Sacroiliac Joint Pain Successfully Treated with Chiropractic

Sacroiliac Joint - Left Side

Just completed a chiropractic treatment plan for a patient who came in complaining of low back pain.  Upon close examination, the problem wasn’t really in her lower back (spine), it was her right sacroiliac joint.

The sacroiliac joint is where each pelvic bone attaches to your sacrum.  The sacrum is a triangular shaped bone below the spine; at the end is the coccyx, commonly referred to the tail bone.  The pelvic bowl is made up of the sacrum and the two pelvic bones, or ischiums.

The sacroiliac joint is a tough, rigid, fibrous joint.  Movement there is very minimal.  However, in women, the sacroiliac joint can move during pregnancy.  It slides to allow expansion of the pelvis during delivery.  Sometimes it doesn’t return to its normal position after giving birth, and gives the mother pain in that area for a long time.

A hard fall on the buttocks can injure the sacroiliac joint and cause it to move out of place.  I’ve had skateboarders, surfers, rock climbers, and other patients who do things that put them at risk of falling on their seat complain of sacroliiac joint pain.

When I make the diagnosis, I have the patient come in for several treatments of chiropractic spinal manipulation and physiotherapy.  I use a drop table to gently nudge the sacroiliac joint back into alignment.  Then, I use manual techniques to put it through its range of motion until realignment sets in.  Hotpacks, phototherapy, and InterX stim are also used to speed up healing.

If you are experiencing very low,  “low back pain,”  it may not be your back, but your sacroiliac joint.  Check your local chiropractor.

Dan Perez, DC

Chiropractor San Francisco

(415) 627-9077

Chronic Muscle Pain and Chiropractic Treatment

I’ve been getting a lot of patients lately complaining of  “non-specific” pain in various parts of the body.  One complains of pain around the shoulder blade ranging all the way down to the latissimus (lats) muscle along the ribcage.  Another complains of pain around the axilla (armpit).  Neither patient could clearly explain what caused it; only saying that the pain just appeared over time.

After 15 years seeing patients in my downtown San Francisco office I’ve been able to compare and contrast these types of cases.  What is the common denominator?  Does it affect males or females mostly?  What does the pain respond to?

To this day, the diagnosis of such types of presentations remain elusive.  These patients typically have ran the gamut of health care providers.  They’ve seen their primary care MD, orthopedic specialists; sometimes neurologists; had physical therapy, massage, chiropractic, acupuncture; over the counter anti-inflammatories like Ibuprofen; and prescription muscle relaxants.  Yet in most cases, the pain doesn’t completely go away.  What can it be?

Well, the most important thing to know is that despite the similarities, the origin of the pain differs from case to case.  Based on my clinical experience, here are the things that can cause “non-specific” muscle pain:

1.  Old injuries resurfacing.  I have a patient who used to snowboard.  He took a hard fall on his back over ten years ago.  It went away for a long time.  Now older, he is experiencing pain in the same area after standing too long.  You see, as we age, our connective tissue (ligaments, tendons, muscle) gradually lose their strength and allow an old joint injury to “come back to life” in the form of abnormal joint movement.

2.  Fibromyalgia.  This is a syndrome that many health professionals originally rejected, but now accept as a legitimate health condition.  The reason for the controversy is there are currently no diagnostic tests available to confirm fibromyalgia– it  is diagnosed based on how the patient describes her pain (widespread, constant, no apparent cause).  A person suffering from fibromyalgia will report extremely sensitive areas all over her body, like over the sternum, the side of her hips and legs, arms, etc.   Some studies attribute it to a virus; others suggest it is a metabolic disorder.  It is usually accompanied by another condition called chronic fatigue syndrome.

3.  Prescription Drug Side Effects.  Many types of prescription drugs cause muscle pain as a side effect.  You see, your muscles rely on a steady flow of electrolytes (calcium, sodium, potassium) in order to contract and relax properly.  Some drugs alter this electrolytic flow and cause muscle pain.  If you are on some type of prescription drug, try Googling (your drug name)(side effects) and see what comes up, or ask your doctor.

