By Dan Weissling on Friday, January 04, 2002 - 05:04 pm:

I've had SI problems for about 6 years. My therapist says I have a posterior rotation of the pelvis on my left side, and his correction works like a charm....for a little while...then it slips back out again. Everything I read discusses anterior rotation problems, which I assume is much more common.

Do any of you know about posterior dysfunction and whether prolo can correct it? If so, what ligaments are usually targeted?

Thanks in advance for any help you can give me.

By Park Griffin on Saturday, January 05, 2002 - 11:59 am:

You are going to be surprised at something!!! There is no such thing as POSTERIOR DYSFUNCTION!!! All sacroiliac dysfunction is anterior! Studies have been done on cadavers and literally one must fracture the pelvis to truely create a posterior dysfunction. The problem may seem posterior, but the problem is always the same, the pelvis is rocked down in the front and up in the back, featuring a subluxation of sacral segment "S3". Both sides should always be treated. The goal is to treat both sides alternately, using manuevers designed for anterior rotation of the pelvis. Measuring leg length difference can be very misleading. The objective finding that should be used is a direct shortening of the legs. When the pelvis roted back into a functional position from a dysfunctional position the hip bone rides higher up the skeletal plane and makes the leg appear shorter by centimeters. The goal is to correct both sides until no more shortening occurs in either leg. In 75 percent of SIJD cases, following appropriate anterior corrections on BOTH SIDES, will correct the dysfunction to the FULL FUNCTIONAL SELF-BRACING POSITION.

Why do you feel good and slip back out??? I will list them from highest probability to lowest.

1. By not treating both sides until each leg has shortened asd much as possible, you are not experiencing a COMPLETE CORRECTION TO THE SELF-BRACING POSITION and your slipping right out again.

2. Your long and/or short posterior SI ligaments are stretched allowing your dysfunction to occur. Prolotherapy into the the long and short posterior SI ligaments along with good physical therapy and possibly the application of SI belt will correct most stubborn cases of SIJD.

3. You may have a tear in the anterior joint capsule of the SI. In this case, step 2 along with wearing a good lumbosacral support may do the trick.

4. In severe cases after much consideration patients have their SI's surgically fixated or fused in place.

Dan, the longer you can stay corrected the better. You will have to continue to do corrective exercises at home between therpay visits. Another thing, your therapist may be doing the right thing for the wrong reason, so I wouldn't give up on them. They need a pat on the back and some fuel for thought.

This is a great forum, but you need to find one dedicated to SIJD, also. Here is what I suggest:

1. Joint the SI forum at: www.delphi.com/sijd/start

2. In the ask an expert section, seek out advice from Richard Dontigny. He has over 40 years experience treating and researching the SI. In your post tell him how your injury occured and the manner of treatment that is being provided.

3. During this time visit the website of www.kalindra.com there is more information on SIJD than any other place on the net. She also moderates the SIJD forum.

4. The two articles that will serve you and your therapist the best are: Manual Therapy Rounds and Critical Analysis of The Failure of The Self-Bracing Position.

I wish you the best!!! Park

By Robyn on Monday, January 07, 2002 - 10:27 am:

Hi Park..
I remember "meeting" you on the Kilandra forum a few years ago. It seems you really have mastered the science of si dysfunction and rehabilitation. This forum is lucky to have you visiting!! I hope your wife is doing well also !!!
I do have a question for you, if you don't mind -
I wondered if someone with Ehlers Danlos Syndrome - and ligamentous laxity resulting from defective connective tissue production is at a huge disadvantage when attempting prolo??? If I understand EDS - patients hoping to regenerate tissue to strenthen ligaments of the SI joint - may be not be able to reproduce good ligamentous tissue - even after sclerosing takes place. One physical therapist who had EDS herself once told me this..she said we make "stretchy" tissue - so prolo really just invites more of the same.?? Hmmm..just something I thought I'd run by you - not sure if Richard DonTigney has ever referenced this specifically.

