3 Steps to Permanent Relief for SI Joint and Pelvic Pain
Today we are going to cover the 3 steps topermanent relief for pelvic and SI joint pain. Now what is SI joint painé The SI joint, ifyou do have SI joint pain, is pain on either side of the tailbone where the tailbone connectsto the pelvis. So this is a drawing of the pelvis. This is your tailbone. This isyour lumbar spine or your lower back, the bones in your lower back called vertebraesitting on top of your tailbone. Then on either side of that you have your right hip or yourleft hip if we are looking at a person from the front. When we see somebody with SI jointpain, they will typically have pain on that given side. 70% of the time, it is on theright side. Don't ask me why that is but
70% of the time we know it is on the right. You canalso get shooting groin pain, buttocks pain and symptoms down the outside of the leg thatis affected. It might be pain, numbness, tingling, burning. Typically, that personsuffers from a heaviness as well. It can also cause some incontinence and leaking issuesas along to effect sexual performance as well. It can be absolutely devastating ifthe pelvic problem is bad enough. Fortunately, most people just have pain on one side. Sowhat can you do about ité That person who has SI joint problems typically has troublerolling over in bed, getting in and out of a car, crossing one leg over the other. Usuallythey have trouble sitting for long periods
of time especially if it is on a couch or a softsurface. So it can be absolutely devastating. Now what are the steps to permanent relieffor thaté Number 1 is this. Most people when we seethem if they are going to try exercises on their own and they only have a little bitof SI joint pain or pelvic pain, they are doing stretches. Yes, there is a very basic stretchwhich most people show me on Day 1. It is a piriformis stretch which is where you grabthe knee and pull it up and across to the opposite shoulder. It will give the personwho suffers pelvic or SI joint problems and pain temporary relief. However, long termwe don't want to stretch. We want to
strengthen or stabilize. Why is thaté Whensomebody has an SI joint problem, so the center of gravity of your entire body is inthe center of your pelvis. That needs to move the right way and it needs to be stable whenyou are doing day to day activities. If it is not stable enough, what will happen is thejoint will move so far that it becomes stuck. So if we are looking at the tailbone, we havethe tailbone and we have the pelvis and you get a normal gliding day to day. If morestress, more force is put through the pelvis than the pelvis itself can handle, that SIjoint can handle, what will happen is you actually become stuck. Now that creates allsorts of problems for the muscle around it.
What most people do is try to stretch theirway out of it. The problem is not stretching and it is not flexibility. It is actuallya stability issue. If we want to stabilize, we need to do strengthening exercises. If you go on ourYouTube channel, on the Madden PT official YouTube channel, there is a tutorialcalled Top 3 Exercises for SI Joint and Pelvic Stability. They are very low grade, kindergartenlevelexercises where you can at least begin stabilizing the muscles that controlyour pelvis. But we don't want to stretch, we want to think stabilize. Step 2 is we want to take a look at our habits.So what are some habits that lead to
pelvic instability and problemsé Number oneis standing with the weight shifted. So if I'm standing like this with my weight shiftedside to side for long periods of time, what that does is over years and years and yearsit weakens the ligaments which are tissue that hold joints together that we can't control.Think about somebody with an ankle sprain. They sprained a ligament. They stretchedthe ligament but it is not a muscle. It is different than a muscle. There are littlehabits that we do. If I stand like this and let's say I weigh 175 pounds and if I'm standinglike this, I have 150 pounds on one side and 25 pounds on the other. Where if I'm standingbalanced, I have 87 Â½ pounds on each
Knee pain neuropathic knee pain
Hot off the press news about knee arthritisfrom Madridâ€¦ not all knee pain comes from the knee Neuropathic pain features common in knee OA Lucy Piper writing in Medwire News reportedenough patients with knee osteoarthritis (OA) experience pain with neuropathic characteristicsto warrant attempts to diagnose and classify these features, say researchers.They found that among 2176 patients with OA, a third scored positively for neuropathicpain on the Douler Neuropathique (DN4) questionnaire, after patients with reasons other than OAfor such pain had been excluded.
Analysis showed that three of these potentialconfounders â€“ conditions other than OA that cause changes in cutaneous sensory perceptionson the knee, or cause abnormal sensations over the area of the knee, and referred backor hip pain â€“ were highly specific for neuropathic pain, but less sensitive than the DN4.â€œWhen these factors are absent, the presence of neuropathic pain is unlikely, yet the DN4can sense additional neuropathic features in some patients,â€� explain the researchers,led by Ã�ngel OteoÃ�lvaro ( General Universitario Gregorio MaraÃ±Ã³n, Madrid,Spain). Further confirmation and classification ofthese additional features could reveal links
between neuropathophysiology and signs andsymptoms of the condition, they note. Comment: Neuropathic pain may require differenttreatment than pain coming from other sources.
ICD10 Coding of Osteoarthritis ICD10 Coding Guidelines
Chandra: A: For the ICD10 for osteoarthritis,the guidelines actually state that you should use the multiple osteoarthritis code unlessthe specific codes are more appropriate for the circumstantial coding, and basically itcomes down to the payer rules. If you're seeing a patient simply to manage their osteoarthritisand they've got osteoarthritis in multiple joints, maybe they got in their left shoulder,their right shoulder, their left elbow and their left hip. Most providers are going toreport that with a multiple osteoarthritis code. The times that you would break into the specificjoint and laterality would be when you're
trying to prove or substantiate medical necessityfor certain things, like if you were evaluating a patient or planning to do a hip replacementon that same patient, they may have osteoarthritis and all these different joints but you'refocused on the hip joint, specifically the left hip joint. So, your claim should havethe specific code to say, â€œSpecifically we're dealing with osteoarthritis of theleft hip,â€� then you could add additional codes, say â€œthey also have it here, here,and here,â€� but for our purposes we want that specificity. That's really the onlytime that she usually going to come into play, it all comes down to payment, unfortunately.
Laureen: Is this the guidelineé Alicia: M15 â€“ M19 are the codes that we'relooking at, that's it. Chandra: Yeah. Usually there's a multiplesites option, for categories where there's no multiple site, code should be used to indicatethe different sites involved. Alicia: M15.3 secondary multiple arthritisé Chandra: That's secondary. When you'retalking M15, remember secondary is the result of something else. These are more than likely,I think they're M19s if I remember correctly. Alicia: Yeah, I was thereâ€¦
Laureen: I just wanted to share this is howyou can be your own consultant and basically answer your own questions. Not that we don'tlove doing it, but this is what I typed in as they were talking â€œICD10 guidelinessite and lateralityâ€� boom! It brought me right here, I opened it up. I typed in â€œsiteand lateralityâ€� and it brought me right to it. Google is your friend, double checkit, but when you have questions like that, that's how we startall of these questions and then we try double check each other. Chandra: Especially when you have ICD10 questions.My colleagues and myâ€¦