“I can’t believe the progress I have made.” This is what she said as I entered the treatment and examination room.

The timing was perfect. The Beach to Beacon 10-kilometer road race was the next day. She felt very confident she was now going to have a good race. She told me her goal and she wanted to set a personal record, even though her training was hindered.

She gave me a substantial history of right lower back pain and hamstring issues. It started a year ago, when she ran the Beach to Beacon. During the race she pulled her hamstring.

Prior to last year’s race she was having pain. It was aggravated by lying in bed on one side or the other too long. It would make her hips ache.

The pain was interfering with her running. Sitting at her desk at work also caused pain on her right sit bone, which is part of the pelvic bone.

She had tried a number of different treatments. She had a cortisone shot in her spine, physical therapy, acupuncture and sports massage. She was somewhat better but still in chronic pain.

She feels she is too young to feel this way. She wants to be active.

She can’t remember a single incident that lead to her chronic pain issues. She does give me a history of several sprained ankles.

I examined her and found her to be very fit. She has a slight bow in her legs, the left more pronounced than the right. She had muscle spasm in her right lower back and buttocks muscles. Her pelvis was rotated with a locked sacroiliac joint.

I could feel scar tissue in her right hamstring from when she pulled the muscle last year. I also found substantial loss of range of motion of her right ankle. Neurological testing for disc and sciatic nerve issues were all negative.

My diagnosis was mechanical joint dysfunction of her ankle and pelvis. This was causing motor and muscle imbalance, and it was the cause of her chronic pain.

I needed to restore the motion to her ankle. This change would alter her running gait and put tremendous stress on muscles like her hamstring. I also needed to balance her pelvis.

I manipulated her ankle and got an excellent release. I also used a special table that flexes and distracts the lumbar spine and pelvis. This helped balance her pelvis and unlock her sacroiliac joint.

I also performed deep tissue cross friction massage to breakup the scar tissue in her hamstring. She was given exercises to do at home.

She started care four weeks prior to the race. Her pelvis was more level and balanced. Her ankle range of motion was much better. Her hamstring still had a knot in it from the old pull, but it was less pronounced.

I got an email from her with an update on her results. Even though the day was very humid and her training was limited prior to the race, she broke her personal record. She was very pleased.

She was a little sore after the race. This she expected. She is going to take a week off to recover.

Chronic pain can be so frustrating for athletes and non athletes alike. It interferes with work, play and family life.

There are many causes to chronic joint and muscle pain. Finding the cause and developing a treatment plan can yield tremendous results.

“I have not been able to workout for over a month.” She has not been able to play golf. It is very difficult for her to sit at her desk and work.

Her girlfriend told her she is walking funny. Summer is going by and she wants to be outside enjoying herself.

The pain started while on vacation in the islands. She noticed carrying her purse and luggage was uncomfortable. The pain got worse on the plane. Over the next several days she was miserable.

She tells me the pain is in her lower back going into her buttocks. She also has pain in her mid back, between her shoulder blades. She has no previous history of back pain or injuries.

She did everything she could think of to avoid seeing a doctor. She took over-the-counter drugs for inflammation and pain. She used heat and ice at home. Her friends gave her their unused prescription medications for the pain and muscle spasms.

She was a former worker’s compensation adjuster and had frequently denied chiropractic treatment. Her friend recommended she make an appointment with me for an evaluation. She was skeptical.

She told me she was worried about the cost of care for her condition. She is a self-employed single mother of two. She has to purchase her own health insurance. She has a $10,000 deductible.

My examination reveals a woman that appears much younger than her stated age. She seems to be very fit. Her gait and posture are compromised. She had to swing her hip and leg around to step forward.

There is muscle spasm in her left buttocks, lumbar spine and between her shoulder blades. There is tenderness to palpation over a rib attachment between her mid back and her shoulder blade.

I tested her range of motion. Side bending of her lower back is restricted and she has lost motion in her left sacroiliac. Her reflexes and motor strength are normal. She is not pinching her sciatic nerve.

My diagnosis is mechanical lower back and mid back pain from joint dysfunction in her pelvis, lumbar and thoracic spine. Imaging studies did not appear appropriate at this time.

I recommended a short trial series of chiropractic spinal adjustments. She agreed.

This was her first time to a chiropractor. She was a little nervous and concerned that the manipulation would be uncomfortable. She tolerated my procedures very well.

She scheduled a follow-up appointment in four days.

She was so excited on her next visit.

Her pain was almost gone and she was functioning at a much higher level. “I wish I had come in to see you sooner.”

My examination revealed a significant reduction in her muscle spasm and tenderness. Her joint dysfunction and range of motion returned to normal.

I discharged her from active care with a few simple exercises.

I gave her the green light to return to all her normal activities including golf and going to the gym.

She was also surprised at how affordable the care was that she received. The high deducible for her insurance caused her to delay care and treat the condition herself.

I highly discourage patients from taking drugs that have not been prescribed specifically for them. This can be dangerous.

Many times patients just need a high-touch, low-technology approach to restore their health.

“You wrote about me.” This is what my new patient said as I introduced myself to her.

She had read my previous column about lower back and leg pain caused by the sacroiliac joint. She was one of many readers that emailed me for more information. She also wanted an appointment for an evaluation.

She has been an athlete all her life. She also has coached women’s basketball at the college and high school levels. Now all she wants to do is play golf without pain while summering in Maine.

She tells me her pain is in the right side of her back and goes into her buttocks. She has had the pain for several months. It was not going away.

I asked if there was any weakness in her leg. She said her foot feels weak at times, especially when she gets tired.

My examination found muscle spasm in the lower back and buttocks. She can stand on her heals and toes. The strength of her large toe is weak. Stretching the sciatic nerve is negative.

Overall she is a very fit and healthy woman.

I diagnosed her with a possible herniated disc in her lumbar spine. This was indicated by the weakness in her leg and was complicated by her sacroiliac and pelvic misalignment.

Not all herniated discs need surgery. Studies indicate only about three percent of patients with herniated discs require surgery. Surgery is warranted for severe and unrelenting pain or when neurological signs like motor weakness progress.

Portland is fortunate to have an excellent neurosurgical group. Our practices work well together and we often refer our patients to the most appropriate care.

I agreed to treat her. I told her we would constantly monitor her for any negative changes in her neurological signs. If this happened she would be referred for an MRI and neurosurgical consultation.

We started using chiropractic manipulation. The strength came back in her toes and her pain subsided so she could play golf in comfort.

She was thrilled. After three visits she stated “this is the best I have felt in years.”

Another patient contacted our office for an appointment after reading my last column. She is training for the Beach to Beacon 10K. She had pain in her left-lower back and buttocks.

As athletes increase the intensity of their workouts this puts more strain on their structure. If they are out of balance they are prone to injuries.

I found that her pelvis was not level. She had a weakness of the hip flexor and gluteus maximus. She had one very tender spot on the outside of her buttocks. This is the attachment of the piriformis muscle.

This muscle was described by Dr. Glazer in his column last week. He wrote how training with a properly fitted bike is so important to a cyclist with piriformis syndrome.

I recommended manipulating her sacroiliac and some sacroiliac exercises before and after each run. These exercises are easy to do and are so effective. They help heal and prevent abnormal gait issues.

On her follow-up visit the strength of the hip flexor and gluteal muscles returned to normal strength. What most impressed her was the pain in her piriformis was reduced by 50 percent after one visit. She is expecting to run a great race.

If you are training for a summer competition and your training is not going well, your structure may be out of balance. Do not postpone an evaluation. Diagnosing and correcting the problem will make your summer more enjoyable.