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Effect on Cycling of Radio Ablation for SI Joint



 
 
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  #1  
Old August 10th 05, 09:58 PM
max
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Posts: n/a
Default Effect on Cycling of Radio Ablation for SI Joint

I have back pain in the sacroiliac (SI) joint, most likely the effect
of being struck by a car while riding several years ago.

My pain management doctor wants to perform radio ablation to kill the
nerves that are generating the pain. This is sort of like microwaving
that part of the pelvis and cooking the cartilage and ligaments. This
is supposed to provide at best temporary relief for as long as several
months. I have corresponded with others who have had this procedure
for similar problems, but I want to know if any cyclists have had this
procedure, and what the effects were, and for how long, particularly
the effect on riding.

As things stand, the pain limits my cycling (among other things.) As a
diagnostic procedure they shot an anaesthetic in the joint. The next
day I could ride normally for the first time in months, but it wore off
in a few days. I'm concerned because some of the people I've talked to
had severe pain after the procedure, though some eventually had good
results for several months, being relatively pain-free. However, none
were cyclists, or even very athletic. It seems to me, if you kill the
nerves, you can't feel the pain, and can make a problem worse by not
backing off.

At present I can ride at a recreational level for a few hours, but even
training eough to merely suck is out of the question.

Anyone have any experience?

Ads
  #2  
Old August 10th 05, 11:22 PM
D. Ferguson
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Posts: n/a
Default Effect on Cycling of Radio Ablation for SI Joint

On 10 Aug 2005 13:58:05 -0700, "max" wrote:

I have back pain in the sacroiliac (SI) joint, most likely the effect
of being struck by a car while riding several years ago.

My pain management doctor wants to perform radio ablation to kill the
nerves that are generating the pain. This is sort of like microwaving
that part of the pelvis and cooking the cartilage and ligaments. This
is supposed to provide at best temporary relief for as long as several
months. I have corresponded with others who have had this procedure
for similar problems, but I want to know if any cyclists have had this
procedure, and what the effects were, and for how long, particularly
the effect on riding.

As things stand, the pain limits my cycling (among other things.) As a
diagnostic procedure they shot an anaesthetic in the joint. The next
day I could ride normally for the first time in months, but it wore off
in a few days. I'm concerned because some of the people I've talked to
had severe pain after the procedure, though some eventually had good
results for several months, being relatively pain-free. However, none
were cyclists, or even very athletic. It seems to me, if you kill the
nerves, you can't feel the pain, and can make a problem worse by not
backing off.

At present I can ride at a recreational level for a few hours, but even
training eough to merely suck is out of the question.

Anyone have any experience?



As a chiropractor I have a lot of experience. Your comment about
masking symptoms and continuing, making the problem worse, is exactly
my thoughts.

Sacroiliac joints, like all joints, are made to function in a certain
manner. Correcting that dysfunction and THEN strengthening the joint
should be the goal. Not just stretching, strengthening, medicating,
etc... and hoping it will heal.

Even more interesting to you, as a cyclist, might be regarding SI
Joint dysfunction and quadriceps muscle inhibition.
J Manipulative Physiol Ther. 1999 Mar-Apr;22(3):149-53.
The pain is limiting, as you know, but the dysfunction itself leads to
inhibition of the quadriceps and therefore less output on the bike.

Exactly the reason Discovery employs chiropractors. Dr. Jeff Spencer
has been on the payroll since 1999. And you might have heard on the
OLN telecast about how Armstrong is fanatical about making sure his
pelvis is not "off".

Sometimes things are so unstable that they can't be helped without
invasive measures such as you describe. But chiropractic,
prolotherapy, acupuncture, osteopathy, etc... would all carry less
risk and a higher chance of correcting the problem rather than just
making the symptoms.

Good luck. I know how painful the problem can be.

D

  #3  
Old August 10th 05, 11:42 PM
external usenet poster
 
Posts: n/a
Default Effect on Cycling of Radio Ablation for SI Joint

On Wed, 10 Aug 2005 18:22:38 -0400, D. Ferguson
wrote:

On 10 Aug 2005 13:58:05 -0700, "max" wrote:

I have back pain in the sacroiliac (SI) joint, most likely the effect
of being struck by a car while riding several years ago.

