Pelvic Girdle Dysfunction and Low Back Pain

Have you ever had low back pain, hip pain, glute pain that just will not go away? Maybe traditional physical therapy has not helped or you have tried chiropractic care with only mild success. You doctor gives you muscle relaxers and maybe even steroids, but the pain continues to be present. Low back pain can be very hard to treat because of the complexity of the spine and the neuromuscular system interaction that occurs to create the pain. Sometimes the treating practitioner needs to look further into the body for the cause of the pain than just thinking of the lumbar spine.

Chronic low back pain is often a combination of lumbar dysfunction along with pelvic girdle dysfunction. The pelvic girdle involves iliosacral movement, which is how the ilium of the pelvis moves around the sacrum (tailbone), and sacroilial movement, which is how the sacrum moves in the ilium. When the mechanics of either are abnormal, low back pain often occurs along with other pelvic disorders. Dr. Greenman, author of Greenman’s Principles of Manual Medicine, found in his research that people that have chronic low back pain have some common dysfunctions present. He termed these dysfunctions the “Dirty Half Dozen” because there were 6 problems people had in the lumbar spine and pelvic girdle. The problems/dysfunctions that were present included pelvic girdle dysfunctions such as upslip/downslip, pubis symphysis malpositioning, abnormal anterior movement of the sacrum, along with lumbar spine FRS dysfunctions, a shortened leg, and muscle imbalance. Finding and treating the “Dirty Half Dozen” can help reduce pain significantly, but the problem is finding someone to do that.

First you must know what to look for when treating low back pain effectively, so segmental diagnosis is crucial. Segmental diagnosis is basically figuring out which of the “Dirty Half Dozen” are present in the lumbar spine and pelvic girdle. Once the dysfunctions are found, OMT and MET can be easily used to correct the underlying problem and then appropriate exercises can be given to work on the muscle imbalances. At Wright Physiotherapy, I have been trained in segmental diagnosis and how to use OMT and MET to treat out the underlying problem. This has made me very effective in helping people with low back pain, hip pain, and glute pain that just won’t go away. Usually significant changes occur in just a couple of visits. Pain reduction can be life changing!

Why Become A Case Of Failed Lower Back Syndrome?

Low back surgery is not something you should take lightly and one should understand what back surgery is trying to accomplish.  Back surgery is performed to either decompress and take pressure off a nerve to reduce leg pain or to stabilize unstable joints.  Having surgery completely changes the anatomy and how a normal spine works effecting the appropriate feedback loops into the system for muscle and joint control.  Often people go into surgery thinking all the pain will be gone.  This is not always the case.  Remember, surgery is done to either decompress the nerves or to stabilize the joints.  What happens if the pain that is being generated is not always coming completely from a nerve pinch or the instability of the joints?  In this situation, the pain will often still be present after surgery and the patient experiences failed lower back syndrome.  You don’t have to have surgery to experience a failed lower back either.  You may be someone that has been searching for pain relief without success; trying therapy, chiropractic care, injections all without help.  Often people that experience failed lower back syndrome have certain dysfunctions of the lumbar spine and pelvis that were never addressed properly.  If it is these dysfunctions that were involved in causing the pain in the first place, having surgery does not eliminate them, therefore pain often comes back or never goes away.  People with low back pain often have abnormal tailbone positions along with flexion (FRS) and extension (ERS) dysfunctions of the lumbar spine, dysfunction at the pubic symphysis, hip shear dysfunctions, a short leg pelvic tilt syndrome, and muscle imbalance of the trunk and lower extremities.  These abnormal spinal positions are called somatic dysfunctions.  Often, somatic dysfunctions are not treated by chiropractors or general physical therapy very well.  This is because identifying the somatic dysfunctions takes a very specific type of segmental diagnosis that is performed with osteopathy.  Once the dysfunctions are diagnosed and treated, then a specific strengthening and stretching program needs to be established to help prevent the return of pain and dysfunction.  Many people in society suffer from low back pain and it does not have to be this way.  What is often missing is the appropriate diagnosis of dysfunction with proper treatment with osteopathy.  Don’t let yourself become a failed lower back statistic.  Come to Wright Physiotherapy and get the appropriate treatment. 

