A minor facial injury, a year earlier than the pain started.
A 17-year-old competitive gymnast came to see me with chronic lower-back pain, centered around her sacroiliac (SI) joint. Her team trainer, also a physical therapist, had been working on strengthening and stretching around that joint without much change.
She had no memory of an injury that started the pain — it had simply come on gradually.
What I found
Muscle testing showed neurological inhibition in her adductor and gluteus maximus muscles, which left her pelvis and pubic symphysis unstable. Looking for what might be causing that inhibition, her history became relevant: about a year earlier, she’d had a gymnastics accident that dislocated both elbows and also caused her to hit her face on the floor. At the time, a bloody nose and some scrapes seemed minor and unrelated.
On exam, I found that impact appeared to have jammed both nasal bones into the frontal bone — and that finding correlated with the neurological weaknesses I’d found in her pelvis and legs.
What I did
I adjusted her nasal bones.
What changed
She practiced the next day with no pain.
I could have adjusted her pelvis directly and possibly seen some short-term change, but I don’t think it would have addressed what I believed was the underlying restriction. This case is a good example of why a seemingly minor facial injury — even one that happened a year earlier and seemed unrelated — is worth asking about.
Related reading
Read about cranial adjusting and facial asymmetry, or see more real patient cases.