My pain management doctor wants to perform radio ablation to kill the
nerves that are generating the pain. This is sort of like microwaving
that part of the pelvis and cooking the cartilage and ligaments. This
is supposed to provide at best temporary relief for as long as several
months. I have corresponded with others who have had this procedure
for similar problems, but I want to know if any cyclists have had this
procedure, and what the effects were, and for how long, particularly
the effect on riding.

As things stand, the pain limits my cycling (among other things.) As a
diagnostic procedure they shot an anaesthetic in the joint. The next
day I could ride normally for the first time in months, but it wore off
in a few days. I'm concerned because some of the people I've talked to
had severe pain after the procedure, though some eventually had good
results for several months, being relatively pain-free. However, none
were cyclists, or even very athletic. It seems to me, if you kill the
nerves, you can't feel the pain, and can make a problem worse by not
backing off.

At present I can ride at a recreational level for a few hours, but even
training eough to merely suck is out of the question.

Anyone have any experience?



As a chiropractor I have a lot of experience. Your comment about
masking symptoms and continuing, making the problem worse, is exactly
my thoughts.

Sacroiliac joints, like all joints, are made to function in a certain
manner. Correcting that dysfunction and THEN strengthening the joint
should be the goal. Not just stretching, strengthening, medicating,
etc... and hoping it will heal.

Even more interesting to you, as a cyclist, might be regarding SI
Joint dysfunction and quadriceps muscle inhibition.
J Manipulative Physiol Ther. 1999 Mar-Apr;22(3):149-53.
The pain is limiting, as you know, but the dysfunction itself leads to
inhibition of the quadriceps and therefore less output on the bike.

Exactly the reason Discovery employs chiropractors. Dr. Jeff Spencer
has been on the payroll since 1999. And you might have heard on the
OLN telecast about how Armstrong is fanatical about making sure his
pelvis is not "off".

Sometimes things are so unstable that they can't be helped without
invasive measures such as you describe. But chiropractic,
prolotherapy, acupuncture, osteopathy, etc... would all carry less
risk and a higher chance of correcting the problem rather than just
making the symptoms.

Good luck. I know how painful the problem can be.

D


Dear D.,

How do you treat turtles?

Carl Fogel
  #4  
Old August 11th 05, 12:10 AM
Bill C
external usenet poster
 
Posts: n/a
Default Effect on Cycling of Radio Ablation for SI Joint


D. Ferguson wrote:
On 10 Aug 2005 13:58:05 -0700, "max" wrote:

I have back pain in the sacroiliac (SI) joint, most likely the effect
of being struck by a car while riding several years ago.

My pain management doctor wants to perform radio ablation to kill the
nerves that are generating the pain. This is sort of like microwaving
that part of the pelvis and cooking the cartilage and ligaments. This
is supposed to provide at best temporary relief for as long as several
months. I have corresponded with others who have had this procedure
for similar problems, but I want to know if any cyclists have had this
procedure, and what the effects were, and for how long, particularly
the effect on riding.

As things stand, the pain limits my cycling (among other things.) As a
diagnostic procedure they shot an anaesthetic in the joint. The next
day I could ride normally for the first time in months, but it wore off
in a few days. I'm concerned because some of the people I've talked to
had severe pain after the procedure, though some eventually had good
results for several months, being relatively pain-free. However, none
were cyclists, or even very athletic. It seems to me, if you kill the
nerves, you can't feel the pain, and can make a problem worse by not
backing off.

At present I can ride at a recreational level for a few hours, but even
training eough to merely suck is out of the question.

Anyone have any experience?



As a chiropractor I have a lot of experience. Your comment about
masking symptoms and continuing, making the problem worse, is exactly
my thoughts.

Sacroiliac joints, like all joints, are made to function in a certain
manner. Correcting that dysfunction and THEN strengthening the joint
should be the goal. Not just stretching, strengthening, medicating,
etc... and hoping it will heal.

Even more interesting to you, as a cyclist, might be regarding SI
Joint dysfunction and quadriceps muscle inhibition.
J Manipulative Physiol Ther. 1999 Mar-Apr;22(3):149-53.
The pain is limiting, as you know, but the dysfunction itself leads to
inhibition of the quadriceps and therefore less output on the bike.