Come To A Doctor Of Physical Therapy For Low Back Pain In Newark, Granville, And Pataskala, Ohio

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Who is your doctor? Think about that. When you have low back pain or some other kind of pain the first thing most people do is wait to see if the pain will go away. When the pain does not go away the next action on the list is to call your doctor to get an appointment. This is an “old school” way of thinking in today’s healthcare model, and this is how people with low back pain or other kinds of pain get stuck and never get help. In a study by Fritz and Childs {Spine (Phila Pa 1976). 2012 Dec 1;37(25):2114-21)} it was determined that only 7% of people who went to their doctor for low back pain were given a referral to physical therapy despite the evidence that physical therapy drastically reduces total costs of care and recovery time for the patient. That is amazing to me! Think about that, only 7% of people were ever given a referral to physical therapy even though the stats show that physical therapy lowers costs and recovery time for the patient. Therefore 93% of people were most likely given pain meds or told to give it more time to see if the pain would go away. This is how healthcare fails.

I am trying to get a change in thinking so that is why I asked, “Who is your doctor”? I am a doctor of physical therapy, therefore I am a doctor. Most of the time when people say they are going to the doctor because of low back pain or some other injury type pain, they really mean their primary physician. This needs to change. As the study by Fritz and Childs notes above, low back pain sufferers are only sent to physical therapy 7% of the time by their physician even though recovery time and costs are reduced with physical therapy. As a physical therapist I am the expert in pain, tissue healing, and musculoskeletal injuries. I have a doctoral degree that justifies me being the first person to care for low back pain and other painful injuries. When I think of going to see a physician it is for broken bones, diseases, or for being sick. When someone goes to the doctor for low back pain or some other painful injury the only action that can be taken is to be given pain meds, which in its self is a problem, or to be given a script for physical therapy. We know based on the research only 7% of low back pain sufferers are given a script for therapy even with all of the known benefits. Going to see a physician is not necessary anymore. In Ohio and throughout the rest of the states, there is something called direct access. This is the ability for someone to come directly to physical therapy without a physician referral. This law is very powerful and very important because it allows the experts in the field of pain, healing, and injuries to work autonomously, which we know helps reduce costs and speeds up healing time. So when someone has low back pain or some other painful injury, why be in the 7%. I am your doctor. I am the expert in healing of low back pain, neck pain, shoulder pain, knee pain, and any other musculoskeletal injury. Why wait and see a physician when you can come to Wright Physiotherapy.

Treating high school athletes for improved performance and post game healing

high school football

Stacy Sykora, the designated libero for the U.S. Women?s National Volleyball Team, two-hands a return during an exhibition match against top-ranked Brazil at Clune Arena on the campus of the U.S. Air Force Academy, Colo., June 14, 2008.  Team USA is concluding a three-match 2008 U.S. Olympic Team Exhibition for Volleyball series that started June 11. (U.S. Air Force photo by Rachel Boettcher/Released)

High school athletics are very demanding and can take a toll on the body. A season of wear and tear and injuries leads to underperforming and a less successful season. No athlete wants to underperform especially when the raw talent is present. Performing at the highest level is every athlete’s goal. Most athletes perform conditioning and weight lifting to prepare for and stay strong during the season, but they are missing ONE BIG COMPONANT when it comes to staying healthy. Trainers and conditioning coaches are good at pure strength and endurance exercises but they do not have the education and the ability to evaluate, make assessments, and treat dysfunctions/injuries an athlete may have before and during the season that is limiting the athletes ability to play at the highest level. There is no reason to miss out on the ONE BIG COMPONANT that can lead to a much more successful and healthy season. And what is the ONE BIG COMPONANT? It is having a total body movement evaluation from Wright Physiotherapy to look for problems the athlete may have in muscles and joints that is limiting the highest level of performance. Then the appropriate hands on manual therapy will be performed to correct any dysfunctions that are present. At the end of the session a group of exercises will be given to specifically strengthen the body and deficits that were found. During the season, manual therapy and hands on treatment techniques can be used to heal injuries such as sprains, strains, back pain, knee injury, shoulder injury, hip injury, and injuries of all kinds to keep the player on the field or court throughout the season. Wright Physiotherapy can keep you healthy, so you can be an all-star performer. Give me a call for a healthier and more productive season!