4.  RSD- Reflex Sympathetic Dystrophy.  Similar to the old injury resurfacing, but more serious.  RSD is basically neurogenic pain.  It is believed to be an over-reaction of the sympathetic nervous system following an injury– the nerve pain fails to “shut off”, and the RSD patient is plagued with pain long after the injury is healed.  For example, you can fracture your wrist, have the  bones heal, but be plagued with RSD pain.  It’s not clear why some people develop it, and others don’t.

5.  Psychosomatic.    This word, loosely translated means “mind affecting body”.  It is widely believed that psychological factors can play a role in the body’s pain levels.  The saying “it’s all in your head” originated from the diagnosis of psychosomatic disorders.

So, how can chiropractic help non-specific pain?  I would first determine which category the pain falls under.  If I think  it is a #5, I refer out to a professional in the mental health field.   A #4 would probably be referred to a pain management specialist for consultation and possible co-treatment (pain management specialists use drugs, injections,  and special surgical  implants to reduce pain).  I would still attempt to treat categories 1-4.

Chiropractic adjustments to various parts of the spine and extremities can do a number of beneficial things; such as increase the range of motion of a joint; break up adhesions (scar fibers that restrict movement), fire off nerves that help with posture, and improve circulation.

I employ phototherapy (therapeutic light) to the areas, which helps stimulate ATP production (cell energy units)  in the muscle cells.  This stimulates protein synthesis and cellular waste removal.   InterX Muscle stim can help block the pain, and also stimulate fibroblasts– the cells that repair damaged tissue.

Active Release Therapy is great for category #1 cases.  It’s a special, active form of massage that involves moving your limbs in a certain pattern as the therapist works on you.   And then there’s nutritional supplements.  I use supplements based on fibrinolytic constituents like bromelain and papain enzyme.  These are substances that can  safely dissolve scar tissue/ debris, and are known to help reduce non-specific muscle pain.  Although you can find them in your basic vitamin store, I use a proprietary, extra-strength blend, made only for health care providers.

So if you are suffering from muscle pain and you aren’t sure what is causing it, this information hopefully can provide you with some answers.

Dan Perez, DC

San Francisco Chiropractors

San Francisco Chiropractors Resource Site Now Online

If you are a prospective patient looking for a chiropractor in San Francisco, a new website has been created to help you in the process.

Choosing the right chiropractor is not easy.  There are so many variables to consider, such as technique used, years of experience, treatment philosophy (pain treatment?  wellness care?  holistic?) and of course, personalities.  This website is designed to make the chiropractic experience transparent.   It addresses chiropractic techniques, the language/terminology that chiropractors use; chiropractic approaches/philosophies on treatments, tools and equipment that chiropractors use, and even billing practices.  The purpose of the website is to enrich and educate patients so that they can make smart decisions on choosing the right chiropractor.

Check out the new San Francisco Chiropractors website, and pass it on to friends/ acquaintances who you know can use a good chiroprator.

San Francisco Chiropractors Resource Website

I’ve been a chiropractor since 1995, and over the years I’ve become familiar with the misconceptions many people still have about chiropractic.  For example, many cannot distinguish between chiropractic and physical therapy.  Some patients are wary of chiropractors because of something they heard on the news.  And some people still don’t even know that chiropractors are doctors licensed by the state in which they practice.  But the most pressing problem is basically people aren’t clear on what we chiropractors do.  Are we massage therapists?  Medical doctors?  Can we write a quick prescription for pain?  The list goes on.

It is this confusion that motivated me to put up a website that can serve as a resource hub for those in the San Francisco area who are looking for a chiropractor.  I have attempted to anticipate and answer any question a first-time chiropractic patient might have.  The website is http://www.san-francisco-chiropractors.com.  I quickly put it up to get things going.  I will add to the site each month.   I plan to add a free “Ask the chiropractor” form as an added public service.

