I posted a few days ago regarding my PT's assessment of me having SI joint dysfunction due to a fall on my lower left back last Oct. Went through 12 PT visits, x-ray, MRI, pain is still there. X-ray showed slight scoliosis, MRI showed mild facet arthrosis in L-4 ,5 joints. Ortho doc was awful, didn't offer much explanations other then the arthritis which he pointed out on the MRI. Never disagreed with PT on the SI joint dysfunction. Everything else looks healthy regarding discs and such. Sends me to pain mgmt doc today for SI joint.
Pain mgmt doc looks at my MRI and says all is healthy, no arthritis. Shows me a different film than the surgeon pointed out. I pulled out my MRI report which shows I have arthrosis. Asked him to put the films again and show me where the written report was wrong. All of sudden, he finds the arthritis, but says it's not a problem. Says I don't have SI joint dysfunction, but facet joint dysfunction. Well, the arthritis is in the facet joints, so I guess we could say the pain could come from the arthritis in the joints? And, how do you know it's not the SI joint when the test hasn't been done (injection into the joint) to confirm this? Isn't it correct these do not show up on MRI's? True, he says. He never offered me any tests, I am the one who had to ask him. I had my packet of research and notes with me.
He is sending me to a chiropractor for treatment of facet joint dysfunction! He said if that didn't work, he would consider doing the injection. He discounted everything I have been told thus far, basically implying my MRI wasn't accurate, my PT was off base, and my arthritis (which I didn't have at first) was normal for my age (44), and the numbness I get from sitting too long is normal when people sit too much. Never had it before!
I told him exactly I how felt about my meeting, that I could not believe how he could discount these things, yet not offer to do the test first before sending me to a chiropracter. I am very frustrated and told him so. I guess I go on my merry way, take pain pills, and deal with it then? He even discounted my PT on ALL things, including assessments of my flexibility and such.
Hmmmm, do I sense *IMCOMPETENCE* here? I found out my parents went to this guy, and said he did the same thing to them.
Need to look for another doc. I did make an app't with a chiro. for Monday just to get his input. I will call my PT on Monday to tell him what the doc said.
It isn't normal to have this pain every single day. I know it's my SI joint along with the arthritis. I'm the one who has to feel it every day!!
I have a lot in common with you. I too am 44 with constant pain every single day. I have done a whole battery of tests and injections. The docs have narrowed it down to SI joint dysfunction also. I go to a pt next month to see if he can definetly pinpoint it to the SI joint. I would definetly seek another doctor out. I still go to a chiro for this problem. I think one would benefit you also to some degree. My accident has been 14 months ago and I still have the same symptoms as you. I guess it is VERY difficult to pinpoint SI jjoint dysfunction. Please feel free to talk to me anytime. Good luck and keep us all posted! iearn
Thanks everyone for the replies. I asked him about a cat/bone scan, and he said I didn't need one. He's just so sure it's not my SI joint. He wrote on my chiropractor script that my dx is *facet strain, not SI.* He also did not offer me any pain medication. I didn't ask b/c by this time I knew I was going somewhere else. I do have some tramadol from the ortho doc. b/c I can't take naproxen for the next two weeks b/c I'm having surgery for something unrelated to this. I will go back to naproxen after that. Don't need a script, just buy it over the counter.
Betty, he did the leg raise test and said I passed. The PT did the same test and said I failed. I get pain from small and large movements, it can hit at any time. It takes me off guard alot. The surgery I'm having in two weeks involves the pelvic area, maybe my gyn can find something. The doc agreed that dx of SI joint dysfunction involves doing the injection....but he would rather disagree with me, the PT, the ortho doc and send me to a chiropractor.
Iearnmom, how interesting that you point out the docs are sending you to a PT for help in dx SI joint dysfunction. My pain mgmt doc acted like they don't know anything!! Again, he discounted my PT's assessment 100%. I don't mind the chiro. option, perhaps he can help, but I don't like one bit how this PM doc handled me today.
