Lumbar Spine Epiphany, Part 2

Hi everyone!

So, here is Part 2 to the post I published yesterday.  It’s about how, all this time, I thought only a chiropractor would be able to help me with rotation of the lumbar vertebrae… but it turns out, I was wrong.

Well, as it turns out… there are other medical professionals who can treat it.  It just goes by a different name.  

What I am talking about is “segmental spinal hypermobility.”

That’s the term I first discovered in this article, sent to me by a reader.  Since then, I’ve been doing some research and have been realizing it’s essentially the same thing, by a different name.

What is segmental spinal hypermobility?

Essentially, it means that some of the joints of the spine– where the vertebrae come together– are moving more than they’re supposed to.   That’s what hypermobile means– moving too much.  And segmental means it’s not necessarily the entire spine– it may be only localized sections of it.

375px-lumbar_vertebrae_anterior

The lumbar spine, where I am the most hypermobile

As the article explains, “Hypermobility may present as increased movement compared to what is expected. It may occur at one joint, one segment, in just one direction of movement, or as a more generalized phenomenon.”

Now– this article is from a chiropractic magazine.

So, while it was a great start, my next step was to Google “segmental spinal hypermobility” and see what I got.  Because, as you know, I’ve been looking for alternatives to chiropractic adjustments, since a chiropractic adjustment sent me to the emergency room back in May.  I wanted to see what I could find from a more mainstream medical source.

And one of the first things I got was this informative article from a physical therapy practice based on Oklahoma called Therapy In Motion.

The explanation in their article makes a ton of sense to me.  Let’s take a look:

“Hypermobility is a reflection of ligamentous laxity and muscle weakness and is
diagnosed when the ligaments are looser than necessary and creates instability of the spine and greater movements of the spine in every direction.

Causes/Mechanism of Injury:
Hypermobility is increased movement compared to what is expected. Differences in how the segments are moving may occur at one joint, one segment, in just one direction of movement, or as a more generalized phenomenon throughout the body.  Hypermobility can be congenital or can occur due to trauma experienced by the ligamentous structures resulting in increased movement patterns of the spine.”

That’s exactly what all of my chiropractors said to me. 

In their case, they were really only talking about an explanation for the rotation of the vertebrae.  In this explanation, it’s about excessive movement in all directions (not only can the spine rotate, but it can also bend forward, backward, and side to side).   However, we are still technically talking about the same thing– excessive movement of the vertebrae, due to loose ligaments.

Honestly, it seems like such a silly difference in terminology, but it had big differences in my treatment.

There’s a reason why I thought chiropractors were the only ones who could treat this issue.  Because I asked my various doctors and physical therapist (I even asked my SI joint guru, Paula).  No one really knew what I was talking about– even Paula said it wasn’t something she had learned in school.

And it’s just crazy to me now, to know that maybe if I’d asked my question in a different way, maybe I would have gotten a different answer.

I mean, chiropractic adjustments have risks, as I myself have seen.  (If you haven’t yet, please check out my post where I explain some of the other chiropractic injuries the ER staff described to me!).   I’d much rather pursue gentler modes of treatment.

The Therapy in Motion article outlines a few things that can be done as treatment.  Some of them are pretty basic for relieving pain and relaxing the muscles around the hypermobile segments, as they will likely go into spasm.

It also mentions therapeutic exercise, in order to “stabilize hypermobile segments, increase spinal muscle endurance, improve balance, and coordinate muscle firing patterns.”

This is because with a problem like this, even if you don’t start out with weak muscles, the muscles around the spine will likely go into spasm and become weaker, over time, as get worn out trying to protect the area.  So this exercise would be to reverse the process.

The last thing the article mentions is manual therapy– hands on therapy.  It’s sort of similar to chiropractic adjustments, except when done by a PT, it’s usually a bit gentler.  (It also doesn’t necessarily produce such dramatic results in one appointment, but that’s totally fine with me!).

To tell you the truth, I’m a little bit freaked out by the idea of any adjustment at all right now, so I would personally try to skip it at the moment.

But I am really relieved to see that this issue that is recognized by PT’s, and can potentially be treated by conservative methods such as exercise alone.

It’s all in a name.

There are a few reasons I wanted to share this with you.  First, as I mentioned in my last post, this type of spinal pain is something that can be pretty common for SI joint sufferers.  If you have altered motion at the SI joints– particularly if that motion is restricted– it’s likely to put extra wear and tear on the spine itself, and can potentially stress those ligaments as well.

