My meeting with a spine specialist who doesn’t believe in SI joint dysfunction.

Hi everyone!

So… my goal with this blog is to provide you guys with as much accurate information as possible.  I share, from a patient perspective, the information that has helped me, across the course of my various meetings with doctors, chiropractors, and physical therapists.

And I want to be clear about the fact that there’s always the possibility that what I say could be wrong.  That is why I never want you to simply take my word for things– I always want you to make decisions based on what the providers who see you in person suggest.

So, with that being said, I am going to tell you about a very interesting (although, in my opinion, somewhat disappointing) meeting I had with a new sort of spine specialist today.

I’ve often wondered how doctors could flat-out tell so many patients their problem was the spine, not the SI joints.

I mean… how do they really know?  How can they not address the research that’s been done on SI joint dysfunction (even if they don’t necessarily agree with it– at least acknowledge it.  I mean, come on).

I’ve often been surprised by the stories I’ve heard from some of you, about doctors who left you feeling more confused than reassured.  But now, I’ve had that experience myself, and I think I see how it happens.

As you may know, I am super happy with the new PT I saw last week, with training in advanced orthopedic manual therapy.  

However, since my recent visit to the emergency room, I’ve sort of been on a quest for answers, to find out more about what happened to me.  I’ve been really curious about what providers within different specialties have to say.

As you may know, I’ve also been curious, for a while, about the possibilities that could arise from collaborations between mainstream medicine and chiropractic.

So today, I met with someone who had training in both areas.

The person I saw today was originally trained as a chiropractor, however he then continued his education to become a Primary Spine Practitioner.

This is, as I understand it, a relatively new type of specialty.  He received his training through Brown University, although he told me the PSP program has since been moved to the University of Pittsburgh.

As I understand it, a Primary Spine Practitioner is like a primary care doctor… specifically for the spine.  Both physical therapists and chiropractors can become PSP’s (although I specifically chose the person I saw so I could ask chiropractic questions).

As the Primary Care Spine Provider Network website explains,

“Our medical system has developed a model in which a primary care physician (PCP) serves to provide care for the majority of patients and conditions as well as to guide patients through the maze of health care.  However PCP’s are provided very little training specific to the spine during school and residency…  As a result, and through no fault of their own, these practitioners are ill-equipped to effectively and efficiently deal with spine related disorders.

…the health care system desperately needs a professional dedicated to primary care for patients with spine related disorders – a Primary Spine Practitioner (PSP).”

In other words, because primary care doctors have to be knowledgeable about so many different things, they aren’t able to learn about the spine in the in-depth manner the subject requires.  That’s why the specialty of Primary Spine Practitioner was created.

I think this idea is really cool…. but the appointment today did not give me what I needed.

I really hesitate to say anything bad about the doctor I saw… because I really liked him as a person.  He was really nice, and I could tell he was super smart.  In another context, maybe we would have even been friends.

However, as doctor and patient, we seemed to be working with an entirely different set of facts.  He’s of the school of thought I mentioned in my last post, that SI joint dysfunction doesn’t really exist.  Or that SI pain is possible, but it can be brief.  He basically didn’t believe me when I said I’d struggled with it for years– he said it had to be coming from the spine.

Now, my big issue here is that he didn’t even actually examine my SI joints.  Like, at all.  He did not touch my pelvis or back once during the entire exam.

Instead, he cited statistics about how rare SI joint dysfunction really is, and talked about how strong the SI joint is.

Which is not to say the studies he cited are necessarily wrong.  And in a 60-minute appointment, I suppose it wouldn’t have been appropriate for us to get into a discussion about the scientific method and the methodology of these studies.

But… I think most of you can see why I found it hard to believe him, as he disagreed with my years of lived experience, when he didn’t actually examine me.  There was no physical evaluation– at all– during our appointment.

It was a case where it seemed his mind was already made up on the topic of SIJD, he believed he had the facts to back it up, and that was that.

To be fair… I have not had anywhere near the amount of schooling he has had.  I can’t really claim to know more than him.

But I can point in the direction of people who have, and do treat SI joint dysfunction, and also the peer-reviewed scientific studies which do claim the SI joint can be a generator of pain.

The impression I get is that people cherry-pick facts, to support the idea that SIJD doesn’t exist. 

It was honestly pretty striking to me, that the doctor wouldn’t even think it was appropriate to examine my SI joints.

Both of the physiatrists I’ve seen have actually put their hands on me and examined the joints as sources of pain.  So, it’s not like I have no other doctors to compare him to.

