Sacroiliac joint case file

Hip replacement

Sacroiliac joint case file is not scientific evidence but these are the kinds of challenges that every chiropractor faces on a daily basis.

This interesting patient's story is of a woman with a ball and socket arthrodesis who developed lower back pain after surgery; in part because of a difference in the heights of the femoral heads.

Four years ago, this 60-year old woman had successful surgery for an arthritic hip. The only problem was that after the procedure her left leg was 10 mm shorter than the right, and then she started suffering from mild low back pain.

The first problem is that, looking at the x-ray above, it would appear that she has a short right leg. The radiograph was taken four years previously, and she couldn't remember if it was taken standing or supine.

Six months ago she developed very acute low back and leg pain, radiating to the posterior right thigh after some vigorous gardening. The only treatment prescribed was an anti inflammatory, naproxen, and the ache gradually subsided.

Here's a not unimportant aside; almost all cases of severe low back pain have a fairly long history of a niggling ache; a stitch in time saves nine. If you are experiencing LBP episodes, why not start our exercise program before it radiates down your leg?

It's the onset of symptoms in the leg that gets the surgeon interested; prevention is better than a cure.

This page was last updated by Dr Barrie Lewis on 10th April, 2019.

Lower back and leg pain

Lower back and leg pain are daily complaints in chiropractic clinics; but it's less common that they would fit into a sacroiliac joint case file.

SacroIliac Joint case file

Sacroiliac joint case file gives an unusual lower back and leg pain condition of a woman after a total hip replacement.

Incidentally, Naproxen should never be used:

  1. In pregnancy - it is associated with birth defects.
  2. In association with aspirin, or other DUAL ANTI-INFLAMMATORY DRUGS.
  3. In association with Lithium (taken for Bipolar depression)
  4. With sodium-sensitive high blood pressure.
  5. Patients suspected to be at higher risk of heart attack or stroke. All smokers?
  6. Also taking anticoagulants.

Another aside: Some medical sites strongly recommend no chiropractic for patients on anti coagulants. A load of bunkum, but it's important to mention it clearly to your chiropractor. There may be increased risk for neck treatment. I have never in thirty plus years had a patient on anti coagulants react badly to chiropractic help.

Taking two or more antiinflammatory drugs simultaneously raises the risk of permanent kidney damage many times.

Then two months ago she again developed acute right low back pain, this time without referral to the leg. The typical disc signs were on this occasion absent. However it didn't pass over with the anti inflammatory drugs; instead, it got worse.

When she consulted me, looking for chiropractic help, she was suffering from all the signs of an acute sacroiliac joint syndrome.

The problem of course is how to treat an older woman who has had a total hip replacement, sufficiently vigorously to effect a change, but gently enough so as not to aggravate the arthrodesis.

She came, of her own admission, in fear and trembling to an open day, but she's no sissy; one very tough Dutch lady but anxious about her hip. I managed to convince her that I was fairly sure we could help her without disturbing the arthrodesis.

What was different, in her case, was quite severe stabs in the groin, in a large back muscle that inserts into the inner thigh; it's called the iliopsoas. Treatment of that tendon was very painful for about 40 seconds.

What was also odd, was that on the physical examination she clearly had a short left leg, in total conflict with the x-ray. Radiographs taken lying down are not reliable when it comes to evaluating the length of the lower extremity.

We have specialised treatment tables today for the management of the sacroiliac joint, and it's particular useful for the patient who has had a hip replacement; there is no stress on the surgically replaced part.

Chiropractic Help

Chiropractic help focuses first and foremost on the correct diagnosis; if the lower back and leg pain is being caused by a disc bulge then it's not primarily a sacroiliac joint case file.

Treatment in this sacroiliac joint case file consisted of soft tissue therapy, a glorified name for massage, lasting perhaps 2 minutes, around the sacroiliac joints. Then the drops using the specialised treatment table on her SIJ. She had a sacral subluxation, required a specialised thrust on the sacrum. Finally we finished with the painful treatment of the iliopsoas in the groin; sore, using a technique called ART. And then she was given three very basic exercises for sacroiliac joint pain.

Oh, yes, and an inexpensive, five dollar 5mm heel lift that goes in her left shoe. That's permanent, but we may increase it.

Within 2 weeks she had 50 percent less pain, and today, after two months, she said she has virtually no discomfort. We are busy with more difficult rehabilitation. You can find them on YouTube via our lower back exercises page; see the navigation bar on your left.

Eight treatments in total and she's a very happy lady. Miracles we do at once, but the impossible takes a little longer; so said my mother, also a chiropractor.

Sacroiliac joint treatment anecdote

This Sacroiliac Joint Case File is merely an anecdote and has no scientific value. I include it mainly to indicate to you that having a hip prosthesis does no disqualify you from having chiropractic care. We have patients on a daily basis who have had hip replacements.

Short leg

A leg length inequality is not uncommon but it's usually a few millimetres and not significant, unless there is also a sacral subluxation, or an anomaly at the lumbo sacral junction. But it in some situations it's absolutely crucial to correct for the short leg in a sacroiliac joint case file, usually with a orthotic inside the shoe.


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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I have left alone. After seven treatments his pain and stiffness is 50 percent better, and he is happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti-inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He is doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost pain-free. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he is well pleased; sixty-five percent better after three treatments.

5. Mr T is a wise man; he has taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily stroll has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift; he has a short leg.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. X-rays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65-year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88-year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done. 

10. Mr X is a 71-year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a few months ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It is a non-complicated upper cervical facet syndrome, and she is doing well.

12. Mr D is a 38-year old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he could not sleep on that shoulder.

13. Mr D, a 71-year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors should not be treating the elderly most medical sites state but that is so much bunkum.

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Interesting questions from visitors

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