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    myofascial pain lower back
    marieh9 posted:
    Hi, I have written on other sites but was referred here. I was initally injured in 2006 by my dog pulling me forward. I have since seen a GP, pain doc, ortho surgeon, neurologist and now integrative med doc. All think I have myofascial. I did PT and recovered after 7 months (MRI was negative). I was out of pain for 1 1/2 years. I recurred when doing a move in yoga. I went to 3 physical therpists two/three thought I had SI joint regardless of what the doctors said. MRI, bone scan, and hip xrays negative. 1st, new PT (after recurrance), got me out of pain in 6 weeks but then she didn't tell me not to bend so I reinjured, then I went back and she didn't tell me to stop certain excercises I reinjured. I changed PT's again. This second PT (after yoga recurrance) was using manual manipulation to get my SI joint "back in place". He did the wrong side one day and I went into major pain. I was told by my GP to not move much so I sat for a month and walked very little and got atrophied. So I went to PT #3 who tho' I told them I was weak had me do a lunge and I pulled a muscle. Then he did traction on the left leg to loosen the thigh, again felt like I couldn't walk. He then tried to adjust the muscles to put the sacrum back and that hurt alot and he bruised my ribs. I quit and at home I was trying one of PT #3's SI corrections and I was laying on my back and had knees bent and my left leg fell out to the left. Since then I can't cross my left leg enough to put pants on.I couldn't lift my left foot to step into the shower or go outside for two months. I am now with a integrative med doc and doing accupunture, biofeedback and I am walking 1 hour plus starting a hill. But I am still very weak (arms and buttocks and legs etc.) from sitting too much despite the walking. I am trying to increase. My question here is I am doing much better but my doctor wants me to try PT again. I am thinking of going back to the original one I had with my first recurrance as he didn't injure me. I am afraid and want to know if there are any suggestions on how to get through PT without reinjury and so that I can go forward. I can't do steps yet only one at a time and starting with my good right leg first. I am taking an NSAID, Flexeril and lots of supplements. Any other suggestions please feels free. Any suggestions on how to bring this all up with the PT. He listens well.
    thanks and sorry for the long email.
    Melissa R Cere, PT, DPT responded:
    Sorry to hear you've been down such a difficult road with your back since 2006. It sounds like you are a good candidate for PT, but often the hard part is finding the right PT to treat your particular needs. It would be helpful to see a PT who specializes in manual therapy -- such as skilled soft tissue massage and joint mobilization. Some PT's get additional credentials in this area such as MTC (manual therapy certifcation) or FAAOMPT (Fellow of American Academy of Orthopedic Manual Physical Therapy), although seeing someone with those credentials is not necessary as they may just have a lot of experience and training in manual therapy. However, you also want to make sure that physical therapy includes core stabiliation and hip strengthening (particularly gluteus medius as it's a big supporter of the SI Joint). Having good strength/stability can definitely help prevent recurrent low back/SI joint pain. If you do go back to your first PT, be sure to share with him/her how you have responded to other episodes of PT in the past so that he/she can use that info to determine the best treatment plan for your current condition. Hope that helps!
    marieh9 replied to Melissa R Cere, PT, DPT's response:
    Thanks for your reply. Unfortuately, the two PT's that injured me both had Ph.D's and both had the creditials you mentioned, and the one that really hurt me was doing manual therapy, joint mobilization. I don't have SI joint I have myofascial pain syndrome, As I said 5 doctors including my integrative med doc says I don't have SI problem. The Two PT's said I had SI joint. My pain went away with muscle relaxants and finally I am getting better without PT. The person that did massage helped me and let me do the stretches and strenthening on my own. This did help but she didn't tell me not to bend and I was injured then she had 3-5 patients at once as wasn't watching me and after the injury she didn't say not to do certain stretches and I did all and hurt myself again. So, my husband says no more. It is hard for to trust another one. I did well with the first one but I was in good physical shape (had just hiked the rocky mountains and was jogging 3 miles a day) when dog injured me. So when I started with him I did well but was not atrophied like I am now. he said I had a torn ligament not SI joint syndrome. It is a shame and hard to know what I can do at home . A catch 22. Any ideas on exercises for home?
    Melissa R Cere, PT, DPT replied to marieh9's response:
    check out this's got some good exercises on it for helping to strengthen your core trunk muscles, which also help to stabilize your low back and pelvis.
    Let me know how it goes!
    marieh9 replied to Melissa R Cere, PT, DPT's response:
    Thanks for the website. I have done some of these in the past. I will try to incorporate them into my plan. I have been trying to do stretches. I also can't bend or cross my left leg over my knee when sitting (I can but far enough to reach my foot). So I can't put my shoes or pants on myself. What exercises would help with this problem? If I am walking a hour a day and doing hills (one hill so far), will I eventually loosen up naturally?
    Thank you,
    marieh9 replied to marieh9's response:
    Hi Dr. Cere,
    I meant to say I can't cross my left leg far enough to reach my foot to say remove socks, dress myself (pants) and so forth. Sorry for the typo.
    Melissa R Cere, PT, DPT replied to marieh9's response:
    If your movement of your leg is limited due to pain, then it may be that you need to get it checked out in person by an MD or PT because stretches alone may not improve your mobility. Several factors including the mobility of your back, hip and knee can affect the motion you are a thorough exam by sometime who can visually watch your movement and apply some hands on techniques to look at your motion at each of those areas would be best to determine how you can best treat your limitation. Sorry I can't be of more help, but I'd want to make sure you are getting an accurate, individualized assessment and treatment or exercise plan that you actually need.
    marieh9 replied to Melissa R Cere, PT, DPT's response:
    Hi Melissa,
    Thanks for the reply. Well, when I move the leg to cross it the range of motion isn't as far as the right side. Also, it feels like it pulls but I'm not sure whether it increases my pain or not. I think it does but since I haven't used it that way my integrative med doc said not to do anything that increases pain right now. But, as some point I'll have to address this issue too. I have had an MRI, bone scan and hip Xrays and all are normal. When I got this secondary injury (before this I just had the back pain problem and I could cross that leg ok) I got it by laying on my back with my knees bent and I got distracted by my husband and I let my left leg (bent at the knee) fall out to the left. I felt a tearing like feeling but didn't hear anything. I couldn't lift my foot much for about a month and it took me two months to get outside over the step and also to get into the shower. At that time I couldn't squat to wash myself (privy parts) and now I can wash myself and squat and I can cross the leg but not well enough to reach my shoe or sock to get it off. I think I am starting to improve and I am walking up a hill now and walking a hour but still have pain. I was getting minor strains that would last a week and then that finally stopped for two months so I was told to go ahead and walk hills. The minor strains have come back but they last a day to 3 days. I am still able to do my walk with the pain most of the time. I am being followed closely by the integrative medicine doc who specializes in pain management. He knows about the problem. I just wanted extra advise since the time with my doc is limited. Does this info help? I appreciate your advice.

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