During my SI joint battle, I pretty much kept it in line with chiropractic adjustments, but it’s really good to know there are physical therapists out there who recognize it as well, and can treat it with much gentler methods.

The reality is that sometimes you have to know the name of your problem, before you can find help.

It’s unfortunate– it isn’t our job, as patients, to come up with a diagnosis.

But I know that I walked around asking multiple PT’s and doctors about rotation of the lumbar vertebrae, and got nothing.

What if I’d just printed out this article about segmental spinal hypermobility and brought it in to my appointments with me?   Maybe things would have been different.

Luckily, I’m totally fine.  My temporary nerve injury from that chiropractic adjustment has healed, and I’m never going back.  (And luckily, I’m in a position to help spread the word about chiropractic adjustments, via this blog!).

I feel like Dorothy at the end of the Wizard of Oz.

Turns out, I never had to be relying on chiropractors as the only people to help with this problem.  There are physical therapists out there who can treat it– they’re just calling it by a different name.

For more info:

Here is another fantastic physical therapy article on this subject.  It’s a case study on a patient with some fairly complex issues, from The Student Physical Therapist.  It is, of course, geared to physical therapy students, but I thought some of you might appreciate it.  I think I might break it down into bite-size pieces in another post, because this patient’s story sounds fairly similar to the stories of some of the readers who’ve reached out to me recently.

So… I hope this was helpful!  As always, any questions, leave a comment below or email me at sunlightinwinter12@gmail.com.

Thanks!

P.S. In case anyone’s wondering, segmental spinal hypermobility is VERY different from segmental spinal instability.  Please don’t get them confused– the instability is a much more serious condition!  So if you have hypermobility, I don’t want you to worry unnecessarily!

4 thoughts on “Lumbar Spine Epiphany, Part 2

  1. Kathleen Betz says:

    Your SI joint saga sounds a lot like mine. In April, because I was experiencing stiffness in my back, I went to see a local chiropractor. She made some adjustments, and then insisted on stretching my hamstring, even though I had told her I had SI joint issues 4 years ago, and in the process rotated my pelvis. I was in agony until I found a local ortho group and a Physical Therapist who admitted he wasn’t sure what was wrong, but through trial and error, found the solution. Still working with him twice a week and with exercise, I seem to be making headway. Your blog was very, very helpful to me and I wanted to thank you for writing it.

    Like

    • Sunlight in Winter says:

      Hi Kathleen, I’m so glad my blog was helpful. I really appreciate the kind words.

      That’s really terrible that the chiropractor didn’t seem to listen to you. I’m glad you found a PT who was willing to work with you. It’s funny– out of all the medical professionals I’ve seen over the years, it’s usually the people who are able to admit they don’t have all the answers who turn out to be the most helpful. I think there’s a lot to be said for being a flexible, creative thinker, especially when it comes something as complex as SI joint dysfunction.

      Thank you again for your comment. I wish you all the luck on your journey!

      Like

  2. Jill johnson says:

    I use a myofascial release pt and a pelvic floor pt-
    Initially went to a chiropractor after the injury who “thumped “ around the joint causing sever e stiffness in leg – big knot on adductors. Etc. now I’m strengthening
    (Starting Pilates), pool therapy and use my pt people who are gentle .
    PT wants me to meet with her chiropractor who does
    Neurokinetiic technique on muscles. You know anything about that? I’m scared to go. I’m not that far post – injury and chiros scare me. I’m gonna just consult I guess- not let them touch me.
    When I had my back injury- I learned the hard way about chiro.

    Like

    • Sunlight in Winter says:

      Hi Jill, I hadn’t heard about NeuroKinetic therapy, but I just looked it up. I think it sounds interesting. I would probably do the exact same thing you’re doing– go for the consultation, but take some time and process it afterwards, before deciding whether or not to actually proceed with the treatment. I have had experiences where even light touch can produce some pretty powerful results.

      Actually, if you see my response to Kathleen above, I think I would give you the same advice about looking for someone who is flexible, and can adapt their treatment to your individual needs. If the chiro wants to give you a one-size-fits-all treatment, that probably won’t be a good idea (even if it’s gentle). If they’re willing to start small with you, and literally just adjust one muscle in the first treatment (if that’s what you want), then that’s a good indication that they’re a good listener.

      So– I wish you the best of luck as you proceed! Feel free to let me know if you have any more questions.

      Like

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