts it is not a "subluxation", but it's certainly a recipe for problems.

Well, terms are difficult to define. Let the name be whatever, upslip or subluxation. Let's say the system is in wrong position or something... Same thing can happen to shoulders. They are too much forward, mut is there a subluxation that cause it? Perhaps not, but the whole shoulder system has moved forward...

And your right, the sight of pain is not always the cause of the problem... pain should never dictate where you work in that manner. I don't treat people according to where their pain is... that is symptomatic work, not a causal approach.

Thank you. So many other experts follow always and only the pain...

Here is one procedure that is totally wrong:

Physical Therapy. Volume 82. Number 8. August 2002: Evaluation of the Presence of Sacroiliac Joint Region Dysfunction Using a Combination of Tests:
http://www.ptjournal.org/cgi/reprint/82/8/772
According to Table 3
(Description of the Interpretation of the Possible Findings for Each Diagnostic Test):
1. Standing flexion test: "Left PSIS moves cranially more than right PSIS (left SIJ hypomobile)"
-My left SIJ lifted, so it was hypermobile! (hypermobile = dislocated = SIJD)
This test alone should have given enough evidence that it was left SIJ dysfunction/dislocation!

2. Prone knee flexion test: "Symptoms are on the right side, the right leg appears shorter than the left leg in the prone knee extended position, and the right leg appears to be about equal to or longer than the left leg in the prone knee flexed position"
-I had the pain on right side and right leg was longer, so this test gives the wrong diagnosis to me: posteriorly rotated right innominate. Wrong diagnosis!

3. Supine long sitting test:< "Symptoms are on the right side, the right leg appears shorter than the left leg in supine position, and the right leg appears to be about equal to or longer than the left leg in long sitting position"
-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 diagnosis!

4. Sitting PSIS test: "Right PSIS lower than left PSIS (left anteriorly rotated innominate if pain on left side; right posteriorly rotated innominate if pain on right side)"
-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!

Many experts follow that procedure. Do you think it is correct? After all that is the procedure most "experts" follw as far as I understand...

[structural75]

Let me help you...
PSIS Posterior Superior Iliac Spine
SIPS Spina Iliaca Postero Superiore

Yes, I'm very familiar with PSIS,PIIS,ASIS,AIIS... but I've never heard anyone use the Latin form SIPS... thanks though.

I think you misread this...

According to Table 3
(Description of the Interpretation of the Possible Findings for Each Diagnostic Test):
1. Standing flexion test: "Left PSIS moves cranially more than right PSIS (left SIJ hypomobile)"
-My left SIJ lifted, so it was hypermobile! (hypermobile = dislocated = SIJD)
This test alone should have given enough evidence that it was left SIJ dysfunction/dislocation!

It says the left PSIS that moved cranially (superior) was hypomobile, not hypermobile as you then concluded. If your left PSIS lifted, it was hypomobile as stated above, congruent with what I had described in the previous post.

"HypOmobile means restricted motion... HypO = less, HypER = more... that's how a HYPOmobile joint can be labeled as restricted.

Hypermobility describes the relationship of something moving through a larger range of motion relative to its counterpart or the 'normal' expected range. It doesn't mean something is dislocated... although it might be more likely to happen to a hyper rather than hypomobile joint.

Tests 2 and 3 show that when the knee is flexed the tibias reveal roughly equal length... the bent knee aspect of the test is to isolate and reveal and length discrepancies in the tibias. Leg length discrepancies with the knee/leg straight will show either a functionally shorter leg as a result of innominate rotation/torsion, up/down-slip or a lateral tilt of the pelvis or sidebend in the lumbar spine. They don't necessarily have to involve dysfunction of the si joints. The other possibility is a structurally short leg or femur. But only an x-ray can accurately confirm this.

All in all, this procedure is led predominately by the presence of symptoms... which are always important to consider and acknowledge but does NOT provide for accurate diagnosis in any way. It just tells you where it hurts... plain and simple. The pain itself in one side or the other has nothing to do with the direction of tilt in the innominates. There can be pain present in either si or both in any position of the pelvic innominates.

It's sad to think 'professionals' are actually using this method for diagnosis... it's no wonder people have little faith and result from manual approaches by certain practitioners.

[structural75]

Maybe this topic of discussion should be happening on another forum??