As you may know, recently I’ve been trying to find people with the knowledge base to help me better understand what happened to me back in May, when I ended up in the emergency room after a chiropractic adjustment.
It’s not so much that I’ve been looking for treatment, in the traditional sense. It’s more that I still need to make sense out of what occurred.
After all, I never got an exact explanation at the time. Although the doctors I saw were able to rule out a structural problem, through x-ray and MRI, none of them were really able to come up with a concrete explanation for exactly what happened. Neither was the physical therapist at the hospital (although he gave me the best explanation out of anyone at the time), or the neurologist I followed up with on an outpatient basis.
It’s not their fault, of course– they aren’t trained as chiropractors. So they really had no idea of what may have been going on during the adjustment; much force my chiropractor applied to my spine, and in which direction he was applying it.
This is why I sought out David, a physical therapist with advanced training in Orthopedic Manual Therapy.
I think this post will be useful for everyone in my SI joint crew, even though we are technically talking about a problem in the lumbar spine. There are a few reasons for this:
- The lumbar spine and the SI joints are so closely related, it can be hard to tell where the pain is coming from sometimes. I think it would be pretty unlikely for anyone to make it through a battle with SIJD without also having to address the lumbar spine (the spine of the lower back).
- A big struggle for anyone with SIJD is finding the right medical specialist to actually help you. I hope that, with these posts, I’ll give you a better idea of the possible treatment types that are out there…
- This is especially true, when it comes for looking for someone to adjust you. Because, let’s face it– adjustments of some sort can be a really helpful (and sometimes necessary) part of recovery from SIJD. The goal is to find someone qualified who, of course, won’t make you worse!
So, for all of these reasons, that’s why I’m excited to be sharing these experiences with you.
So. Let’s talk about how I found David, and why I decided to make an appointment with him.
Because so many of you ask me how to find help, here’s what I did.
I went through my insurance website, and found a list of covered PT’s in the area. Then, I read as much about them as I could, knowing that, in my case, I was looking for someone who was likely to understand adjustments.
I read through the websites for a bunch of physical therapy practices, until I happened to come across David’s little online bio. I hadn’t heard of Orthopedic Manual Therapy before, but as soon as I saw it, a little light-bulb went on over my head.
I know, from all of my classes, that orthopedic means something having to do with the bones, muscles, and joints.
Manual therapy essentially means “hands-on” therapy. The term can refer to a lot of different things, such as massage and soft-tissue techniques. It can include Muscle Energy Technique. Anything where the therapist’s hands are actually on you (thus, the meaning of the word “manual”).
And… I know that it can also include something called joint mobilizations, which are similar to chiropractic adjustments.
That’s why I was immediately intrigued. I figured that, out of all the PT’s I’d searched through thus far, David seemed the most likely to have an idea of what may have happened during my chiropractic adjustment.
So I made an appointment.
I didn’t even want an adjustment… I just wanted to talk to someone who would understand.
And… what I ended up getting out of it was way more than I’d hoped for!
I’ve only had one appointment with David so far, and I’m sure I’m going to continue to have even more to say in the future! But in this one appointment, I found out that he can do both the less-aggressive joint mobilizations we normally think of PT’s performing, and the same joint manipulations that chiropractors do!
Now, I personally have decided I never want to receive another joint manipulation again, and I stand by that, regardless of who’s performing it. But David was totally cool with that. He understood my experience with the chiropractor, and knew that I was mostly just there looking for information.
And it’s in that same spirit that I share this post with you. I’m personally not looking for an adjustment (other than the Muscle Energy Technique). But if you are, it’s certainly your own decision. And I want you to be as informed as possible.
So… David was able to give me a better sense of what he thought was likely to have occurred during that fateful chiropractic adjustment.
He differed from the PT at the ER, who had thought the adjustment had temporarily compressed one of the nerve roots where it comes out from my spine.
David was actually able to explain to me that, in order for that to occur, my chiropractor would have had to move one of my my vertebrae by centimeters, not by the 1-2 millimeters it would have moved due to the low force coming from an Activator (the tool my chiropractor used).
