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!

What is Muscle Energy Technique (MET)

Over the weekend I had a continuing education course for physical therapy to continue my license. The course dealt with using manual therapy, specifically muscle energy technique (MET), to correct problems of the pelvic girdle, sacrum, and lumbar spine. I have taken many courses over the years to learn my specialty of MET and I am very partial to the courses and education provided by Michigan State’s Osteopathic medical school and their manual medicine series. Michigan state has given me the knowledge and skill to treat my physical therapy clients outside of insurance, because of the great outcomes I get. The course I took was not a Michigan State course but it did provide a great review of the knowledge I already have along with reminding me how powerful MET is. Using physical therapy and MET is how I get such great outcomes far and above the norms and is why I can be an independent practitioner and not have to deal with insurance.

What exactly is MET? Muscle Energy Technique (MET) is defined as a form of soft-tissue treatment in which the patient’s muscles are actively used, on request, from a precisely controlled position, in a specific direction, and against a distinctly executed therapist-applied counterforce. The key defining element of MET is the use of an isometric contraction before subsequent stretching or movement of restricted tissues. What this means is if you have a sacrum/tailbone that is stuck in an abnormal position for example, I can put your body in a specific position and use your own muscle contraction to put the sacrum back in place. I can do this with your pelvis and the vertebra up and down the spine.

Using MET not only puts the bones back in the appropriate positions it also resets the normal length of the muscles that are involved in locking the bones into the abnormal position. When bones and joints are in abnormal positions this can cause muscles to shut down and significant pain that can become chronic unless the dysfunction is fixed appropriately.

Using manual therapy and MET takes time when done appropriately. I spend at least an hour evaluating leg length, the pelvic girdle, SI joints, lumbar spine, pubic symphysis, muscle strength and tightness. I then give physical therapy exercises that are very specific to help hold my adjustments in place that are a complement to the manual therapy. Treating by this method, in my opinion, can only be done appropriately on a cash based manner because of the time and attention involved. Insurance gets in the way of the best care I know I can give. In the long run, I am much cheaper than other treatment methods because my clients usually respond very quick and my goal is to have the pain mostly gone within 4 visits.

I am very passionate about what I do and using MET has allowed me to help many people and achieve great outcomes. I am greatly appreciative to all the instructors I have had over the years that have furthered my career and given me the knowledge to help people in pain.

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.