sacrum dysfuntion and unstable hip

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Lisa

Liverpool, NY

#1 Feb 6, 2009
I've been seeing a physical therapist for si dysfunction/hypermobility. My symptoms are pain in my left hip and right knee, sometimes alternating, and sometimes simultaneously. Right now, my right knee has stabilized and all the pain is in my left hip. I also have a length discrepancy - my left leg is sometimes 1/2 shorter, but after adjustment it leveled out. My therapist has not been rechecking it and has not been continuing to try to adjust me, because he doesn't want to contribute to the hypermobility.

My PT is treating me with inner core strengthening: transversus abdominis, multifidus, and pelvic floor. My problem is that whenever I work my transversus abdominis, either by itself, or co-contracting with the multifidus and pelvic floor, it seems to push my left hip out of joint. I get pain at the trochanteric bursa and an achy, stretched feeling around my entire left hip joint. When I stop the exercises, it gets better. An si belt also pushed my left hip out, rather than keeping it in.

When I first started doing the transversus abdominis training, it pushed me so far out of alignment that I could feel my si joint flopping open on the left side and had symptoms of trochanteric bursitis at my left hip. I discovered I could pull the si joint mostly back in my clenching my glutes. But now, I've started co-contracting the transversus abdominis, multifidus, and pelvic floor, and even all three together push my hip out.

Any ideas? Is my pelvic asymmetrical? Does this mean my left pelvis is tilted to the front or back?

BDC

“Want Truth?”

Since: Dec 07

South Carolina

#2 Feb 6, 2009
The stretches/exercises depend on if your ilia are rotated posterior/anterior and/or with internal /external rotation. So for a diagnosis (which can't be done over the internet) or best help please see a good chiropractor, also a good sports PT can also help.
Here is a little anatomy and biomechanics lesson.
Multifidus do not any major attachment or effect on the ilium so that would help by strengthening your back and not your pelvis. Strengthening the transverse abdominis will pull the anterior superior iliac spine, ASIS, medially (thus pulling the PSIS laterally in the back). This would open up your si joint in the posterior or in the chiropractic field named an externally rotated ilium. This rotation can put strain on the knee since your foot normally tries to correct by staying straight. The pelvic floor exercises will open up the top of the pelvis and si joints.
FYI: Runners can quickly tell when their hip is “out” because knee pain is often the first sign.

BDC

“Want Truth?”

Since: Dec 07

South Carolina

#3 Feb 6, 2009
If you are strengthening the pelvic floor muscles and transverse abdominis to achieve entire pelvic stability then you also must incorporate the External oblique, quadratus lumborum and iliacus muscles to counteract the prior to stabilize or strengthen your entire pelvis, instead of just pulling the ilia one way. Likewise, the strengthening and/or stretching of the anterior and posterior leg muscles can rotate your ilia anterior or posterior so they should also be incorporated into your regime in the appropriate manner.
So to strengthen the instability of your pelvis, the exact area or listing would need to be known to help the best for stabilization, ie. the proper strengthening exercises instead of a generic workout sheet. Again see a good chiropractor for diagnosis and correct listings or a good sports PT.

I hoped that helped.

BDC

Since: Jul 07

Edmonton, Alberta, Canada

#4 Feb 6, 2009
I'm going to sound like a broken record here, but if your hip continually goes "out", you have a 1/2" short leg, and the problems are resistant to muscular therapy and standard adjusting (as it seems they are from your post), then you need to have your upper cervical (neck) alignment checked by a qualified upper cervical chiropractor.

The vast majority of control to your postural muscles all stems from proprioceptive input from your neck ... meaning if your head and neck are out of position from each other, then the rest of your body compensates to try and minimize that. This pulls unevenly on your hips and creates the functional short leg.

This leads to some parts of your spine "wearing out" faster than others ... in your case, it's your SI. Getting your upper cervical alignment corrected won't directly address the issues with your hip/knee, but it will remove one of the key factors for why they are resisting treatment. Once that is corrected, then your body will either be able to heal and repair an its own or will respond much more readily to other treatments.

To find out more or find a doctor in your area, check the following sites:
www.nucca.org
www.upcspine.com

Best of luck!
DrVertebrae

Rowlett, TX

#5 Feb 6, 2009
NUCCA, I have been following this forum for quite some time.

I have a blog called TruthinTreatment. Google DrVertebrae and you'll find a link to it.

The reason I wanted to get your attention was because a commenter, anonymous, has made some statements regarding the "falability" of NUCCA.

I am not a big believer in NUCCA but I can appreciate the latest study on upper cervical manipulation and Bp.

The post is the one about subluxations. The comment I am referencing is from this evening.

DrVertebrae

Since: Jul 07

Edmonton, Alberta, Canada

#6 Feb 6, 2009
I touched on some of the basics, Dr. Vertebra ... reading through those comments actually made me tired with all of the incorrect and half-understood "points" being made.