Check it out!

Dr. Dan

San Francisco chiropractor

San Francisco Chiropractor offers unique Therapeutic Massage

Are you one of those people who have chronic pain and/or stiffness in your neck, back, or extremities? If so, you may want to consider Active Release Technique, of ART. This is a participative form of therapeutic massage, much different from your typical, “lie down and receive” passive massage.

A joint, whether the spinal joints of the neck or back, or the shoulder joint, knee joint, or hip joint, consists of two bones connected by ligaments and muscles. When a muscles is injured/strained, it becomes less elastic (stretchable), and may develop painful trigger points. This affects the muscle’s ability to contract properly.

In ART, the therapist identifies the problem muscles, and has the patient repeatedly move the joint in the plane of muscle contraction while “stripping” it with point pressure using the thumbs and fingers. As a result, scar tissue adhesions are broken up and the muscle fibers are elongated. The therapy also causes oxygenated blood to the area, further improving healing.

Check out ART being done on the upper extremities and neck by visiting this link.

Sessions are usually 15-35 minutes long. It is an area-focused massage procedure. In most cases, you will notice a noticeable increase in range of motion in the joint immediately following the therapy.

San Francisco Chiropractic offers Active Release Technique Mondays-Fridays at our downtown office. This therapy is particularly effective for sports injuries, but is also good for people who have overuse-related muscle pain such as tendonitis, carpal tunnel, and chronic neck and shoulder pain.

For more information, call us at (415) 627-9077

Dr. Dan

San Francisco Chiropractor

New Resource: Directory of San Francisco Chiropractors

With close to a million people living and working in San Francisco, there are going to be some who injure their back, overuse their wrists or shoulders, and even get into car accidents.  For these people, looking for a good San Francisco chiropractor to help them return to normal becomes a priority.

I am working on a web directory of San Francisco Chiropractors that will include helpful information on chiropractic care so that the prospective chiropractic patient can familiarize herself with the methodologies used by chiropractors before she makes a decision on which one to choose.

Choosing a doctor of any kind should not  be taken lightly.  Patients should do their due diligence.  Getting a referral from a friend or relative can save a lot of time; but even so, one must do her own research and find out what kind of doctor she is going to  be working with.

Chiropractic, thanks to its diverse nature can be difficult to understand.  There are over 50 chiropractic techniques practiced within the profession, and myriads of therapeutic modalities.  On top ot that, your treatment recommendations will typically vary greatly depending on the philosophical approach of the chiropractor.

With the new website I am in the process of putting together, I intend to help prospective patients locate a good chiropractor; one who will fit the individual’s needs.  Social sites like Yelp.com are nice, but many of the testimonials are solicited by the businesses and are therefore slanted in the positive.  It’s  best to research chiropractic thoroughly, familiarize yourself with the techniques and treatment approach used by chiropractors, and the terminology used in the chiropractic profession.  That way, you can ask intelligent questions and better evaluate each chiropractor.  Plus, going through this process will enable you to observe the chiropractor’s  bedside manners.

Dr. Dan

San Francisco chiropractor

Fibrosis: What Is It and How Can Chiropractic Help?

Fibrosis refers to abnormal soft tissue healing, post injury.  Also called scar tissue, it is the build-up of unorganized fibers during the reparative process of soft tissue injuries.  This includes muscle, fascia (muscle covering), ligaments, tendons, and bursae (pads that cover tendons to reduce friction during movement).  For example, a car accident whiplash usually results in soft tissue damage.   The pain and stiffness that is felt several hours after a whiplash trauma is due to microtears and resultant swelling.

Muscle tissue is organized into longitudinal strands.  The basic composition is actin and myosin fibers, specialized protein structures that have contractile properties (can shorten and elongate, much like “stretch pants” or a garter).  When injured from hyperflexion/ hyperextension such as that which occurs from a fender bender car collision, these strands look like snapped threads when viewed under a microscope.  Immediately, the inflammatory cascade follows:  the release of histamines and heparin to make blood vessel walls more permeable, prostaglandins and arachidonic acid to mediate repair, and the arrival of macrophages to remove debris.

