By Amy Price PhD

SI Pain is often caused by sacroiliitis (inflammation of the SI Joint) and can cause low back pain which often hurts on one side. The pain can be extreme aching sensation which is referred to the low back, buttock or thigh.  This is called  sacroiliac joint (SI) dysfunction The reason it hurts is because there is too much or too little movement in the joint which  causes strain because the bones are not adequately supported and the anatomy becomes  asymetrical. It is estimated this area is painful for as much as 15% of the population at any one time. 85 % of us will experience significant back pain in our life times

The sacroiliac joint or SI joint is the joint in the bony pelvis between the sacrum and the ilium of the pelvis. The joint is a strong, weight bearing synovial joint. These joints are shaped much like kidney beans.The joints are covered by two different kinds of cartilage; the sacral surface has hyaline cartilage and the ilial surface has fibrocartilage.  Prolotherapy is often used to strengthen the cartilege and provoke a healing process, it is important that the joint is mobilized and positioned correctly before prolotherapy and that prolotherapy be guided by flouroscopy so that treatment is accurately placed. The dermatome map can show pain patterns   Cortizone  injections are sometimes used to treat this area but release can be short lived unless the structural problem is addressed.

There are other conditions such as disk herniations, lumbar nerve compression,  hip degeneration or sensory  motor  proprioception deficits that can mimic this difficulty so it is important to be examined and treated by a qualified medical professional.  With an SI joint dysfunction present it is not a good idea to do psoas stretches as this can increase movement and instability.

 Richard Don Tigny has developed some excellent methods for treating this problem through correct positioning and strengthening exercises. I have personally found this method very beneficial. I was erroneously treated for piriformis syndrome and other things for years before I finally found relief using these simple effective corrections I could do myself. I know of several individuals who were recommended for surgical procedures, tried this method instead and became pain free without surgery. Don Tigny has validated his method with research. There is a video available for purchase by patients and professionals which is well worth the investment. He has granted permission to show three corrections and there is also a link  supplied to his website. He has made available multiple materials, research links, explanations and solutions. A link to his site and some useful corrections are available here.

Nerve Glides can help relieve chronic spinal pain

Amy Price PhD

Nerve Glides can help release a lot of the pain that comes from trauma and even arthritis. A lot of the pain may be originating from the nerves in a cascading effect which inflames surrounding soft tissue. The peripheral nerves in your arms and legs are mobile structures  that can stretch when elongated. Injury and scar tissues can trap them but you can do special stretches called nerve glides to release these areas.

To see how your nerves move try this.  Take your finger and touch your nose.  Then bring your hand all the way out to your side and stretch it out as far as it will go.  Next tilt your head away from your outstretched hand (if it’s your left hand, bend your head right).  You will likely notice a pulling sensation in your hand and arm with your head bent.   Now try to bring the head towards the hand, does it go away?  This is a demonstration of  nerve tension. 

 There is no muscle that goes  all the way from your neck to the hand.   Since bending your head away from the hand tightens the nerves that go from your neck to your hand, you feel pulling. If you feel pain, numbness and tingling, this is a problem you should tell your doctor about. Nerve glides can be used in multiple body areas not just the hand and neck. Nerve pain is referred to other body areas and you can get an idea of the patterns  by looking at a dermatome map

Another example  is that the nerve when inflamed looks like a thick lumpy rubberband, but as you stretch and glide the nerves, they thin out making an easier passage through the channels they move theough. If you stretch a rubber band it “thins” out.

The nerves in your body have a normal range of motion like the joints.   Nerve glides are stretches that help get back that normal movement.  Nerve glides must be done gently and should never increase pain. The goal is to  free the area up and not to inflame it so in this case pain is not gain.  Technique is critical. It is best to have an occupational therapist that specializes in neural education who can show you how to do these nerve glides. They will give you a sheet with the instructions on how to do these right and you can watch as you perform the nerve glides in the mirror to make sure your form is correct. Nerve glides are also known as nerve flossing or nerve stretching.

Ligament injury refers pain see chart

 By Amy Price PhD

The ligaments act like duct tape to hold our bones and joints together.  When ligaments lose their elasticity the bones and joints move too much and irritate the structures around them. Ligaments provide boundaries for movement.  For example when we bend our fingers backwards the ligaments will stop us from pushing them too far back and breaking the bones. It is this way with most of the joints in our bodies. The ligaments cause them to work within a safe range of motion. When one of the ligaments is torn or stretched, the excess movement will cause pain and swelling. In an injured joint and you may notice more popping, cracking or even a grinding feeling.  The joint may have become unstable.