Exactly the reason Discovery employs chiropractors. Dr. Jeff Spencer
has been on the payroll since 1999. And you might have heard on the
OLN telecast about how Armstrong is fanatical about making sure his
pelvis is not "off".

Sometimes things are so unstable that they can't be helped without
invasive measures such as you describe. But chiropractic,
prolotherapy, acupuncture, osteopathy, etc... would all carry less
risk and a higher chance of correcting the problem rather than just
making the symptoms.

Good luck. I know how painful the problem can be.

D

Have you seen any follow-up studies to that? I've been dealing with
the same thing, with perfectly matching symptoms since I tore up the
muscles around the SI way back in Feb. When we finally got a good
diagnosis, the treatment was cortisone, and immobilization with a heavy
duty brace when doing anything standing basically. My limit riding
before my legs just flat stopped working was about 1 1/2 hours,
yesterday after a couple of weeks with the brace and the shots a week
ago I was able to do a solid 3 hours with more climbing than I've done
in the past 2 years combined. But as you pointed out my legs aren't
anywhere near full strength again, but I do seem to be really making
progress now.
Thanks for the info.
Bill C

  #5  
Old August 11th 05, 12:35 AM
Jet
external usenet poster
 
Posts: n/a
Default Effect on Cycling of Radio Ablation for SI Joint

On Wed, 10 Aug 2005 18:22:38 -0400, D. Ferguson
wrote:

On 10 Aug 2005 13:58:05 -0700, "max" wrote:

I have back pain in the sacroiliac (SI) joint, most likely the effect
of being struck by a car while riding several years ago.

My pain management doctor wants to perform radio ablation to kill the
nerves that are generating the pain. This is sort of like microwaving
that part of the pelvis and cooking the cartilage and ligaments. This
is supposed to provide at best temporary relief for as long as several
months. I have corresponded with others who have had this procedure
for similar problems, but I want to know if any cyclists have had this
procedure, and what the effects were, and for how long, particularly
the effect on riding.

As things stand, the pain limits my cycling (among other things.) As a
diagnostic procedure they shot an anaesthetic in the joint. The next
day I could ride normally for the first time in months, but it wore off
in a few days. I'm concerned because some of the people I've talked to
had severe pain after the procedure, though some eventually had good
results for several months, being relatively pain-free. However, none
were cyclists, or even very athletic. It seems to me, if you kill the
nerves, you can't feel the pain, and can make a problem worse by not
backing off.

At present I can ride at a recreational level for a few hours, but even
training eough to merely suck is out of the question.

Anyone have any experience?



As a chiropractor I have a lot of experience. Your comment about
masking symptoms and continuing, making the problem worse, is exactly
my thoughts.

Sacroiliac joints, like all joints, are made to function in a certain
manner. Correcting that dysfunction and THEN strengthening the joint
should be the goal. Not just stretching, strengthening, medicating,
etc... and hoping it will heal.

Even more interesting to you, as a cyclist, might be regarding SI
Joint dysfunction and quadriceps muscle inhibition.
J Manipulative Physiol Ther. 1999 Mar-Apr;22(3):149-53.
The pain is limiting, as you know, but the dysfunction itself leads to
inhibition of the quadriceps and therefore less output on the bike.

Exactly the reason Discovery employs chiropractors. Dr. Jeff Spencer
has been on the payroll since 1999. And you might have heard on the
OLN telecast about how Armstrong is fanatical about making sure his
pelvis is not "off".

Sometimes things are so unstable that they can't be helped without
invasive measures such as you describe. But chiropractic,
prolotherapy, acupuncture, osteopathy, etc... would all carry less
risk and a higher chance of correcting the problem rather than just
making the symptoms.

Good luck. I know how painful the problem can be.

D


FYI the abstract is in pubmed:

http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Citation

I also have some kind of SI problem that seems to manifest as piriformis
syndrome, but in my case may be due to some problems with the L3 joint
according to a diagram I saw. I have loss of ability to contract the left
gluteus, and my outer quad is often very tense, as well as the area to the
outside and front of my hip joint. Here's a link to a diagram I made.

http://s41.yousendit.com/d.aspx?id=0...Y0V9ADQT3XE9IX

The places in red are the spasmed/affected areas, but include the
piriformis region, also. A few times the whole thing has spontaneously
relaxed and I spent the whole day without pain, no limping or anything.

