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As a 68 yr old woman whose SIJ cortisone shot was ineffective, is PRP my next step? A leg length discrepancy is a cause. 

Ineffective cortisone shot for SIJ pain? Consider PRP.

What's up everyone? Dr. Sean here and I have a question from Susan today. It reads, as a 68 year old woman whose SI joint cortisone shot was ineffective, is PRP my next step? And this is followed by a leg length discrepancy is a cause. So before I go into the steps that I would take, what I would pose as a question back to you is, what was the reason they were giving a cortisone shot? Were they suspecting that there was a lot of inflammation there that was actually giving you the pain? And if that was the case and they gave you the shot and it didn't work, that's diagnostic to us. Because if the pain is say muscle in origin, nerve in origin, or something else that that cortisone might not necessarily help, it won't be effective. So that can help us reevaluate our treatment plan. That being said, the way I like to work is from least invasive to most invasive. So going to your statement of the leg length discrepancy is the cause. I would say if that discrepancy is related to a bad position of your SI joint, meaning one's pivoting one way versus the other, as that moves, that can either make the leg shorter or longer. In that case, you need to do something to work on SI joint mobility and then start doing some therapy to restore some strength and stability to that area. If your leg length discrepancy is not because of position, and let's say you had a fracture as a kid and you have an anatomical leg length change, that's when we start evaluating is a heel lift or something to level the feet even better for you. If you've already tried a cortisone shot, PRP may be helpful, but I would say reevaluate that diagnosis and make sure there's not something that's being skipped that you know there's a weakness issue, a tissue issue, or a joint issue. If every one of those options has been exhausted, then you can keep working from that least to most invasive. PRP is a helpful therapy, but again it doesn't fix everything, but it is a possible next step.

As a 68 year old woman with an ineffective SI joint cortisone shot, the next step may be PRP. To determine if this is the right step or not, reevaluate the diagnosis and make sure there are no other issues that need to be addressed such as weakness, tissue, or joint issues. If all of these have been exhausted, then PRP may be a helpful therapy.

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As a 68-year-old woman who had an ineffective SI joint cortisone shot, you're wondering if PRP (platelet-rich plasma) is your next step, considering a leg length discrepancy as a cause. Before discussing the steps I would take, I'd like to ask why the cortisone shot was given. Was there suspicion of inflammation causing your pain? If the shot didn't work, it helps us diagnose whether the pain originates from muscle, nerve, or another source that cortisone wouldn't effectively treat. 

My approach is to start with the least invasive treatments and move towards more invasive ones if needed. In terms of the leg length discrepancy being the cause, if it's related to poor positioning of your SI joint, which can make one leg longer or shorter as it moves, focusing on improving SI joint mobility and engaging in therapy to restore strength and stability in that area would be important. If the leg length difference is due to an anatomical change from a past fracture or other reasons, then evaluating if a heel lift or other methods can better align your feet would be considered.

If you've already tried a cortisone shot and exhausted other options such as addressing weakness, tissue issues, and joint problems, then PRP may be a helpful therapy to explore. However, it's important to note that PRP doesn't fix everything and should be approached as a possible next step after careful evaluation of your diagnosis.

How does radiographic imaging help to diagnose the underlying cause of pain?

How Radiographic Imaging Can Confirm and Guide Treatment

Hey everyone, Dr. Sean here. My question reads, how does radiographic imaging help to diagnose the underlying cause of pain? Well imaging certainly does assist, but let me give you a little bit of a background. When someone comes in to see me, they usually tell me what's bothering them. When we go through the history, I learn the majority of the information that I need from just talking to a patient. And that can help me kind of design my examination to say that these specific exams are pertinent and I don't need to do these things. From there, I should have a pretty good understanding. As long as there's no red flags, then we can engage in treatment. Where radiographic imaging comes in is if during either the exam or the history I recognize a red flag, I'm going to have a pretty good suspicion on what it is. I'm going to use radiographic imaging or some form of imaging study to help confirm what I think I already know. Other times when there's no red flag, but someone's not actually responding to treatment, even if we've modified treatment, we need more help. That help can come in a second opinion, a third opinion, someone that is in a totally different health discipline, or it can come from some form of imaging to get a closer look. So radiographic imaging does help, but it shouldn't be the substitute for a good history, a good exam, and a reasonable treatment for what we suspect the patient may have.

Radiographic imaging helps to diagnose the underlying cause of pain by providing an additional layer of information that can be used to confirm a diagnosis or provide a second opinion. It should not be used as a substitute for a good history, exam, and treatment plan.

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Radiographic imaging, such as X-rays, can be helpful in diagnosing the underlying cause of pain, but it is not the sole determinant. When a patient comes to see me, I gather crucial information through conversation and history-taking. This often provides me with a good understanding of the issue at hand and guides my examination. In cases where there are no red flags, treatment can be initiated based on this information. However, if during the evaluation or history-taking process I notice any red flags, I may suspect a particular condition. In such cases, radiographic imaging or other forms of imaging studies can be used to confirm my suspicions.

