For some reason this subject has come up a lot in my emails to readers recently, so I thought it was high time I give it its own post.
At one point into my journey– I’d say it was probably about two years into the whole five year saga– I made an appointment with an orthopedist.
I’d already seen one physiatrist, who hadn’t really been able to help me. I’d sort of given up on trying to get help from doctors, but my boyfriend at the time was urging me not to give up, and instead to cast a wider net. (Looking back, I can totally see that he was right!).
I’d heard that orthopedists sometimes treated the SI joint and offered injections, so this seemed like it was worth a try.
This orthopedist wasn’t anyone I’d seen before– I was just looking for someone who took my insurance. He practiced at the same location as other specialists I’d liked, so I thought it was worth a go.
Initially, he did say what I was expecting based on my research:
That there was no way to know for sure whether or not I had SI joint dysfunction, without doing a lidocaine (or lidocaine and cortisone) injection into the joint to see if it helped my pain.
Now, before we go on– what are we talking about?
Lidocaine is a local anesthetic that will numb the area almost immediately, and last for a few hours.
Cortisone is a steroid which dramatically reduces inflammation. It takes a few days to start working and the effects can last for a few weeks.
Many doctors who treat the SI joint consider a lidocaine injection to be the “gold standard” of SI joint diagnosis. Lidocaine is injected into the joint, and if it takes away the person’s pain, that means the pain was coming from their SI joints (as opposed to somewhere nearby, like the lumbar spine).
You can find lidocaine injections referred to as the “gold standard” of diagnosis in tons of articles and informational videos about the SI joint. This seems to be more common among doctors and surgeons– I have seen physical therapists (and chiropractors of course) who didn’t feel they needed the results of a diagnostic injection to treat SI joint dysfunction. (However, I’ll talk more about that in future posts).
And, as this doctor offered me, you can have lidocaine and cortisone injected simultaneously. This way, you can have the lidocaine “test,” and also receive cortisone for long term benefit, while only having to receive one injection. (Here’s a good article that explains more– check out the “therapeutic injection” section for the part about cortisone).
There was one concept I didn’t really understand at the time, and to be honest, I’m not sure I really understand now.
I told the orthopedist that I only seemed to have pain in my SI joints when they were out of alignment. (Remember that when an SI joint is out of alignment, or “stuck“, it means one of the hip bones, or ilia, has rotated backwards and gotten jammed against the sacrum).
I explained that my pain seemed to be entirely dependent on the position of my joint. I only had pain when it was out of place, and as soon as my chiropractor put the joint back into place, the pain stopped.
So, I wanted to know, would a lidocaine or cortisone injection really be able to take away the pain of my joint being jammed like that?
The doctor thought for a minute, and then said no. If I had significant pain that went away almost immediately when the joints were put back into place, a lidocaine or cortisone injection wouldn’t really be able to change or cover up that kind of pain.
He was still willing to give me the injections to see if they helped, but he didn’t really sound confident about what he was doing, or what the expected course of treatment would be afterward. It didn’t really inspire me to have much faith in him. I went to see him because I was hoping to talk to an expert, but ultimately I felt as though he was trying to treat a condition he was still learning about himself.
Because the injections themselves can also pose risks, and cause side effects, I decided it probably wasn’t worth it for me. Based on the pain relief I felt when my chiropractor put my SI joints back into place, I felt as though there wasn’t any question of whether I had SI joint dysfunction or not– of course I had it.
A new chiropractor?
The way this doctor and I left off, actually, was that he suggested I make an appointment with the chiropractor who worked at his practice. Not because it sounded as though there was anything wrong with my chiropractor– it’s just that he actually knew this chiropractor, and together they could communicate about what was going on. He thought that maybe this made more sense, and that we could re-consider the injections at a later point in time, once we had learned more about what this chiropractor thought.
At the time, however, I was happy with my own chiropractor and didn’t want to go through all the trouble of travelling this far on a regular basis. (After all, my joints were so hypermobile they actually had trouble staying in place on the way home).
Looking back, maybe it was a mistake not to pursue this option. My philosophy is somewhat different now. I’ve come to think that when you’re faced with this type of complex medical problem, it can be worth it just to pursue different options, if only so you can cross them off the list if they don’t work out. If you leave something on the table as a “maybe” forever, you might never really get any concrete answers.
But at the time, I was feeling overwhelmed, and I was trying to conserving my energy. (Plus, it would turn out that my too-frequent chiropractic adjustments were backfiring anyway).
But there you have it. That was my experience seeing an orthopedist, and why I personally did not pursue lidocaine or cortisone injections.
Of course, I’m not sharing my experience to suggest that you shouldn’t pursue these injections– not at all. I’m just trying to provide you with whatever information I can, in case it helps you figure things out on your own journey.
If I could go back in time, or if (God forbid) I’m ever faced with as complex a problem as this again, I think I’ll try to do things differently. If one specialist doesn’t help, instead of giving up on specialists, I’ll try to see another. And another.
After all, I was in a licensed orthopedic surgeon’s office, and although he was a nice person and I’m sure a competent surgeon on the issues he normally treated, it was really pretty clear he was not terribly familiar with the SI joint.
So, my advice above all else would be to actually look for someone who sounds confident about the SI joint, and who has actually seen patients recover under their care before.
I’ve since seen other doctors who did offer these injections, and who actually had seen their own patients recover under their care. (Check out my posts about Dr. Joanne Borg-Stein and this other physiatrist I once saw).
I also think that part of the problem for me was that I didn’t have the expectation of really finding help, or getting answers. So when I hit potential roadblocks and disappointments like this, I was perhaps too accepting, instead of moving on quickly and trying something else.
I’ve already had to go through this with my allergy battle this last winter and spring, and I think I’m just starting to understand that sometimes it really takes three, four, or even five doctors before you find the information you need on any topic that’s a little bit complex. It’s frustrating, but that just seems to be the way it is. (After all, it was only the third allergy doctor who really helped me).
This same phenomenon has played out multiple times in my life, with my various health issues. Each time, it turned out there were answers out there– I just gave up looking too early.
Ironically, after the first physiatrist I saw was so disappointing, I’ve since met others and have come to feel that physiatry is a pretty useful specialty, in terms of treating the SI joint. It’s just that not everyone has the same training and experience– unfortunately, sometimes you have to find the right person.
So keep going.
In conclusion, I have to share this totally awesome video with you again. It features a physiatrist who’s well-versed in the SI joint giving an overview of the various treatments for it.
Ideally, you want to try to find a doctor who has this type of knowledge base, and sense of familiarity when talking about the SI joint. Hopefully the video gives you an idea of what to look for.
And, if you’re interested, here’s a post where I took some notes on it for you, because there’s a ton of useful information contained here.
Okay, I hope this post was useful for you! Any comments or questions, let me know below or email me at firstname.lastname@example.org!