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 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 gives an unusual lower back and leg pain condition of a woman after a total hip replacement.
Incidentally, Naproxen should never be used:
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.
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 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.
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.
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 total joint replacements.
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.