Living with Psoriatic Arthritis (PsA)

Fascial adhesions

Hello all. It’s been awhile since I’ve posted but as usual I’ve been lurking in the background keeping up with y’all. A quick question if I may.
As a refresher, let me start with saying that the nearest rhumy and/or spine specialist is 1,200 miles away (Ah! The price we pay to live in Alaskan paradise! :grin:) and can take a couple of months to get an appointment. So my only other option for spine stuff is a chiropractor who knows me well. I know, not the best. But a girl’s gotta do what a girl’s gotta do. Anyhooo, a few weeks ago the eternally cranky sacrum decided to turn all El Diablo Evil :imp: and I found myself hobbling around with some spectacular pain going all the way down my left leg. I finally decided something had to be done and went to my long suffering chiropractor. He said my sacrum and (for lack of the anatomically correct term) the left back strap muscle in the lumbar were inflamed. :no_mouth: He said it sounded like the pain down the leg was ‘Facial Adhesions’. He looked at my latest spinal MRI and X-rays (admittedly 4 yrs old but still informative) and determined I had significant sacral ‘mechanical instability.’ I’ve known that for years but no one has ever seen fit to address it. He was also a bit concerned that my Anterolisthesis was slipping into a grade 2.
Sooo, all that to say that he has prescribed PT for the sacrum and core strengthening (YAY!) and did some adhesion breaking on the leg. An experience somewhere between a root canal without anesthesia and maybe childbirth. The bruises are fairly colorful but not quite spectacular. Yet. They are still forming.
I’m all over the PT. Done a lot of it and I know it’s very helpful. I also know it takes time so I’m not looking for instant gratification. And I think the adhesion breaking has helped. However my question is, has anyone else here experienced anything similar? I really don’t want to make more problems for myself but I had to do something. @tntlamb anything to add, admonish, advise?
Thanks all!

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You can hardly get a massage these days without someone talking about Fascial Release. There is no evidence of the condition is existing but bazillions of dollars are spent on foam rollers and therapy anyway. That being said if it provides some relief (even temporarily) its prolly not a bad idea.

Now years ago when I spent some quality time in the cadaver lab I came across a lot of fasciae. And while there is little doubt adhesions can occur, I just don’t want to meet the guy who says he can release them or manipulate fascia in a dark alley. He could thump the Incredible Hulk with one hand tied behind his back.

You can learn all you want here:

Now about your chiropractor. You need to understand Anterolisthesis grades 1 and 2 is something just about everyone over the age of 30 has, the reason no one has mentioned it is because it is completely normal. Rarely is it symptomatic and if there are symptoms, it’s far from clear if Anterolisthesis is the cause. But chiropractors the world over make a killing fixing it. They can do more harm than good. It concerns me when they start mixing what they do with what the medicos do. It takes more years of training and education to properly read an MRI than your chiros total education.

Sacral ‘mechanical instability isn’t diagnosed by imaging. The biggest influence is non-functional factors (psychosocial factors) and functional elements of the spine (ligaments, muscles) These can’t be seen on imaging. Those Factors also allow compensation of degeneration which most often leads to an alleviation of clinical symptoms. The problem is when its messed with (chiropractic adjustments In return, decompensation he does of LSI may cause the new occurrence of symptoms and pain. Relief is temporary and requires additional treatments to undo what the previous treatments cause. Once someone starts chiropractic they are committed until they finally give up and allow the body’s natural compensation to take over. This process of compensation/decompensation of the condition explains individual differences of identical structural disorders leading to changes in clinical symptoms and pain. Now that is not to say that there are never structural issues because there are especially with PsA patients, but those are nothing a chiropractor OR PT can fix. (and damn few surgeons though they are getting better at it)

I think the old phrase candy is dandy but liquor is quicker applies to PT. If you have ever woke up with a world-class Hangover. (I have only had one in the last 30 years and it was @Seenie fault - long story) PT is the best option (and NSAIDs) but by necessity takes a lot of time and a lot of dedication. Hang in there.


Thanks. I have mixed feelings and some doubts about the efficacy/legitimacy of a good bit of chiropractic stuff. But that said, PT has helped at varying degrees in the past on other body parts. And as I said, I really have no other options. Except my exceedingly wonderful GP. But the last time I talked to him about my spine he said my options were all out of town. Far out of town. (Oh shizzle!) I figured I’d give the adhesion thing a try. If It helps, great. If not I just end up with bruises. I can live with that. As far as the anteriolethesis, I’ve had mine since I was a teen ager and it was something my spine dr (who rudely retired without my permission) liked to keep an eye on. It’s probably from an unfortunate and painful encounter with a 6 or 7 foot deep hole and many years of very, very manual labor that would have best been done by The Hulk. But that’s another story. What I’m really hoping for is some improvement in the El Diablo sacrum. Several (actual medical) doctors have somehow decided that my sacrum pain is “mechanical” but have never offered anything in the way of even a remotely possible solution. So I figured, “What the hay!” If it does no harm I’ll give it a try.
Thanks for the input! It is appreciated.