Osteopathic correction of lumbar and sacrum

Left on right sacral torsion correction

LEFT ON RIGHT SACRAL TORSION CORRECTION 7/17/16

This is an osteopathic manipulation technique for a sacral dysfunction.  More specifically a sacrum that is rotated left on the right oblique axis.  This dysfunction can cause intense pain in the low back and/or down the legs.  This is one of the problems people often have if they have had therapy or chiropractic care in the past without much help.  Unless the dysfunction is corrected, the pelvis and lumbar spine will never move appropriately and pain may never go away.  Manual therapy is very helpful in correcting these dysfunctions.

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Preparing for Right FRS at L5 correction

RIGHT FLEXED, ROTATED, SIDE BENT L5 (R FRS L5)

When a sacral torsion is present, their is also ALWAYS a dysfunction at the L5 vertebrae.  This is due to how the sacrum and lumbar spine interact with each other.  The picture shows the set up for the right FRS L5.  This has to be corrected out before the torsion is corrected.  Again, an easy diagnosis and treatment for someone trained in osteopathic treatment techniques specializing in manual therapy.

 

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Right ERS dysfunction set up for treatment

RIGHT EXTENDED, ROTATED, SIDE BENT L3 (R ERS L3)

This is another dysfunction that can occur at the lumbar spine.  Instead of the spine having an FRS dysfunction, it can also have an ERS dysfunction.  These dysfunctions are also easily corrected by manual therapy and can also occur in the presence of a sacral torsion and an FRS in the lumbar spine.  When the ERS is at L5 vertebra, their is often a posterior unilateral sacral nutation also present.

 

Treating low back pain

WHAT DO I LOOK FOR WHEN TREATING LOW BACK PAIN? 4/10/16

Low back pain is very common in today’s society. Most people have dealt with low back pain themselves or at least know multiple people with low back pain. It can be very debilitating and life changing, especially if the pain does not go away. Treatment for low back pain in physical therapy is usually mediocre at best due to the difficulty in being able to properly diagnose where the pain is being generated. Pain can come from the discs, nerve roots, facet joints, and abnormal muscle use. Having a good understanding of how the spine moves and functions, and how abnormal spinal movement affects the body is key to successful treatment in physical therapy.

What do I look at when evaluating a low back? I look for specific weakness in the glute max and med muscles. They are very important in lumbar spine and pelvic stability. The hip flexors are often times very tight, therefore specific manual therapy releases have to be performed along with stretching. Transversus abdominal and deep low back muscle called the multifidus also need to be retrained appropriately. I also look at very specific movement of the individual lumbar spine vertebrae, thoracic vertebrae, and sacrum. If the vertebral segments are not moving the way they should, osteopathic manipulation is performed to help correct the movement. I use a lot of osteopathic manipulation (OMT) called muscle energy techniques (MET). Uncorrected vertebrae will cause muscles to shut down and not do their job. This is where the skill of a movement expert and manual therapist comes into play to be able to find and correct the abnormal spine movement or lack of movement. The abnormal spine movement is called a somatic dysfunction which will be discussed in another blog. Using those basic guidelines is how I have been able to be very successful in fixing low back pain be it chronic or acute. Acute low back pain is much easier to fix with usually only needing 1-2 treatments over a 2-4 week period. Chronic low back pain is more difficult to fix but can usually be done over a 6 week period and a total of 4-6 visits. Come give physical therapy at Wright Physiotherapy a try and you will be amazed at your new pain-free way of life! Go to the contact page and send me an email to schedule an appointment or give me a call.