As for me.. I have the L5S1 problem too (you may recall)..and was finally going to have the spinal fusion at that level - as my physiatrist felt this had to be stablized before the SI ever could. To make a long story short..1st time I was scheduled, I was diagnosed with early stage (thank God) breast cancer...so that surgery date was cxled. Took care of the bc..and was set to do the fusion again December 11. My spine surgeon sent me for a myelogram (Sept. 27) and I had a rare complication from this (a prolonged leak of csf - which by the way, I hear is more common in EDS patients) causing me a horrendous orthostatic headache which has been with me now 24/7 for over 3 months. Had to cxl the fusion once again. I'm wondering if someone doesn't want me to fuse my spine!! I've tried much of the Mannual Therapy Rounds..and done multiple attempts at prolo..to no avail. My physiatrist finally said she thinks my disc herniation and floppy facet joints are making it impossible for me to stablize the si joint - maybe one more try is in ordrer??? What do you think?

Be well and good to hear from you again, Robyn

By Park Griffin on Monday, January 07, 2002 - 11:46 am:

I remember now... Michelle's doing pretty good. She has had 15 sessions of prolo spaced one month apart. She is 3 months post prolo and hanging in there. For people that have been injured and don't have EDS, go for the prolo everytime. For people with EDS, there is a slight morbidity factor and prolo for the sake of pain relief may not be worth it. However, in most EDS cases, the benifits outway the consequences, when using prolo to stave off disk degeneration and or debilitating scoliosis.

I would be careful about your case. I know someone in a similar condition as you and has been chasing gremlins ever since she has been fused. Basically, her lumbar back fell apart after the fusion. I would try prolo again, but I would go this route. My wife had it done and it helped immensely. Adding Glucosamine/Chondroiton/DMSO to the prolo solution helps all types of soft tissue, including cartilage. I'd first do whtever I could to reduce the sheering forces at L5-S1, without treating L5-S1. Problems at L4-L5 and the SIJ's can really contribute to problems at L5-S1. Have you ever had a discogram of L4-L5? Michelle's prolotherapist went to a prolo seminar and a study was done correlating patients whereby prolo did not help and instances of annular tears @ L4-L5. 85 percent of the patients, whereby after 6 sessions of prolo saw little improvement, had annular tears at L4-L5. Michelle after six sessions was not where the doctor felt she should be and he performed a discogram a L4-L5 and he noted a slight annular tear. GC/DMSO/proliferant in and around L4-L5 did wonders.

Bottom line Robyn: In more cases than not L4-L5 is more causative to problems at L5-S1 than L5-S1 is.

Park

By Robyn on Monday, January 07, 2002 - 02:13 pm:

Hi again Park, Thanks for your thoughts!
No..the discogram is the one and only test I have not had. My disc is so clearly "destroyed" at L5S1 that no spine surgeon (and I've seen several) has felt suspicious of which level is the culprit. L5S1 showed a clear large annular tear 7 years ago...now it is a "calcified" herniation..guess there's no more fluid left!! All the other levels of my spine are really in tact...I've had several mris with contrast in addition to the infamous myelogram/CT scan (which I would do anything to undo). It was several years ago now that I attempted prolo. One dr. used the Hacketts solution (glucose) but added some phenol as well. No relief whatsoever. Perhaps now there are more advanced solutions which are more effective in stubborn cases?? The thing is - I never felt ANY relief or increased stability from the multiple rounds of prolo injections... To me - that said I was likely in the wrong place??!! Yet - all the physical medicine people see the si dysfunction clear as day - and the right manipulation (if I get lucky) - brings relief. The other element that I wonder about... I had an SI block at one point - right into the joint capsule... It also had no impact at all. Facet blocks helped quite a bit more..though temoporarily. Perhaps the SI joint does the anterior dysfunction thing..subluxes .. and reaps chaos on the rest of me. I've even started to have problems in my ribs..and shoulders..neck etc. As you mentioned in another post, when the si joint is subluxed - it stresses out the entire skeletal structure - and leads to increased hypermobility - right?
I know what you mean about chasing gremlins.. though I feel like I've done enough chasing for a lifetime already!! Hubby wants me to try Tai Chi - to see if I can regain some stability of the pelvic girdle. I'm very tiny (5 ft tall - 104 lbs) - and very flexible. I keep thinking there must be some way to address this from a rehab perspective..but I've tried sooo many times. I'm always interested in your thoughts Park..as you have obviously self-educated yourself in a tremendous way. I try to do that too... best I can. Think I'll go back to read DonTigney's papers again (have them all printed and in a binder)! Best to you and Michelle. I hope she continues to progress and conquer this!! Robyn