I think he's the type that doesn't like patients questioning him. You should have seen the reaction when I pointed out my MRI report about the arthritis. All of sudden, he found *a little bit* on the MRI. He would not put up the view the ortho doc used that showed the arthritis, even after I insisted. The bottom line is, (and I told him this), I am very confused b/c he discounted everything else I was told (PT, ortho doc, radiologist who read my MRI), didn't listen to me during the exam when I told him I had pain just moving around the table, didn't offer any pain relief other than a chiropractor. My parents told me that's how they were treated, and my mom actually had epidurals from this guy. But, everytime she went back, he asked her if she ever had an epidural. HELLO??? They don't go there anymore.
I've got new names for PM's in my insurance, but how do you know if they are any good? I plan to call my PT on Monday to let him know the PM doc's view on his assessment. I also plan to call a spinal neurosurgeon to see if he handles this type of problem, if not, please direct me to a good PM doc.
I KNOW there's something wrong with my SI joint, along with the facet joint. Iearnmom, I appreciate your offer to talk with you, I will take you up on that. It sounds like we have alot in common, and maybe we can come up with ideas for each other.
Thanks, Johnny, and welcome to the boards. I am new, also. The leg test he did was a straight leg test (I was on my back). I got alot of pain along the side of my knee (from tight hamstrings), so he couldn't go very far. He also twisted my legs around in different directions and I did get some pain from that. The worst pain happened when I sat up and turned around on the table. He also had me lie on my stomach and pull up and bend my legs toward my back. I had slight pain on my left side again (where I have the problem). Is this the leg raise test you are referring to?
My script for the DC says not to do any SI joint manipulations, only facet joint. I don't agree with this at all, how else am I going to know if it helps my SI joint? My PT did a manipulation on me three times....he pushed down on my right lower back in the SI joint region to push my left side up to make the joints even. The last treatment hurt like crazy, but it didn't relieve the pain I've been having for months. It did line up the joints at least.
PM doc also told me to tell the DC if he tries to do the same thing the PT did, to not let him.
Interesting that 85% of LBP goes undx. I never thought it would be this difficult to get proper help.
If it is SI dysfunction then they should have you on an SI belt. I wore one for awhile but it did not help. It was part of the insurance hoops and hurdles. It might work for you. I had torn the ligament and it didn't heal properly.
The Chiro can actually do more damage to you SI than before you started.
I would go to an Osteopath who does manipulations.
As for the bone scan, they will put you off on this because it is so expensive. But, it does show the areas that are inflammed.
By the time you see everyone that you have to see and do all of the tests that you have to do, you might as well of had the bone scan test.
I did try the SI joint belt. It didn't really help, but I probably didn't give it enough time. I had more pain using it. It's so ironic you mention OD, b/c I just spend the better part of this afternoon reading about them, and looking for one in my area I don't feel totally comfortable about seeing the chiro. And, strangely, the quacky PM doc wrote on my script to the chiro NOT to touch my SI joint, only the facet joints. He also told me if he did, I am to tell him to stop immediately. He sends me to the chiro, but has a sense that I shouldn't trust him.
I have found that with insurance, nothing is ever done in a timely, best for the patient way. Absolutely ridiculous.
Thanks again for all of your great advice. It's been VERY HELPFUL!!
I would definitely find another pain doctor.
But just FYI, I don't think even a competent physical therapist can always diagnose things correctly either.
My spine doctor suspected S-I dislocation/inflammation, and sent me to a very good PT to see if PT help heal the joint. The PT, who I did like and who has worked on some big-time pro athletes, said he didn't think it was my S-I joint that was causing the pain. Well, he was wrong.
PT didn't work, and then a pain doctor did steroid injections into the joint, and what do you know, I got huge pain relief from the shots. Then my spine doctor sent me for prolotherapy on the joint (to tighten it up), and that worked wonders, to the point where it basically seems to have cured that problem.
I don't understand why your pain doctor was so hesitant to do an injection. Hope you have much better luck with someone else.