 In the neck and spine, ligaments are crucial for holding vertebrae together. Spinal ligaments are especially vulnerable to overstretching or tears in a car wreck.  If you experience these symptoms after a wreck you may want to be examined for a ligament injury:

•             popping, cracking, or grinding in the neck with movement

•             pain or spasms that get much worse with activity

•             Numbness or tingling into the hand(s) or feet that gets worse with activity or accompanied by popping, cracking, or grinding.

 Flexion-extension x-rays, or digital motion x-rays can be a good way to help diagnose ligament instability.  A good physician will want to test the spine segment by segment to test for stability and this is  an essential step for enabling accurate treatment. The diagram above shows some of the ways ligament pain is referred in the neck area. For referred pain in other body areas look at our dermatome pages

Treatment usually proceeds as follows:

•             Specially trained medical practitioners such as Chiropractors or Osteopaths can mobilize any stiff segments that may be overloading the unstable segment

•             Posture Training can improve stability, injury can increase tightening of muscle structures which can cause guarding of the painful area. This throws posture off balance and  can aggravate instability.

•             Strengthen any weak, deep supporting muscles (like multifidus) that may be allowing too much movement. Core strength exercise like modified Pilates with the guidance of a trained physiotherapist can be helpful

•             Don’t be talked into mobilizing or manipulating an unstable segment as this can bring a temporary improvement but over time can make things worse. Sometimes bracing is used and while this may seem like a good solution to reduce pain initially prolonged bracing can cause further weakening of the surrounding muscles and later slow recovery.

•             Prolotherapy may prove helpful, adult stem cell therapy using your own cells has been reasonably successful in initial trials.

•             Surgical stabilization is sometimes used when no other treatment brings improvement.

 This page is offered by Simon who became a quadriplegic after a car crash. He has a phenomenal site that helps people understand the complexity of spinal damage and shows how you can choose to do what you want to do in life anyway. Some people let life happen others make things happen. Simon makes things happen! Please visit his site by clicking on the banner on the bottom of this page

This page describes the role of dermatome and myotome locations and how you can have pain at one area when the damage is really somewhere else. We urge people to take a dermatome map into your doctor  and show them the pain patterns

 Spinal nerves have motor fibers and sensory fibers. The motor fibers innervate certain muscles, while the sensory fibers innervate certain areas of skin. A skin area innervated by the sensory fibers of a single nerve root is known as a dermatome. A group of muscles primarily innervated by the motor fibers of a single nerve root is known as a myotome. Although slight variations do exist, dermatome and myotome patterns of distribution are relatively consistent from person to person.

myotomes-dermatomes by permission Apparelyzed.com

Myotomes

Each muscle in the body is supplied by a particular level or segment of the spinal cord and by its corresponding spinal nerve. The muscle, and its nerve make up a myotome. This is approximately the same for every person and are as follows:

C3,4 and 5 supply the diaphragm (the large muscle between the chest and the belly that we use to breath).

C5 also supplies the shoulder muscles and the muscle that we use to bend our elbow .

C6 is for bending the wrist back.

C7 is for straightening the elbow.

C8 bends the fingers.

T1 spreads the fingers.

T1 –T12 supplies the chest wall & abdominal muscles.

L2 bends the hip.

L3 straightens the knee.

L4 pulls the foot up.

L5 wiggles the toes.

S1 pulls the foot down.

S3,4 and 5 supply the bladder. bowel and sex organs and the anal and other pelvic muscles.

Dermatomes

Dermatome Apparelyzed.com used by permission Click to enlarge (2009) C

Dermatome is a Greek word which literally means “skin cutting”. A dermatome is an area of the skin supplied by nerve fibers originating from a single dorsal nerve root.  The dermatomes are named according to the spinal nerve which supplies them. The dermatomes form into bands around the trunk but in the limbs their organisation is more complex as a result of the dermatomes being “pulled out” as the limb buds form and develop into the limbs during embryological development.

In diagrams or maps, the boundaries of dermatomes are usually sharply defined. However, in life there is considerable overlap of innervation between adjacent dermatomes. Thus, if there is a loss of afferent nerve function by one spinal nerve sensation from the region of skin which it supplies is not usually completely lost as overlap from adjacent spinal nerves occurs: however, there will be a reduction in sensitivity.

Medical Specialist visit

By Amy Price PhD

You have been sent to a specialist…what next? First of all sort out what you expect to happen as a result of this visit. What are your goals? Make sure they are realistic. If this was easy your primary care doctor could probably fix it.