By Park Griffin on Monday, January 07, 2002 - 03:52 pm:

Got it... It seems like you've given prolo a pretty decent shot. I would still be concerned about L4-L5 before I'd fuse L5-S1. I've seen where fusing L5-S1 when L4-L5 has even a slight annular tear has damaged L2-L3 and aggravated SIJD. Have you ever tried to wear a lumbosacral support??? They are much better than an SI belt because they offer anterior support, too. Might be something to consider wearing if you fuse L5-S1. A good LS support costs about 100 bucks.

About the rib-shoulder-neck thing: There is a muscle group called the erector spinae group. All three branches originate at the sacrum. They run parallel to the spine attaching to the base of the skull, neck, thoracic vertabra, and rib heads. Also if you have pain deep underneath your anterior lower ribs, this is the psoas muscle. When someone has SIJD, the anterior rotation of the pelvis strains this muscle.

At this point, I'd say treatment for chronic pain is secondary to your disc degeneration at L5-S1.

What would I do?:

1. Check condition of L4-L5. If leaking, either try GC/DMSO/proliferant into and around the disc. A slightly less conservative approach, but with quicker results is to have IDET. This is a thermal procedure that seals tears in the disc annulus.

2. Fuse L5-S1, recoup and wear a lumbosacral support.

2. When your doctor feels that manual therapy can be performed again, I'd inject the long and short posterior SI ligaments ONLY and follow up with PT. (Note: Keep using the lumbosacral support)

3. When and if you are able to hold a correction to the SI, add the iliolumbar ligaments to the prolo sessions. This will help to stabilize your lumbopelvic junction.

4. After these steps, it may be warranted to have prolo performed at the insertion spots of the erector spinae muscle group. (Michelle has had prolo in her cervical and thoracic back and rib heads where the erector spinae muscle group attaches with success.

Park

By Robyn on Tuesday, January 08, 2002 - 03:50 pm:

Thanks Park...
What exactly would you consider a lumbosacral support - vs - the si belt. I have many si belts which never seem to do the trick. I "lock" right under them -- it's as though my dysfunction is way too deep for any exterior support to control. I also have other supports including a 600$ # custom made (turtle shell brace) - this was a flop as well As far as fusion - I would do anything to avoid this -- have heard way too many horror stories - and am very skeptical about how my hypermobile body will like being fused with rods and screws. I wish I could be trained to at least "control" the si locking - as it seems Michelle has (with your love and support - and some excellent pts and prolo docs I'm sure). Me and my hubby (he's a physician btw) have tried R.DonTigney's exercises and self-corrective measures - but I never get relief when I do them - so I get frustrated. The other thing that happens when I try to do the posterior rotation of the si is the shoulder and ribs start popping (as though they are compensating for the pressure). Does that make any sense? Did Michelle and you get a sense right away that the self-correcting exercises offered by R.D. (mannual rounds) were the "right" thing for her dysfunction? It's so great that she has managed to have some control. Just curious, does her si joint "clunk" (or did it) all day long. Can she actually feel the anterior rotation happen preceeding her worst pain episodes? Any thoughts on Tai Chi..or other "gentle" methods of core stabilization work?? Thanks again!!

By Park Griffin on Wednesday, January 09, 2002 - 02:31 pm:

Robyn, first thing, Michelle and I fought tooth and nail over Dontigny's methods because they killed her to perform. Cascades of muscle spasms and just pain... Nothing elso worked either though. Eventually we did see results and can now tell that Mr. Dontigny is so correct about the importance of the functional (self-bracing position).