Heidi, I'm so happy you found the right treatment!! That is great news. I think the reason the pain doc was hesitant is b/c he didn't want to deal with someone that tries to educate themselves on what is going on! The guy is a total quack. I would trust my vet to inject me before this guy
Well, I'm feeling pretty good right now b/c I did meet with the new chiro, and I really, really like him!!! He spent alot of time with me, and went over every film of x-ray and mri. He agreed with my PT, and not the pain doc...except he said he wants to try chiro treatment before any injections. Then, I will not go back to the quack, but meet the pain doc in his practice.
The chiro found I do have classic SI joint dysfunction, and I have facet joint disorder. He found early degeneration of my L-5 joint where the arthritis is. It's b/c of slight scoliosis, and I have a pretty pronounced swayback which has put alot of pressure on the lower joints for years. None of which two medical docs even mentioned (other than my scoliosis was no big deal). The chiro said I must have had other back pain for a long time....and he was 100% correct.
I was scared to death to try a manipulation, but I did it. It actually felt good. I put ice on my back tonight b/c I do have some soreness. He wants me to come back in one week, try it again. Said he would try around 4 times, then we would reevaluate. I'm not allowed to do my normal treadmill and weight machines for one week, but I had already cut back on my normal workout. I usually walk around 2-3 miles about 3 times per week, then do some weight machines for strength. I also walk my golden retriever alot during warmer weather, got up to 5 miles at one time. Haven't been able to do that much this year.
Met with PT after chiro app't to let him know what happened. He couldn't believe the quack doctor would act like that. Bottom line, I feel like I have some answers now, thanks to the chiro. That's the only sensible thing that came out of PM doc's mouth...see the chiro. Then again, he told my boss when he was a patient that chiros were not good docs. Geesh...
I forgot to ask him about prolo...will make a note to ask next Monday. I feel like a huge weight has been lifted off me today. The chiro may not work, but at least the guy listened to me, and gave me answers that make sense! He said he will do his best to help me with this.
One more thing....he recognized my name, and it turns out my inlaws see him. They love the guy, and said he really helped their back problems. He also knew my youngest son...turns out his son and mine go to school together, and had played on the same BB team. I must be totally oblivious, b/c I don't remember seeing this person before. He remembered me, though.
That's great soaplady that you're finally getting some good answers! I know it's very frustrating when your doctors aren't really listening to you, or really don't do anything to help you or guide you in the right direction.
If the chiro seems to be helping the problem, then definitely do it. I don't know if prolo will work on your S-I problem, but it definitely worked on mine. Apparently the tendons or ligaments or whatever it is that holds that joint in place needed to be tightened up, and prolo does that.
I had very significant daily pain in that joint until I had the prolo, and then my pain level went down to a 0 most of the time. If chiro doesn't do for you quite what you want, then I would look into prolo for sure. Or you might just look into it now, for future reference in case you might need it. I am so thankful my spine doctor was aware of it and decided my case called for it - I had never heard of it before that. But after I'd had the first round of it, I went to Greece, and was talking to a doctor there, and turns out prolotherapy is quite well-known among European doctors.
I am definitely going to bring this up with him next week. We are going to try 4 or 5 chiro treatments, then decide where things are at. My back still hurts today, but not too bad. He told me the first 48 hours after a chiro treatment will give some noticeable relief...the trick is to keep it there! My PT said it sometimes takes several chiro sessions to keep the body in the proper alignment. And, my x-ray also showed my pelvis isn't even b/c one leg is a bit longer than the other. Normally that would not be an issue, but it is adding to the joint aggravation. I have to wear a very small (3mm) lift in my shoe.
I have an app't for a massage tomorrow afternoon. I can't wait!! The last time I did it, my back felt pretty good for a few days, anyway. Hopefully, the cumulative effects of a medical massage will also help. My MT also mentioned that my upcoming surgery should be helpful (gyn issues). I have a tilted uterus which could also be adding to back pain.