I might get a little more energy up later on and address a few more of the issues I saw.
DrVertebrae

Rowlett, TX

#7 Feb 7, 2009
Nucca Chiro wrote:
I touched on some of the basics, Dr. Vertebra ... reading through those comments actually made me tired with all of the incorrect and half-understood "points" being made.
I might get a little more energy up later on and address a few more of the issues I saw.
I like the way you put it, "half-understood points". Not to mention the lack of some basic grammar skills.

This originally started from a post I made about Chirotalk. They found it and issued E-mails to flag the blog and get me off the internet. No such luck for now. When you tell the truth about something, well ...

But anyway, the discussion eventually evolved into anti-chiro vs pro-chiro, specifically anything vs pro-subluxation treatment, so I started another thread.

When this poster started ranting about NUCCA, well, I just figured you would be the one to respond to him/her. Your knowledge seems unmatched on this subject.

Thanks for the input. Comment anytime.

DrVertebrae
Lisa

Liverpool, NY

#8 Feb 8, 2009
A question for NUCCA Chiro. What you are talking about sounds similar to Advanced Biostructural Technique, a technique used by a chiropractor in Ithaca, NY, whose name is Pierre Gremaud. Is it similar?

From what I have read, in theory, I could be helped by this technique. I do have a head and neck that lean forward. This could be causing traction in my spine and the torque in my pelvis, according to the theory of ABT. What do you think about ABT?

Then I could do the inner core strengthening to keep my si joints stable. Although maybe they would be more stable if I got rid of the torque.

Since: Jul 07

Edmonton, Alberta, Canada

#9 Feb 8, 2009
Regarding ABC which is what they call the technique (Advanced Biostructural Correction), the philosophy of care and rationale matches up very closely with what NUCCA does as well.

As for the specifics, I don't know enough about the technique specifics yet to be able to give an informed opinion as to whether the technique (in my opinion) can effectively follow through on it's philosophy. However they are probably on the right track.

My expectation would be that your pelvis would stabilize once the muscles connecting to it were no longer pulling on it in an imbalanced way. It will take time for the body to remould and firm up the ligaments that have become lax, but it will do so if the stimulus of the injury is removed in most cases.

I'm reading up a little more on it now, as you are the second person to ask me about the technique, and will post back once I have a better idea of their treatment protocols and approach.
Lisa

Liverpool, NY

#10 Feb 8, 2009
Thanks! I'll be curious to hear what you think.

Since: Jul 07

Edmonton, Alberta, Canada

#11 Feb 8, 2009
Well, from what I have found, it looks as if their goals are good, but their approach may need some refining (at least in my opinion).

To give you something to compare it to, I'll let you know what the treatment plan to become stabilized and into elective care (meaning you just come in when you feel the need) in my office is using NUCCA as well as what an ABC treatment plan looks like (from what I have been able to find anyway).

NUCCA (at least in my office):
First visit: History, Consultation, Upper Cervical X-rays
Second Visit: Report of Findings on the X-rays, First Adjustment, Post-treatment x-rays (to verify/evaluate the correction).
Checkup visits: twice in teh first week and once per week for 3 more weeks after that. I only end up actually adjusting the average patient on 50% of these visits, since the idea is to simply keep the spine in place while the body heals.

By the end of the 4 weeks (quite often before), the vast majority of my patients are out of pain, holding their correction, and released into elective care - which on average means 2 checkups per year.

ABC (at least the treatment plan I was able to find):
Initial Phase (a "couple" of days?): once or twice a day
"Over the Hump" phase: 3x per week for 3-6 weeks.
"unwinding" phase: 2x per week for 10 to 16 months with intermittent "peak times" of 3x per week again.
After that patients will "not need much from" the doctor at all.

Now with NUCCA, your body may not be balanced out entirely by the time you are realeased from active care, but it has in the majority of cases been given all the help it needs to do the rest on its own. My office uses a fairly limited treatment/checkup schedule - some doctors see a patient more often to ensure that any deviation from alignment is caught as early as possible and corrected immediately, but I don't know of any offices that will see you for more than twice per week for 6 weeks with checkups spread out as you show evidence of being able to hold the correction longer.

So you can obviously make up your own mind about what care you want. There are quite obvious differences between the duration and frequencies of the treatment plans, and to my mind that speaks to efficacy of the approach. However, the nearest NUCCA doctor to you I can locate is 1 hour away whereas you have the ABC guy in your own town. If you think an hour is a long way though, it might interest you to know that about 40% of my patients drive between 1 and 12 hours each way for care in my office because there aren't any other NUCCA practitioners closer to them and they find the care THAT effective.

I wish you all the best in your search for better health and will always be happy to answer your questions or give you an opinion on matters you might be curious of.

Since: Jul 07

Edmonton, Alberta, Canada

#12 Feb 8, 2009
Forgot to mention the source of where I found the ABC information:

http://www.advbiostructuralcorr.com/what_is_a...

I encourage you to read up on it and make the decision for yourself.

As I posted before, you can find information on NUCCA and other upper cervical techniques at the following sites:
www.nucca.org
www.upcspine.com
Lisa

Liverpool, NY

#13 Feb 9, 2009
Thanks again, NUCCA Chiro! I read your message carefully and also read everything on the ABC site and a lot on the sites about NUCCA. An important issue for me is that I have a 3 1/2-year-old son who goes to preschool only three mornings. So I really need someone in Ithaca. I think ABC is the better option if only for that reason.