Michelle had a twisting injury and a fall backwards with her heavy mobility bag while in the military. She had marched across an exercise field lugging 80lbs strapped to her back. When she reached the other side, she undid the clasps of her bag to let the pack slip off of her shoulders, but only one side unclasped. The bag flipped around to the side so all 80 lbs were tourqing her back. Then she fell over. She said she felt a big pop in her pelvis. She suffered with SIJD for about 4 years without a diagnosis. She was swallowing NSAID's like they were going out of style. Finally she was diagnosed with SIJD. Never had her SI lock though, just pain and spasming. Her right piriformis ached constantly.

She suffered a major setback, though. She was diagnosed with Stage IIIC Ovarian Cancer. She's doing good now, though! Praise the Lord!!! However, after having 2 abdominal laparotomies, her AB's are toast now. The AB's and anterior SI Joint Capsule are critical for anterior support. After her surgeries, her right SIJ would lock up constantly. Not a pretty picture! SI belts killed her, too. We were told that SI belts are only good if the problem is purely posterior.

During the first six sessions, Michelle supplemented prolo with a good physical therapist who specialized in muscular spasm problems. She was able to calm Michelle's muscles. Within 3 sessions of prolo, Michelle's SI stopped locking her cold. She could not rotate her hip in a walking manner when her SI would lock up, but after session 3, she could walk, albeit in a funny manner. but she could walk. By session 6, Michelle's gait improved quite a bit, but exercise therapy was out of the question at this point. The sublaxation made it impossible for her to do simple exercises like pelvic tilts, abdominal hollowing, etc... She changed physical therapists. This new therapist specialized in SI mobilization. After 15 months and 15 sessions of prolo, Michelle's SI is quite stable. She never wals funny anymore. Still has lingering chronic pain and inflammation, but it is more prevalent in her upper back, now.

Robyn, with your SI locking, my guess is that you either have badly stretched posterior ligaments or anterior support problems. Maybe this is why SI belts hurt. SI belts also hurt if they are tightened in place while sublaxed. Richard Dontigny states that it is impossible to rotate the pelvis back too far. The bodies functional mechanics make it impossible to do so. But, if your posterior ligaments are pretty stretched and your anterior support is weak/compromised, you probably can rotate your pelvis back more than it normally would. This is probably pulling on your erector spinae muscle causing the popping that your experiencing. Look at anatomy pictures with detailed images of the erector spinae and you will see that they attach to all the areas that are popping on you.

I would say that your posterior SI ligaments could never be too tight. I would prolo the "snot" out of them for a whole year, while attending physical therapy sessions. I would have the discogram if your doctor feels it of benefit and I would try a lumbosacral support.

On the website listed below, is a good picture of probably the best lumbosacral support out there. It gives good anterior/posterior support for the SI. It cover the top of the hips also, this keeps the pelvis from flaring while walking. The upper lateral part of the support comes up to the lower ribcage. This helps support the trunk. The website for the support is:

www.supports4less.com/bodyparts/back/index.htm

The one that I am referring to is called the Drytex Lumbosacral support by Donjoy for 85.00 dollars.

Take Care! Park

By Robyn on Thursday, January 10, 2002 - 08:20 pm:

Thanks once again Park. You are really kind to be sharing yours and Michelle's experience with me. This instabiltiy stuff is a lonely place to be. By the way, is Michelle considered to have hypermobilty syndrome??

The other points you made were interesting. I was surprised to hear Michelle found the self-bracing exercises bothersome. I just wonder how you know if they are doing what they're intended if it's not about feeling relief immediately? Maybe i should keep doing them regardless. I was thinking about maybe doing them - and visualizing the pelvis rocking down in the back and up in the front...Maybe even digging the sacrum into the floor to help push it down.. DonTigney may not like that idea?