Additionally, there are instances where there are no red flags, but the patient does not respond to treatment even after adjustments have been made. In these situations, seeking a second or third opinion from professionals in different healthcare disciplines or utilizing imaging can provide further insights.

While radiographic imaging can assist in diagnosis, it should not replace a thorough history-taking, examination, and consideration of appropriate treatment based on our suspicions regarding the patient's condition.

How long does it take for a patient to experience relief from chiropractic care?

Chiropractic care provides quick pain relief for patients

What's up everyone, Dr. Sean back. My question is, how long does it take for a patient to experience relief from chiropractic care? Well, the short answer goes, you know, it's going to depend on the injury that they're being seen for and also the demographic of the patient. You know, are they younger, older, do they have any other comorbidities or other injuries that might not help them to heal up as quickly as possible? But that being said, I will say that chiropractic care as a receptor-based treatment does provide pain relief pretty quickly the majority of the time. Now there are going to be those outliers, as there always are, that don't experience immediate relief, but that's our job is to recognize the benefits that chiropractic can provide this patient, but also the limitations. This is where we can start coupling our modalities in therapy, meaning we'll call chiropractic an adjustment of a joint, but what about the flexibility of the tissue? What about the inflammation associated with the injury or any of the other factors? So the short answer goes, it usually can provide some pretty quick relief. That relief might be temporary in nature, but remember chiropractic care, physiotherapy, physical therapy, is designed to accommodate that patient while they are healing. So it's not going to be the instant fix, but it's going to help them recover quicker so that they don't do as much to keep that injury from being provoked. It's like the picking the scab analogy. You don't want to constantly pick the scab and make it bleed because you're just re-injuring it again. So when we get a patient to experience relief from chiropractic care, we want to remember the dosage of what we did and what's helpful and make sure we apply that logically moving forward so they keep getting sustained relief while they're healing.

Chiropractic care can provide quick pain relief, but it depends on the injury and other factors. The goal of chiropractic is to help patients heal quicker, so the relief is sustained.

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The time it takes for a patient to experience relief from chiropractic care varies depending on factors such as the specific injury and the patient's demographic. Generally, chiropractic care provides pain relief relatively quickly for most patients. However, there may be outliers who do not experience immediate relief. It is important for chiropractors to recognize both the benefits and limitations of chiropractic treatment. This is where coupling modalities in therapy becomes valuable, addressing factors like tissue flexibility and inflammation associated with the injury. While chiropractic care can offer quick relief, it is important to remember that it is not an instant fix. Instead, it aids in the patient's healing process and helps them recover more efficiently, reducing the likelihood of re-injury. Like avoiding picking a scab to prevent further bleeding, sustained relief comes from applying logical treatment approaches that have proven effective in providing relief during the healing process.

It feels very weird to get my neck cracked. Should I be scared or nervous about getting it cracked?

Should You Be Nervous About Getting Your Neck Cracked?

What's up everyone? Dr. Sean here and I have a question today that reads, it feels very weird to get my neck cracked. Should I be scared or nervous about getting my neck cracked? I'll be honest when I read this I chuckled a little bit and I was like I would be nervous if I read that about getting my neck cracked. So let's switch cracked for adjusted. So what I would tell people is one, you know regular hands-on adjustments are definitely not for everyone. Some people enjoy them, some people dislike them, maybe it's the noise, maybe they're worried about what could happen if it was done incorrectly. Generally speaking this adjustment is very very safe but what you should do is speak with the practitioner whether that's a chiropractor, a DO, or a PT. Whomever is deciding to do this to make sure it's what you need because joints should have mobility. That's how we can tip our head, nod our head, and turn but tissue should also have extensibility or flexibility. So I think when you go through an exam and we're able to articulate to you why we need to do what we need to do that will help you feel more comfortable. Now not all adjustments have to be hands-on where you get this actual pop. There are different soft tissue techniques, there are different mobilizations, the end goal should be to improve your function. Now we as the doctor should always make sure we go over all the risks and contraindications to make sure you're a candidate for it but generally speaking it's a very very safe maneuver but we have to make sure it's right for you first. If for some reason you dislike that type of adjustment like I said there are other ways. The end goal should just be improving the dysfunction that you have or helping your symptoms that you're coming in with.

Getting your neck adjusted can be a safe maneuver, but make sure to talk to the practitioner about why you need it and what the risks are. There are also other types of adjustments that don't involve getting your neck cracked if this isn't something you're comfortable with.