Ever heard of anything like this? I'd like to go to a chiro, but I'm a bit
afraid of their 'high velocity' technique.

It doesn't seem to have too great a negative effect on my cycling - my knee
feels fine, and pedalling doesn't hurt. Can't jog and I limp some of the
time.

TIA,

jj

  #6  
Old August 11th 05, 12:36 AM
max
external usenet poster
 
Posts: n/a
Default Effect on Cycling of Radio Ablation for SI Joint

"Correcting the dysfunction" is what I'd like to do. I've attempted to
treat this for years (pt, chiropracty, and osteopathy.) The last
helped the most but no longer. MRI shows calcified superior ventral SI
ligament, and a bony structure arising from the ligament, bridging the
joint. Osteopath says the joint is imobile on that side. I wouldn't
expect prolotherapy to work as it treats hypermobile joints. Excision
of the bridging structure even if it would work (physiatrist is
doubtful) is a risky procedure requiring major surgery, which doctors
seem unwilling to do without trying other modalities first.

I've found a study which seems to show no better results that a placebo
for ablation of the SI joint. I don't see any treatment obtions, and
just trying RF ablation because nothing else is available doesn't seem
so smart either. Stull, I was hoping maybe it had helped someone.....

  #7  
Old August 11th 05, 12:43 AM
D. Ferguson
external usenet poster
 
Posts: n/a
Default Effect on Cycling of Radio Ablation for SI Joint

On 10 Aug 2005 16:10:44 -0700, "Bill C" wrote:


Have you seen any follow-up studies to that? I've been dealing with
the same thing, with perfectly matching symptoms since I tore up the
muscles around the SI way back in Feb. When we finally got a good
diagnosis, the treatment was cortisone, and immobilization with a heavy
duty brace when doing anything standing basically. My limit riding
before my legs just flat stopped working was about 1 1/2 hours,
yesterday after a couple of weeks with the brace and the shots a week
ago I was able to do a solid 3 hours with more climbing than I've done
in the past 2 years combined. But as you pointed out my legs aren't
anywhere near full strength again, but I do seem to be really making
progress now.
Thanks for the info.
Bill C


Conservative lower back treatment reduces inhibition in knee-extensor
muscles: a randomized controlled trial.
J Manipulative Physiol Ther. 2000 Feb;23(2):76-80. Related Articles,
Links


The biggest thing I find with SI joints is to first find out which
direction they are misaligned and/or restricted in motion, correct
that and then avoid specific postures and movements which stress the
joint in that direction. Sleeping postures being one of the most
common culprits.

I could just about make a living telling people to take the damn heat
off of it. I think only in America are doctors so dumb that they'll
tell people to put ice on extremity problems but to put heat on their
back. Imagine watching Shaq come off the court with a sprained ankle
and wrapping a heating pad around it.

D


  #8  
Old August 11th 05, 12:52 AM
D. Ferguson
external usenet poster
 
Posts: n/a
Default Effect on Cycling of Radio Ablation for SI Joint

On Wed, 10 Aug 2005 19:35:44 -0400, wrote:


I also have some kind of SI problem that seems to manifest as piriformis
syndrome, but in my case may be due to some problems with the L3 joint
according to a diagram I saw. I have loss of ability to contract the left
gluteus, and my outer quad is often very tense, as well as the area to the
outside and front of my hip joint. Here's a link to a diagram I made.

http://s41.yousendit.com/d.aspx?id=0...Y0V9ADQT3XE9IX

The places in red are the spasmed/affected areas, but include the
piriformis region, also. A few times the whole thing has spontaneously
relaxed and I spent the whole day without pain, no limping or anything.

Ever heard of anything like this? I'd like to go to a chiro, but I'm a bit
afraid of their 'high velocity' technique.

It doesn't seem to have too great a negative effect on my cycling - my knee
feels fine, and pedalling doesn't hurt. Can't jog and I limp some of the
time.

TIA,

jj



I can see why it's confusing. You have indications of L3 problems as
well as SI joint problems. I assume the symptoms are all on the same
side? Have you had an MRI?