I certainly wouldn't doubt that I may have posterior ligaments that are mega-stretched - along with anterior suport that is worth little. I had very long labors and difficult deliveries of big babies..and I know I split the muscle (I forget the name) that runs down under the navel.

With regard to the belts... if they only help those with purely posterior si dysfunction...they must not be helping many - hugh?? Isn't most si dysfunction purely anterior? I will defintitely check out the lumbosacral support you shared - thanks. I definitley think that I am malaligned most all of the time - and this, no dobut is part of why the belts (and supports I've tried) dont' seem to work. Not a good thing to put pressure on a joint in a pathological postiion!!

On the prolo... did Michelle feel ANY relief after the first or 2nd session?? It's hard to keep going back for those inflamation causing needles if you don't get good feedback, but maybe I just didn't do enough sessions. I may have had 7 or so injections each visit..and gone 2 sessions with Dr. #1 and 3 with Dr. #2. He started talking about putting pumice in the solution and I got chicken.

We are going to purchase a model of a skeletal structure. Hubby wants to really try to understand the sij movement dynamic that takes place..how it impacts the Lumbar disc levels etc. It's a new field of medicine for him (he's an eye surgeon)...but after 7 years - and his own new interest in the Tai Chi and movement - he feels this may help.

Thanks again Park... and best to Michelle.
Robyn
ps: what part of the country are you in (just wondered if you had pt prolo doctor suggestions).

By Park Griffin on Monday, January 14, 2002 - 05:04 am:

Hi Robyn, Anterior, posterior??? The million dollar question! One thing though, when they state anterior SIJD, they are talking about the position of the top of the pelvis compared to normal position. If you are standing and the top of your pelvis is tilting forward more than normal (anteriorly) that's defined as Anterior Sacroiliac Joint Dysfunction. For most, the abnormal anterior tilt becomes chronic from a subluxation and or stretched posterior SI ligaments. For some though, the anterior SI joint capsule can become torn. I have to run, but I'll post a artists scetch of what anterior tilt looks like and how it affects the hip bones and the lumbar back curve. Park

By Park Griffin on Monday, January 14, 2002 - 03:55 pm:

Robyn, the website to see what anterior SIJD looks like is: www.bonesdoctor.com/sacroiliac_dysfunction.html
Note the lateral view of the two men standing. The image of the left shows an "upright pelvis w/ a normal lumbar curve. Note the hip bone position (it's a little higher than the image to the right. Also, note in the right hand image how the pelvis is tipped anteriorly. Also note the exagerrated lumbar lordosis.

Michelle's problems are totally injury related. "hypermobility syndrome" is genetic in nature.

I wouldn't do any "digging" of the sacrum. You may try a direct innominate rotation, though.

SIJD is such a catch - 22 condition. Not only does the atrophy of the core unit cause the condition to get worse, it's impossible to exercise the core when sublaxed. Also, most therapists and doctors don't know how to treat SIJD, but you are not going to be able to beat this all by yourself. If you can find a compitent physical therapist to help with the manual therapy and slowly work in core stabilization exercises, they will be able to pick up on the subtle changes that signify that you are in the correct alignment. Once you start to have times when you are in and you can work on keeping yourself in; one day you'll wake up and knbow the difference bewtween being in or out.

About the SI belt: If someone has decent posterior stomach muscles and the SI joint capsule is intact - an SI belt may do the trick, but SI belts only work if you are in place first. Actually, the lumbosacrtal support can hurt if you tighten it while your are sublaxed, too. With the SI belt, you want to lay down on it then do a correction exercise, then tighten the belt. With the LS support you put it on loosely, then self correct and then tighten it. Keep either on unless it becomes painful.

Keep in touch. Park

By Richard Carroll (Richard) on Tuesday, January 15, 2002 - 08:10 am:

Park,
Can you tell me who the doctor is who does the prolo injections w/ Glucosamine into the disc? Is this done under florouscopic guidance?