He thought it was incredibly unlikely, given the fact that, by the time I had imaging done at the hospital, nothing was really “out of place” in my imaging.
He also thought that, if a nerve had been compressed, it would have taken a lot longer to heal.
Instead, he thought the adjustment triggered some sort of a localized inflammation response.
He thought that maybe the adjustment, for whatever reason, had been too intense for my body, and had caused some sort of small musculoskeletal injury.
If that had occurred, my body would have instantly sent a flood of inflammation and healing chemicals to the area. (I learned about this in Anatomy & Physiology, and it’s pretty interesting! The body has a whole sequence of chemical signals it uses to attract white blood cells to an area of injury).
And because this injury occurred so close to my spinal cord, my body took it much more seriously than it would, say, a knee or an ankle injury. Basically (pardon my language), when it comes to the central nervous system, the body doesn’t fuck around.
Remember, we are built to survive. If something messes up our central nervous system, we’re basically done for.
So, in addition to that inflammation cascade, my nervous system also went into overdrive protective mode, causing muscle spasms and weakness, so that I stayed the hell away from doing whatever it was that almost injured the CNS.
So, I was so glad I ended up meeting David.
His training in Orthopedic Manual Therapy did give him a much better idea of what could have gone wrong, compared to someone without it.
To be fair, I don’t blame the PT at the hospital. He was doing the best he could, with the knowledge he had, and I also felt he was taking me way more seriously than the neurologist.
But because David had detailed knowledge of exactly how the joints can move, and how adjustments work, he was able to pinpoint a much more likely cause.
David also explained to me that spinal hypermobility is a much better term for what I had.
As I’ve written previously, my chiropractor had led me to believe that “rotation” of the lumbar vertebrae was my main problem.
However, David changed my entire concept around this.
He said “rotation” wasn’t really the problem, and that it was a somewhat outdated idea. Instead, my spine was hypermobile.
It wasn’t like my SI joints, where they could get “stuck” in a bad position (when one of the hip bones would get jammed backwards). My spine wasn’t getting “stuck” in a rotated position. He explained that, anatomically speaking, it just wasn’t possible.
Instead my spine was just moving too much, due to stretched ligaments and muscle weakness.
In fact, there was nothing for him to “adjust.” He wasn’t sure why my chiropractor had been giving me adjustments, when to him, I wasn’t a good candidate for spinal mobilizations. He said my joints were already moving too much– joint mobilizations would only make things worse.
So I got way more out of this appointment than I’d hoped.
I found out that I probably didn’t technically have a nerve “injury,” although I’m still sort of using the term to explain it to people. If David is correct, it means one of my nerves got hit with a flood of inflammatory chemicals that gave it the symptoms of an injury.
And I found out that my concept of lumbar rotation was actually incorrect. (I’ve since been writing a bunch of updated posts on the more accurate diagnosis he gave me, spinal hypermobility. Check them out if you haven’t yet!).
So, as always, I hope this was helpful.
For those of you looking for a PT to help you with your SI joints, I would absolutely recommend looking for someone with this specialty.
David was also familiar with the Muscle Energy Technique, and checked to make sure my pelvis was in line. (My guess is that he also probably could have performed the more traditional hands-on adjustment, if I’d expressed interest).
The two places he trained:
The American Academy of Orthopedic Manual Therapists (which, by the way has a link up to the 2018 World Congress on Low Back and Pelvic Pain! Remind me to give that its own post later!).
The AAOMT also has a cute little Find-A-Fellow section on their website, where you can search for a PT near you who has completed their prestigious fellowship program.
I hope this helps you on your search!
Articles on Joint Mobilization (in case you’re curious!):
Advance Physical & Aquatic Therapy: Joint Mobilizations for Physical Therapy (I totally recommend this place for anyone in the PA area, by the way).
Physiopedia article on Manual Therapy (written for PT’s).
Alliant PT: Joint Mobilization
And a post from me:
Hope this helps!
As always, if you have any questions, you can leave a comment below or email me at firstname.lastname@example.org.
Also, be sure to check out our new SI Joint Facebook Discussion Group. We’ve had some great conversations so far!