As for going to a chiro and safety... the only real danger is
rotational adjusting of the cervical spine which carries a risk 500%
less than taking one aspirin. The rate of complications for low back
adjusting are miniscule. Which is the reason chiropractors have
malpractice insurance rates less than 10% of anyone else.

Regarding "high velocity", there are over 100 chiropractic techniques
and many of them are very gentle and beyond safe. You just need to
find the right doc for you.

D
  #9  
Old August 11th 05, 01:00 AM
Bill C
external usenet poster
 
Posts: n/a
Default Effect on Cycling of Radio Ablation for SI Joint


D. Ferguson wrote:
On 10 Aug 2005 16:10:44 -0700, "Bill C" wrote:


Have you seen any follow-up studies to that? I've been dealing with
the same thing, with perfectly matching symptoms since I tore up the
muscles around the SI way back in Feb. When we finally got a good
diagnosis, the treatment was cortisone, and immobilization with a heavy
duty brace when doing anything standing basically. My limit riding
before my legs just flat stopped working was about 1 1/2 hours,
yesterday after a couple of weeks with the brace and the shots a week
ago I was able to do a solid 3 hours with more climbing than I've done
in the past 2 years combined. But as you pointed out my legs aren't
anywhere near full strength again, but I do seem to be really making
progress now.
Thanks for the info.
Bill C


Conservative lower back treatment reduces inhibition in knee-extensor
muscles: a randomized controlled trial.
J Manipulative Physiol Ther. 2000 Feb;23(2):76-80. Related Articles,
Links


The biggest thing I find with SI joints is to first find out which
direction they are misaligned and/or restricted in motion, correct
that and then avoid specific postures and movements which stress the
joint in that direction. Sleeping postures being one of the most
common culprits.

I could just about make a living telling people to take the damn heat
off of it. I think only in America are doctors so dumb that they'll
tell people to put ice on extremity problems but to put heat on their
back. Imagine watching Shaq come off the court with a sprained ankle
and wrapping a heating pad around it.

D

I really like the guy I'm seeing, and he agrees with you on the heat
100%.
He said, ice, no heat, get it stabilised then we'll work on
strengthening the area. He works with, and refers a lot of people for
further work to a couple of Chiros and a personal trainer that I really
like and respect. Sounds like your someone he'd work well with. he
shares your high opinion of some of the other people out there.
Thanks for the additional stuff.
Bill C

  #10  
Old August 11th 05, 01:04 AM
D. Ferguson
external usenet poster
 
Posts: n/a
Default Effect on Cycling of Radio Ablation for SI Joint

On 10 Aug 2005 16:36:43 -0700, "max" wrote:

"Correcting the dysfunction" is what I'd like to do. I've attempted to
treat this for years (pt, chiropracty, and osteopathy.) The last
helped the most but no longer. MRI shows calcified superior ventral SI
ligament, and a bony structure arising from the ligament, bridging the
joint. Osteopath says the joint is imobile on that side. I wouldn't
expect prolotherapy to work as it treats hypermobile joints. Excision
of the bridging structure even if it would work (physiatrist is
doubtful) is a risky procedure requiring major surgery, which doctors
seem unwilling to do without trying other modalities first.

I've found a study which seems to show no better results that a placebo
for ablation of the SI joint. I don't see any treatment obtions, and
just trying RF ablation because nothing else is available doesn't seem
so smart either. Stull, I was hoping maybe it had helped someone.....



Yuk, that's a tough road you've been on.

I think the ablation will work. For awhile. But during that time you
do risk more injury. However, if it really is imobile then it
shouldn't be too much damage.

Excision is certainly a risk but gaining mobility in the joint would
be a step in the right direction. Example being, if you had to sit
with your finger bent to a certain position all day it would start to
hurt in that joint. Early on in SI joint dysfunction they now believe
that muscles contract to support and become ligamentous, then finally
calcify into bone.

"The altered biomechanical environment produced by spinal
fixation..... can affect the ligamentous properties in vivo, possibly
serving as the impetus for low back pain."
Spine. 1998 Mar 15;23(6):672-82; discussion 682-3.

Good luck with whatever you decide.

D
 




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