55 year old pt. Has a upslip & outflares causing SI Jt, you realign but no relief, you...
***CLINCAL REASONING: I published a paper 4 years ago called “ROOT CAUSE of SI JOINT DYSFUNCTION” detailing how to diagnose and treat SI joint, I know it’s gone viral all over the world which makes me so happy! Go to WheltonMethods.com to read my paper!
The answer is “B”, a lot of times when you perform a long axis joint mob for the upslip and side lying SI gapping for the outflares the patient will stand up and perform the aggravating motion again and still feel the pain. I have found that I just didn’t fully realign the upslip and/or get the outflares fully open, so I started putting a ball between the knees and had them perform standing B adduction and the pain goes away instantly as adduction creates inflares. Some patients, however, need over pressure applied WITH the ball squeeze. So I stand behind the patient have them perform standing ball squeeze and then perform B ASIS medial gapping and have the pt. perform the aggravating motion again and its usually gone. Sometimes I have to press harder and/or have them squeeze the ball harder to completely relieve the pain.
I would not assume it is OA of the L-spine with a patient in their 50’s at first as you usually see that in the 60’s-70’s more often. Like I always say rule out what you can rule out first and then by deductive reasoning you usually can narrow it down to 1 or 2 conditions if not the actual condition.
I would not assume it is an HNP with LBP as when figured out SI and sacral dysfunctions and started realigning them I almost never saw pain in the LB emanating from an HNP. (except central protrusions which cause pain over one vertebrae with lumbar extension). I realize this is radical statement that HNP’s generally don’t cause LBP but my students that are realigning SI joints and sacrums are starting to say the same thing. Try it!
I would not order imaging until I rule out mechanical issues as I have found that is the most common cause of LBP especially when the patient has failed everything.
Hope this helps! Go read my paper at wheltonmethods.com