Next, blood vessels deliver fibroblasts to the injury site.  Fibroblasts are cells that synthesize collagen strands, usually for repair purposes.  That is why the resulting tissue created by fibroblasts is called reparative tissue.   The reparative tissue does not typically line up nicely like the actin and myosin fibers that make up the muscle.  These fibers are laid down haphazardly, like a patch.  So when you try to engage the muscle, the range of motion is usually reduced due to the effect of the reparative scar tissue, which is not as contractile as healthy muscle tissue.

Long-standing fibrosis, besides causing stiffness/ loss of flexibility can sometimes be felt through the skin.  People in heavy labor occupations often have palpable nodules in the muscles, which feel like tiny pebbles under the skin.  These are scar tissue adhesions, thickening over the years.  They can sometimes form trigger points– very tender spots along the back.  Trigger points are formed when nerve endings grow around the scar tissue (the nerves cannot penetrate the tissue, so they bunch up).

Chiropractic can help reduce the effects of fibrosis.  If you suffer an injury, like a sports injury or car accident, make sure to visit your local San Francisco chiropractor.  The first 3-4 days post injury are the most crucial, as your body is busy laying down scar tissue.  Chiropractic adjustments and joint mobilization techniques, done during the healing stage will encourage the scar tissue fibers to line up along the same axix as the normal muscle tissue, thereby limiting the amount of loss of range of motion.   Modalities like ice, heat, and muscle stim can reduce pain and influence vascular flow to the injury site.   Lymphatic drainage massage is done early to help move out swelling and inflammatory byproducts from the area.  Myofascial release, or active release technique is done later to further model scar tissue so that it does not form adhesions or bunch up into trigger points.

Dr. Dan

San Francisco Chiropractor Moving October 1st

After many years at 230 California Street, Suite 600 in downtown San Francisco, we are moving down one block to 311 California Street, Suite 300.  Our new clinic will feature five private treatment rooms, and a more modern look and feel.

Like before, we will feature same-day appointment chiropractic services.  If you haven’t been to our clinic, San Francisco Chiropractic, our practice emphasizes quick relief of pain and discomfort using state of the art physiotherapies combined with multiple-approach manual therapy techniques, such as spinal manipulation, instrument adjusting, and joint mobilization/stretching.  Basically, we aim to make you feel better, and move better, upon your departure from our office.  We try to fix the problem within 6-8 treatments.   We know you are busy and want to get back to work, without being encumbered by a nagging neck, shoulder, back, or wrist pain.  Sometimes the problem can’t be fixed in one session, but other times, it can.

In addition, we offer active release technique, courtesy of Leland Thunes, L.M.T.  Active release technique is a participative form of massage therapy that gets results quicker than traditional deep tissue massage.  It’s a great method to re-energize muscles, strip away old adhesions from previous injuries, and get oxygen to tired and sore muscles and joints.

Lastly, acupuncture is offered by Emily Mooney, L.Ac.  Emily specializes in pain modulation using electro-acupuncture.  She is also a Traditional Chinese Medicine herbalist.  Emily has had great success treating people suffering from chronic pain.

Our Mission:  Serve as downtown San Francisco’s all-in-one center for the non-surgical, non-drug treatment of acute and chronic spinal, nerve, muscle, and joint pain.  We will use modern equipment and techniques to help alleviate, cure, and rehabilitate common musculoskeletal conditions, and we’ll do it in a compressed timeframe in mind.