Before your visit explain what records you have and ask which of these they would like you to copy and pre-send. Usually you can get copies of MRIs or other diagnostic tests on CD. They are easier to carry with you or send than bulky films. If you choose to send your diagnostic results and films call and confirm they arrived. Get a cost for a cash price unless you have medical insurance which will cover your visit so that you will know your costs and if you can absorb them.

If you are making a distance appointment insist on a phone consultation so you will know if your expectations are viable. If the staff you speak with don’t have information about a certain area make arrangements to call back when it is available. This way all the preliminary material is out of the way and your appt can focus on what is most important. Explain you are travelling from out of town and are in pain and request the best time of day to be seen promptly. Emergencies or office back ups can still happen but this step minimizes the possibility.

Write down what you consider to be the most important things you want covered in your visit. You may want to refer to a dermatome map The reason you may want to do this is because chronic pain and injury can cause us to be sidetracked by emotion. You may get a compassionate response but it may eat away at the time available.

This is the place to get your MRI and other diagnostic tests explained. The doctor that ordered the test is the one who needs to explain it. Get an advance copy of the report and ask about what you don’t understand. We get emails every day from people who want us to translate the MRI or other diagnostics. We cannot do this because the MRI is only part of the equipment needed for a diagnosis. It is your job to make sure you understand your diagnosis before you leave the doctor’s office. Here are more practical tips on making the most out of the doctor’s appointment

It is helpful to plan a nice dinner out or a treat for yourself for afterwards and if you can, take someone with you who will remember what the Doctor says. The reason for this is it will be difficult for you to reconcile yourself to a 40 minute appt when the injury has taken over your life 24/7. Even though your appointment time may be quite generous, logic and rational thought cannot always be counted on, when you just want it fixed.

Now relax and trust the specialist you have chosen!

DMX for diganostics

DIGITAL MOTION X-RAY® is a diagnostic test that records real time, full motion x-ray imaging of any body joint in motion. DMX® can often unlock the mystery of spinal pain. It is common knowledge among spinal care professionals including surgeons that damage to ligaments, tendons and underlying support structures can not be corrected with surgery or physiotherapy alone. Until now it has been difficult to diagnose these injuries objectively. Serious ligamentous and facet joint injuries are well documented at autopsy however this is not a working solution for live patients in need of care! Should you ask your doctor to order a DMX® exam for you?…. To find out ask yourself these questions:

• Do I have pain in one or more of my joints that increases with motion?

• Did I injure myself with a sudden jolt to one or more of my joints, as a whiplash injury, slip and fall or blow from a sporting activity?

• Do I have joint pain, the cause of which has not been determined by conventional x-ray, MRI or other diagnostic tests?

If you have answered yes to any of the above, consider a DMX® examination.

Stretched and torn ligaments can result in a condition called “kinesiopathology” or abnormal motion of the bones that make up the joint. This abnormal motion results in ongoing rubbing and grinding of the bone surfaces during motion, preventing normal healing, and leading to premature onset of degenerative joint disease, a wear and tear type of arthritis.  DMX® can fully evaluate internal joint motion, and properly screen for kinesiopathology

What Makes DMX® unique?

Good question! Auto accident injuries occur in milliseconds, too quick for the human nervous system to react and protect. This leaves only bones and ligaments to protect the body. Since cervical bones are rarely broken, the connective tissues are most commonly injured.

The Hidden Culprit – Ligaments

Ligaments are connective tissue that attach bone to bone. The purpose of ligaments is to keep bones in proper position, and work similar to hinges on a door. It has been suspected that ligaments are damaged easily, but until now, it has been difficult to diagnose ligamentous injuries. DMX® can demonstrate these injuries in as little as 15 minutes.

DMX® visually demonstrates aberrant movement of bones, allowing the radiologist to specifically determine which ligaments are injured. Treatment can then be tailored to the patient’s need and progress can be assessed with the help of DMX®. Promising solutions for tissue regeneration are currently in development at the Spinal Injury Foundation.

With the help of DMX® these injuries can be seen from the inside out

A perfect egg sample

Common sense will tell you that one cannot determine the injury an accident victim has suffered by merely looking at the outer shell of the car. When we buy eggs, how often do we open the carton to check if the eggs on the inside are broken? Every time!

Experience teaches that we cannot determine the condition of the egg by looking at the container. The same holds true for a person’s body – the evidence is in the person’s body, not the car.

Although high TESLA MRIs can pick up ligament damage they are sometimes less available that DMX. For information on MRIs see this link