The length of treatment really does concern me, so I called the office of the Ithaca ABC chiropractor they claim for most people it only takes 1-2 months. Here's hoping.

The more time passes since I did the transversus abdominis exercises, the better I feel. I think my sacrum is already stabilizing a little, although my pelvis still feels crooked and my shoulders and neck are of course still hunched. I still have pain in my hip and knee, too.

I called my physical therapist this morning and canceled my next appointment! I'm going to write him a letter and lay it all out. I have had too many people trying to fit me into their preconceived notions of what my health problems should be.

Thanks again,
Lisa

Since: Jul 07

Edmonton, Alberta, Canada

#14 Feb 9, 2009
You are very welcome, Lisa. If you remember to, pop in here again in a month or so and let me know how the treatment with the ABC chiro went. I'd be very interested to know what kind of protocols and adjustments he uses and what kind of experience you have as a patient.

Best of luck!
Lisa

Liverpool, NY

#15 Mar 30, 2009
I'm checking back in to give an update on my progress, as requested by Nucca Chiro. I must say the results have been great!

It only took a month (3, then 2 times a week) of seeing the ABC chiropractor before I had no pain at all in my hip and knee. I can try to describe what Dr. Gremaud has been doing, as I understand it.

The idea behind Biostructural Correction is to correct only the things that they body can't fix. According to ABC, the body cannot correct a vertebra that is pushed out of place toward the front, because there are no muscles which pull it back. The body CAN correct a vertebra that is pushed to the left or right or backward). Another key concept is that the spine can distort itself in three dimensions, not just two. For example, a person who has scoliosis has a spine that is twisted, not just pushed to the right or the left.

At the first session they do two different kinds of scans along the spine (not x-rays). One is EMG and one is the temperature of each vertebra. This shows the stress and tension at each point from the top to the bottom. In my case, the results corresponded exactly to what I had been feeling. The vertebra that is attached to the sacrum was being pushed %439 percent to the left, and the one directly above it was being pushed %329 to the right (I guess this is actually a twist, but it is a two-dimensional scan). Hence the incredible pain in my left hip and the feeling that the joint was being pushed out.

One of the first things that the doctor does is to "release the menenges." This involves crunching the neck in one direction or the other and is the only real crrrrracking that he does. Then he pushes backward four or five vertebra, based on what seem to be the worst offenders that day, by sort of doing a reverse heimlich maneuver right below the vertebra he wants to move (I am not sure about where exactly he is putting the pressure, but will ask at my appointment this morning). He figures out which ones to move by repetitively touching the base of your neck and each vertebra, all the way up and down. Each session only takes 5-10 minutes.

Between one session and the next, the body unwinds just a little as a result of what the chiropractor did, meaning the vertebra which CAN self-correct by moving to the right or left or forwards, will do so. This will expose new problems for the chiropractor to fix the next time. It's a step by step, session by session process. Gradually, your spine unwinds and stops twisting your body out of alignment. A side-benefit for me is that it is straightening the top of my spine, which has been hunched ever since I was a girl. I am so excited about this, because not only do I look straighter, but I've read that as you get older it's really bad to have a hunched posture.

Ask me any questions that you want. I'm pretty excited about this and want to share what's been happening to me.

Since: Jul 07

Edmonton, Alberta, Canada

#16 Mar 30, 2009
Thanks for the update, Lisa! I'm glad that you are getting some relief and results from your care.

Your description along with the information I have been able to find online gives me a good idea of what the protocol is and their theory behind it. I've never been much for the dural tension theory or meningeal adhesions, but if the results are there, then the theory that got them is not really of the highest importance.

I wish you all the best in your continued recovery, and hope that you are able to achieve the health goals that you strive for. All the best, and thanks for the update!
Lisa

Liverpool, NY

#17 Mar 31, 2009
Yeah, it's been great for me. He never tried directly to untwist my hips, but what he did to the vertebrae all the way up and down my spine made my hips untwist on their own. It feels so good to not be twisted any more!!!

And actually, I've talked to many, many other patients who come in at the same time as me, and they are all getting these striking results.
Wisdom

Norwalk, CT

#18 Mar 31, 2009
Does the chiropractic stupidity ever end?

Since: Jul 07

Edmonton, Alberta, Canada

#19 Mar 31, 2009
Wisdom wrote:
Does the chiropractic stupidity ever end?
We all know that yours doesn't. As is so eloquently evidenced by your continued drivel in what is otherwise a very positive thread.
Wisdom

Norwalk, CT

#20 Mar 31, 2009
Ha ha...my stupidity?

You have been exposed, in other posts, that you treat every condition, did you hear that, EVERY CONDITION A PATIENT PRESENTS WITH, by pushing on the sides of their necks, by claiming that every illness is caused by a miniscule, ha ha , misalignment of atlas or axis.

And you call me stupid?

Thank you for your posts, no one would ever believe how bizarre the chiropractic cult has become......errr....remained

Now empty your chiropractic diaper.

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