I mean, there are neurosurgeons and orthopedic surgeons who operate on the SI joint.  It is not crazy to believe that SI joint dysfunction is real.

But… I might as well have been crazy, for all the good my explanations did in this appointment.

To be fair, we both agreed that my current symptoms are coming from hypermobility of the spine, rather than the SI joints.  

The difference in opinion was whether or not my SI joints should be a factor in the exercises he wanted to give me, in order to stabilize the rest of my spine.

I compared his treatment plan to David (my new PT’s) plan.  Both of them actually had agreed that my spine was hypermobile, and that I shouldn’t be receiving adjustments of any sort to my spine!

So technically, they both disagreed with my old chiropractor, whose adjustments had landed me in the ER.

This PSP explained that “rotation of the vertebrae”– at least, in a way where they can get “stuck”– isn’t really a thing.   

He took out the model of the spine and showed me how far the vertebrae would actually have to rotate out of place to get “stuck” that way.  I saw that there was no way for a vertebra to get jammed without causing significant, immediate neurological symptoms (which I had never had).

He said it was certainly possible for vertebrae to shift, slightly, within their normal range of motion, but not to get “stuck” or “out of place” in the way that I thought.

This is similar to what my PT David had said as well– the problem was that my spine was hypermobile, not that it was getting stuck in one bad position.

There was one key difference in their treatment plan.

This PSP was convinced I had some sort of a disc protrusion in my lumbar spine that hadn’t been significant enough to show up on my MRI at the emergency room.  He said that if he took a look at the actual films himself, he might be able to identify more subtle issues that what an ER radiologist might see.

So he was going to have me start doing back extension exercises, which is generally the treatment for this sort of issue.

But again, I didn’t really feel like he was hearing me.

Because honestly, I wasn’t really in his office because I was still having symptoms.  I was there because I wanted an answer to what had happened to me at the ER… which technically, I didn’t end up getting.

I told him how convinced I was that back extension would aggravate my SI joints.  He did take out the model of the spine and show me why this was unlikely.  I know many of you have been given back extension exercises as well, and agreed that it made your SI joints worse (check out my post on McKenzie exercises, for more).

In that moment, I couldn’t really explain to him or convince him that back extension made my SI joints move out of place, but the whole appointment was just a bit overwhelming.

Because he didn’t believe in SI joint dysfunction…

And we didn’t actually have my MRI to see if he was right, about a disc protrusion (which is why I’d be doing back extension in the first place).

We left off that I’d wait to see what he thought, once he saw my MRI.

Frankly, I know from personal experience that back extension is probably not going to be worth it.  Right now we don’t really know if I have a disc issue anyway.

I’m pretty happy with my PT David’s more conservative plan, of strengthening my core and lower back muscles with my spine in a neutral position.

So I am mostly going to look at this appointment as a learning experience.

If this doctor calls me back and says he does believe the MRI shows anything seriously off with my spine, then maybe I will re-evaluate.

But, quite frankly, I’ve been through this enough times to feel as though I have a good sense when someone is going to be able to help me or not.  

And experiences like this– where I don’t feel heard, and where the person didn’t even take the time to examine me– have never really turned out to give me what I need.

However, I also acknowledge that I don’t know everything, and also that things can change.

So… I will keep you posted.

Sometimes, when working on this blog, I feel pressure to always stay strong, and act like I know everything.  I feel like people are counting on me, and that I shouldn’t admit if I’m still having back pain, after everything I’ve been through.

But the thing is… I know you guys don’t think that way.   It’s just the pressure I put on myself.

So I wanted to share this with you, to let you know I know how it feels when you go see someone you think is going to help you, and your words just seem to bounce right off them.

This was the type of experience I’d only really heard about in your emails.  How you could actually physically present in a treatment room, with pain in your SI joints, and have them still not believe you.

Now I see how it happens.

It’s easy to not have to change your views, if you’re never truly confronted with the evidence.

That is precisely why I’m writing this post.

You know what?  It still could turn out that, ultimately, I’m wrong about the things I say on this blog.  (I don’t think so, but it’s certainly possible!).

That is why I will always try to share with you the truth of my experience, good and bad.

I want you to know both sides, of all the topics I discuss here.  I don’t want anyone to just take my word for it– I want you to think about it, speak with your doctor and/or PT, and decide for yourself.

So… I hope this was helpful!

As always, if you have any comments or questions, you can leave them below or email me at sunlightinwinter12@gmail.com.  Thanks!

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