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Absolutely I have always said if painting myself purple and dancing naked under a full moon while licking frog slime would help, get me a bucket of paint and frog…

OMG!!! :joy::joy::joy: That was one of the BEST visuals. EVER! But I’m a bit sick and twisted like that.

Well you were kinder than many in your appraisal of chiropractic “medicine”. I’m sure there are some who do some good…I just haven’t met one and stopped seeing them when one tried so hard to fix my severely herniated disc I was almost crippled. (I was naive and thought they could really fix heartburn and poison ivy too!) As if they can put a disc into place…that would come from one who doesn’t have a clue what a disc is. Anyway, I would strongly discourage chiro’s and PsA…not a good mix at all!

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I’m sorry you live soo far from a rheumatologist. I routinely see my chiropractor in addition to primary and rheumatologist. Plus a trainer. I’m having a flare now and he keeps me active by modifying exercises to be joint neutral in affected joints. I believe it all helps. My chiropractor keeps things aligned and uses a laser on areas that are inflamed. Right now my ankles and that ligament that runs up the shin. Use whatever helps.

Thanks. Fortunately my PsA doesn’t seem to be horribly active. At least right now and/or for awhile. (Knock on wood)
As I’ve said I use the chiropractic approach with caution for several reasons. But I shall not digress.
I ended up seeing my PCP the other day. I wanted to be sure what the chiropractor proposed was not potentially detrimental. We are both good with PT. We’re both also good with not messing with my spine so I’m forgoing much in the way of adjustment. He did give me a Medrol pack. We weren’t sure if this was a PsA flare or something else. It’s obviously nerve encroachment (which really concerns him) but my spine is so extremely arthritic that without a rheumatological examination etc we don’t know if it’s a PaS flare, the spinal OA and/or some other ball of fun. We decided the Medrol pack would be a pretty good indicator. By day 2 on it I could walk without my cane and even stand without it. Something I haven’t been able to do for weeks. So in my insufficiently medically educated mind with results like that I’m leaning toward more systemic inflammation being the culprit. Especially since, as a bonus, my wrists and hands are less swollen and I’m feeling kinda terrific. Which is a bit of a subjective term I suppose but I’ll take whatever I can get. :+1:t2: :grin: We know we can’t live on steroids but I’ll do what’s needed to get through this acute episode. And I go back to see the PCP in three weeks. In the mean time I’ll carry on with PT. It can only help. I think. :laughing:

Does it have to be purple? I sort of thought green helped the best!

My chiro talks about such things, but you just have to do what makes you feel better. I don’t care what they call it, but if the chiro says he is doing something that is supposed to help and it doesn’t I tell him and we try something else.

I have been trying to find a PT person that works with PsA, but haven’t. They all say they can try. I don’t want try, I want someone that knows what they are doing. I have experimented on enough!

Green probably is better but purple compliments my complexion so well…:laughing:
I have a friend who is a PT traveler. Has been his entire career. One summer he stayed with us while he was working in town (and I must say it was great having a really good PT in house :wink:) and he was explaining how PT has changed over the years. Back when he was originally licensed one got a Bachelors with a pretty much all encompassing knowledge of physiology, etc and how to treat such. And of course to keep his credentials and license current he has to do continuing education. But PTs graduating now all have PhDs and often with specialties. And on top of that, there are different schools of thought and training. So depending on where one got their education, there is quite a bit of variance in some parts of treatment.
The current standard is a bit of a mixed blessing. Emphasis is often on a speciality but they all still have the broad base of knowledge. But not necessarily the experience. He further went on to explain that because he has worked (literally) all over the country with probably just about every school of thought and training out there for over 25 years he has learned many techniques or modalities, if you will, to address the same issue. Some places he worked welcomed “cross pollination” and they would freely share different techniques and ideas with each other. Some places were “we don’t do that here” and pretty set in their modality. He used to like to say, “If moving your arm like this doesn’t address your issue let’s stop and try moving it like that” His experience and open enquiring mind was more more valuable to me than seeing someone with a doctorate with a more singular focus. And his lengthy career also helped. I doubt there was much he hasn’t seen, heard about and/or treated. Plus, he’s funny as heck!
So all that to say I’ve learned that if given the choice, I lean toward someone with more experience even if it means a bit less (specialty) education. Unless you can find someone with a rheumatology PT education. I don’t even know if there is such a thing. Too bad ‘cause they would have more patients than they could treat. But then I suppose you already know all this.
And believe me, everyone in town has tried to get him to settle down and practice here. But he is a vagabond at heart. Although he did say that Juneau is the only town that even tempted him to plant some roots. So I suppose there’s hope. Maybe.