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Hey there, Dr. Sean here. Today's question is about feeling weird when getting your neck cracked or adjusted. I have to admit, it made me chuckle a bit because I would feel nervous too if I read that. So let's change cracked to adjusted. First of all, hands-on adjustments are not for everyone. Some people enjoy them, while others may be uncomfortable due to the noise or concerns about possible mishaps. Generally, this adjustment is very safe. However, it's important to talk to a practitioner like a chiropractor, DO, or PT to ensure it's what you need. Joints should have mobility for normal head movements, but tissues should also have flexibility. During an examination, we can explain why an adjustment is necessary, which can help you feel more at ease. Remember that not all adjustments require hands-on cracking sounds. There are alternative soft tissue techniques and mobilizations available. The ultimate goal is to improve your functionality and address any symptoms you may have. As doctors, we should always discuss the risks and contraindications with you to determine if it's the right approach for you. If you prefer other methods over traditional adjustments, there are alternative options available. The key is to focus on improving any dysfunctions or symptoms you're experiencing.

Is a TENS Unit effective for pain reduction in the lower back?

TENS Units: A Temporary Fix for Lower Back Pain

What's up everyone, Dr. Sean here. I have a question from Eric today that reads, is a TENS unit effective for pain reduction in the lower back? Well for those of you that don't know what a TENS unit is, it stands for transcutaneous electrical nerve stimulator. There's two little pads that go on you, you turn up a dial and you get a little electrical impulse through it. So to answer your question, I would say it depends. I know that's not concise, but really what is the origin of your pain? It's going to be different if it's muscle versus nerve versus bone, joint, or disc. What I will say is TENS units are great at pain gating, meaning when you turn them on, they're going to be stimulating specific nerves that have a faster speed of conduction than what pain signals go in certain nerves. An easy analogy of this is if you've ever hung up a picture like what's behind me and you accidentally hit your thumb with the hammer, you instantly shake your hand. Well that's because the speed of conduction of vibration is a little bit faster than pain, so that's why it blocks that signal. And this is kind of the way the TENS unit works. Now when you look at the literature like on PubMed, you're going to see it's kind of good in some areas and bad in other areas. What I will say is it's helpful when you don't have anything else present, but you don't want to rely on that to actually fix your back pain. It's totally good to use to help keep it under control while you're looking for the source. Now for something like an electric muscle stimulation device, there's a specific setting called IFC. We won't get into the details, but with IFC, that one actually stimulates your body to release its own pain blockers, such as endorphins and encaphalins. So that's going to be a little bit different than the TENS. But what I'll say is TENS units do work in a pinch. Just keep trying to find out where that source of pain is and adjust or focus on that while you're using this.

A TENS unit can be effective for pain reduction in the lower back, but it is best used as part of a larger treatment plan that seeks to identify and address the root cause of the pain.

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Hey there, it's Dr. Sean. I have a question from Eric about whether a TENS unit is effective for reducing lower back pain. First off, a TENS unit stands for transcutaneous electrical nerve stimulator. It involves placing two pads on your body and using a dial to deliver electrical impulses. Now, to answer your question, it depends. The effectiveness of a TENS unit varies depending on the origin of your pain—whether it's muscle, nerve, bone, joint, or disc-related. TENS units are known for pain gating, which means they stimulate specific nerves with faster conduction speed than pain signals, similar to how shaking your hand after hitting your thumb with a hammer temporarily blocks the pain signal. However, when you look at the research on platforms like PubMed, you'll find mixed results—good in some areas and not so great in others. While it can be helpful as a temporary measure to keep pain under control while you search for the source, relying solely on a TENS unit to fix your back pain isn't recommended. If you're looking for something like electric muscle stimulation, there's a specific setting called IFC that stimulates your body to release its own pain blockers like endorphins and enkephalins. This differs from traditional TENS units. In short, TENS units can be useful in certain situations but should be used while actively seeking the source of your pain and adjusting your approach accordingly.

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Dr. Sean Burkhardt,DC,FIBFN-FN,CCSP,CFMP,CSCS,CSPS,TSAC-F,PES,CES answers your Chiropractic questions. See all the advice Dr. Sean Burkhardt,DC,FIBFN-FN,CCSP,CFMP,CSCS,CSPS,TSAC-F,PES,CES has and get answers to your own Chiropractic questions.

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Dr. Sean Burkhardt is a Certified Chiropractic Sports Practitioner, a Board-Certified Functional Neurologist, a Certified Functional Medicine Practitioner, and a triple-certified Strength and Conditioning Coach with the National Strength and Conditioning Association. He serves as a mentor and coach for an NGO helping prepare active and future military for special operations.  He has dedicated his postgraduate education to increasing his breadth and depth of knowledge in clinical neuroscience, concussion management, neurochemistry & nutrition, strength & conditioning, functional medicine, and neurological rehabilitation to help you achieve optimal health of optimal human performance. 