By Park Griffin on Tuesday, January 15, 2002 - 02:28 pm:

Vladimir Djuric, M.D. - Prolotherapy
OHIO REHAB CENTER, INC
6651 Frank N.W. Canton, OH 44720
Phone 330.498.9865
Fax 330.492.9869
Satellite clinics in New Philadelphia, Alliance and Carrollton
http://www.chronicpainsolutions.com/articles/djuricsummer99.htm

Richard, my wife has had 15 sessions of prolo from this doctor. He is a certified Physical Medicine and Rehab doctor with a fellowship in Sports Medicine. He has a fluoro unit right in his office. All of his injections are by x-ray guidance.

By Robyn on Saturday, January 26, 2002 - 09:36 am:

Hi Park,
I haven't been online for a while since the chronic headache (post myelogram..now 4 months 24/7) had been horribly debilitating. It's bizzare because I can distinctly feel the connection to the sacrum dysfunction..as thought the sacrum is pulling the cranium out of alignment. There is this constant pressure too..which I'm assuming is a leak of cerebral spinal fluid.

Anyway..thanks for passing on the site that depicts the anatomy of si dysfunction. Funny thing is that the physician who sponsors that site was my prolo doctor. He was 98% sure I'd respond to the treatment..but when I failed after a few tries - I stopped.

I spoke with my physiatrist about the the concept of a purely anterior dysfunction (as R.D proclaims). She had mixed feelings about that - saying the patient can have a combination of anterior and posterior all at the same time.

Anyway..I'm really suffering with this spinal headache and don't know what to do next on that. I wonder if the si dysfunction is perpetuating it..pulling on the dura somehow.

Any thoughts?? Thanks so much for your help.
Robyn

By Park Griffin on Wednesday, January 30, 2002 - 03:57 pm:

Robyn, my wife gets these horrible headaches where it feels like someone is tugging at the muscles on the back side of her head, trying to rip her head off. We are under the impression that the severe tugging is being caused by a massive spasm in the erector spinae muscle.

Park

P.S. Robyn, There is no such thing as posterior dysfunction!!! The quote "posterior side" may look posterior but it is not. When the one pelvis over rotates anteriorly the sacrum tips down on that side and tips up on the other side. This allows the possibility that the "S1" segment on the side opposite to the "anterior" side can catch on the other pelvis. When it catches on the "S1" segment, the hallmark of this is that the pelvis is stuck in the "normal" posterior position. However, ABNORMAL posterior dysfunction is impossible unless you have fractured your pelvis or completely derranged your pelvis. No therapy will help you then. Remember, when we are talking about Sacroiliac dysfunction, we are talking about a subluxation, not some violent dislocation.

Getting back to the "posterior" issue. With one side of the pelvis rotated ABNORMALLY anterior, and the other side STUCK at the "S1" segment in NORMAL POSTERIOR ROTATION, it looks surely like the dysfunction is anterior on one side and posterior on the other.

The treatment on the anterior side is to rotate the front side of the pelvis up and the back side of the pelvis down. GET THIS: SINCE THE SI JOINT ON THE OTHER IS STUCK ON "S1", THE PELVIS IS ALL READY ROTATED UP IN THE FRONT!!! THE ONLY THING THEN TO DO ON THAT SIDE IS TO ROTATE THE PELVIS DOWN IN THE BACK!!! Typically professionals who do not pick up on the fact that the "posterior side" is stuck on "S1", will try to rotate the pelvis up in the back and down In the front. This is opposite and contraindicated to the primary anterior dysfunction!!! In essence, the therapy can make the anterior dysfunction worse by performing illdesigned "posterior innominate rotation exercises". "Posterior innominate corrective adjustments" are designed using flawed biomechanical understanding of the SI Joint, but it takes time to chase down the horse once it gets out of the barn.

Again, correct therapy on the anterior side is to rotate the pelvis up in the front and down in the back. The correct therapy on the "posterior side" is to rotate the pelvis down in the back. It doesn't hurt to rotate the pelvis up in the front on this side either. Hence, you are doing the same basic corrective technique as the anterior side!!! The same basic exercise can be done on both sides! Both designed to correct anterior dysfunction!!!