Dr. Dan

San Francisco Chiropractor

Neck Alignment and Neck Pain

San Francisco Chiropractor

Many people have been to a chiropractor.  If you are one of them, and you came in for a neck and/or shoulder problem; or headache, you may have been advised by the chiropractor to take a lateral (side-view) cervical (neck) x-ray.  The reason for doing so was to determine if the seven vertebrae that comprise the neck are in proper alignment relative to one another.  The chiropractor may have gone on to say that if the neck is not aligned, it recruits the neck muscle to balance the weight of the head in an inefficient manner, causing neck strain and possible headaches.  Also, abnormal alignment may lead to increased pressure in the discs and facet (rear) joints of the vertebrae resulting in arthritis, and possible nerve encroachment (pinching).

So, the question is, is this true?  I believe the analysis has merit.  It basically transfers engineering principles to the human body.

Most chiropractors will explain to their patients that the neck, when viewed to the side (x-ray) must form a gentle arc, with the convexity in the front of the neck.  When the alignment is reversed (convexity at the back of the neck), or if the neck is like a straight line (no curvature), it causes problems in the joints, which can lead to things like a stiff neck, headaches, and even arm symptoms (pain, numbness, tingling).

Consider the arc.  Even centuries ago, ancient civil engineers knew that an arc imparts strength to a structure.  Ancient roman aqueducts had arched ceilings to prevent them from caving in.  If you look at a bridge, you will notice that it has an upward arc to support the traffic that crosses it each day.

The head weighs about 8-10 pounds, and is supported by the neck.  If the neck has an arc, the arc acts like a spring, balancing the weight of the head so that minimal neck muscle contraction is required.  But flatten out the curve, and more neck muscle contraction is needed to hold up the head.  Reverse the curvature, and the demands increase.  And, pressure increases in the discs and facet joints, causing them to wear out faster.

It’s believed that the curvature of the neck is formed during infancy.  When an infant lies on its stomach and raises its head, it forces the neck into an arc.  This starts the process of shaping the neck into the gentle, forward-convexity arc.

The things that cause the arc to flatten include poor posture, prolonged or repeated forward bending of the neck, such as when sitting at a desk looking down, or at a computer monitor; and accidents like whiplash and sports injuries to the neck.

So, if you are experiencing neck pain and/or headaches, or symptoms like tingling in your arms/hands, go see a chiropractor and have your neck x-rayed.  The information will be useful in diagnosing the problem, and deciding on a proper treatment plan.

Dr. Dan

San Francisco chiropractor

San Francisco Chiropractor

Every once in awhile, you might feel like your back hurts.  For many people, low back pain can be a major burden:  the pain interferes with your concentration.  You can’t lift your kids up and play with them.  The gym is out of the question.  Running is out of the question.  Social activities are limited.  Basically, it cuts your productivity by over 50%.

So what do you do if you have low back pain?  If you live in San Francisco, try visiting a San Francisco Chiropractor.  If you back hurts, it is most likely undergoing some degree of muscle spasm and inflammation.  Vertebrae may not be moving fluidly.  And the nerves that control muscle and vertebral movement are under constant tone.  In severe cases, a disc may be bulging.

What you should first do is apply ice to your low back for 20 minutes, every two waking hours.  Do this by placing an icepack on the floor, then a thin cloth, and lie down on it so your lower back is on top of the icepack (no clothes in the way).  For comfort, place a pillow under your knees, and a small rolled up towel under your neck.  Close your eyes and relax.

San Francisco Chiropractors will typically treat low back pain with ice for the first few days, and will introduce movement to the low back by light spinal manipulation and/or passive stretching and joint mobilization.  Modalities like muscle stim (electric current to relax muscle spasms) may be used, as well as phototherapy (therapeutic light, to enhance tissue repair).  Usually, 6-8 treatments can clear up most typical low back pain cases.

To sit up from bed when you have low back pain, first roll to one side while lying down, then let both legs slide over the edge while you push up with your shoulder.  Wait for a minute, then stand up.

When the pain goes away, make sure to avoid heavy lifting for at least another week, to give your back muscles time to return to their normal function.

The Family Doctor offers some good tips  to help reduce the chances of getting low back pain.

The San Francisco Chiropractor