Here is a way to make the "posterior innominate error" evident:

If indeed, one side has anterior dysfunction and the other posterior dysfunction, when correctly aligned the leg on the anterior side will shorten since the hip will ride up higher and the posterior side will lengthen. BUT THIS DOES NOT HAPPEN!!!!! That leg will shorten, too! Maybe not as much as the other side, but IT WILL SHORTEN!

Park

By Robyn on Friday, February 01, 2002 - 02:42 pm:

Hi Park..
This was a very good explanation of why my physiatrist may consider it a "combination anterior/posterior dysfunction". I do believe I have the catch at S1. I wonder though... when this "catch" occurs..does it easily "uncatch" with proper corrective adjustment?? I'm not sure about Michelle's situation..but my pain syndrome will flip from left to right. I will never have pain in both sides at the same time...but one side will always dominate. Maybe this means my pelvis has learned how to catch on both sides?? It's interesting that when the doctors do the standing flexion tests, they tell me I'm "locked" on the painless side...and moving too much on the painful side....??

I've been really suffering lately, with very little painless moments in the lumbar.

Hmmmm.... based on this hypothesis that the pelvis becomes "stuck" on S1...

In your opinion, does it make sense that my herniated and dehydrated disc at L5S1 - along with a 6mm slip (spondylolisthisis) of L5 over S1, is making my SI dysfunction almost impossible to address with mannual therapy or prolo. Maybe when I do manage to get into the self-bracing positon..and things are aligned - L5 just slips over S1 and "triggers" the pelvis to continually rotate abnormally - then I get caught on S1 again..and the whole vicious cycle is perpetuated. Perhaps fusing this level is necessary if I am ever going to have a shot at benefiting from prolo..or corrective mannual work. As you know, I've resisted the surgery for 7 years now... but I can't help but wonder if I am fooling myself...as my pain becomes more and more severe. Let me know what you think...
Have you ever heard of prolo of the actual facets... wonder what would happen if they tried to prolo up at L5. I know from my mris that the facets are showing boney changes - proof of instability and rubbing movement.
Thanks for your kind words of wisdom - and encouragement Park... you are a gem.

By Park Griffin on Saturday, February 02, 2002 - 10:15 am:

Robyn, you seem to have your bases covered. One big factor regarding fusion of L5-S1 is how is your pelvic alignment situation at the time of surgery? Also, how is the condition of your other lumbar vertabrae??? Especially L4-L5. My opinon on the matter is this: I'd have a discogram at L4-L5. If it shows positive for pain or a tear in the annulus, I'd suspect that L1-L2-L3 may have problems, too. I know of somebody that had L5-S1 fused and later found that she had problems with other lumbar discs. She had IDET (thermal sealing procedure to seal annular tears). Had L1-L2 fused and L3-L4 fused. Now, the doctors are saying that L4-L5 needs fused, but that's too may fusions in a row. They now state that they should have left L5-S1 alone and worked on the other things first.

If I were you,while I was contemplating surgery, I'd make sure your long and short psoterior SI ligaments on both sides had at least six more sessions of prolo in them. This will help the side to side and back and forth strain on L5-S1. I'd also have a discogram at L4-L5. If it is negative, I'd go back to work on manual therapy to correct the alignment of your SIJ's. I'd also at this time discuss with your professionals if L5-S1 seems to be in a decent position. If it appears in decent alignment, I'd discuss with them if there is any way to save the disc. The reason I'd work on the other things for a while is that there may be options coming available. IE: artificial discs, hydration of your existing disc through injections, etc...

Park

By Jill Smythe on Tuesday, January 04, 2005 - 10:16 am:

I stumbled upon this website while trying to find information regarding my spine. I recently had x-rays taken, and my lumbar spine rotates to the right. It's not a curve as in typical scoliosis...it's more of a sideways twist. It is causing my pelvis to be tilted as well. What can cause this? Is it congenital? It's been said that I have Marfan's; although, it's a very subjective thing to diagnose, so I"m not sure.
Any info would be appreciated.
Jill