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- Because the sacroiliac joint,
or I'll refer to it as the SI joint,
is a joint between the sacrum and the hip
it is predominantly a pelvic structure
and therefor can be injured during any rapid force
that the pelvis sustains.
The joint serves to almost transmit the force
between the leg and the rest of the body,
or between the low back and the leg,
so anything that would jar your lower back
and then be transmitted to the leg,
or any force that would jar your leg
and then be transmitted to the back
would go through the sacroiliac joint.
So, for instance, somebody who's in a car accident
and they're the driver
and they plant their right leg down on the gas pedal,
that force, that ground reaction force,
that goes to the leg would be transmitted
through the sacroiliac joint and injure that.
Somebody with chronic low back pain
is compensating for that,
that could also throw off the sacroiliac joint.
In addition, many muscles insert
on the sacroiliac joint ligaments,
your hamstring muscles,
your gluteal muscles,
your back extenesors,
so injuring any of these muscles,
even a hamstring strain,
can effect the sacroiliac joint, as well,
and vice versa.
Usually patients localize the pain
with sacroiliac joint dysfunction to the buttock region.
In fact, there is a point,
almost a little dimple,
over the sacrum called the sacral sulcus,
and patients can point,
usually with one finger,
just to this spot.
Pain from the sacroiliac joint
can radiate far down the leg.
In fact, it can almost mimic sciatica
or radiculopathy.
Studies have actually put a probe in the sacroiliac joint
and mapped referral patterns of the pain,
and it can refer as far distantly as below the knee.
- So, I'm concerned that you might have a strain
of your lower back,
so I'd like to do a physical examination
to take a look.
If you could turn around,
the first thing we do is just look
at the low back region.
Have you bend forward.
And look for any significant curviture of the back,
which I do not see.
You can stand up straight, great,
and lean back towards me.
To look at the range of motion.
Have you stand up straight again.
Lean to the left side.
Let's check side-bending.
And lean to the other side.
Good, and stand up straight,
and we'll check trunk rotation and rotate to the left,
and rotate to the right, good.
From there, I'm going to palpate, or touch,
the bony elements of your spine down the middle,
and then we move out to the muscles,
and feel for any tight bands or knots in this region,
then we move down to the sacroiliac joints
in the pelvic area.
To evaluate sacroiliac joint dysfunction,
the first step is the history
followed by a detailed physical exam.
There are many maneuvers that I can perform on the patient,
that either cause the sacroiliac joint to be more painful,
or alleviate sacroiliac joint pain,
and even though you're provoking the sacroiliac joint,
this is very important information.
Being that history and physical exam
is not specific or sensitive for ruling in or ruling out
sacroiliac joint dysfunction,
the gold standard is to inject the sacroiliac joint
under x-ray guidance and see the response to this.
When we perform a sacroiliac joint injection,
the relief is usually noticed in the first few days
from the anesthetic component,
however the steroid can take several days
to take effect,
and the injection may last as long as months to a year,
and when the pain returns it may not be as intense.
We know that the joint receives its nerve supply
by nerves that exit out of the sacrum
from holes, or foramen, as they're called,
and as those nerves branch out of those holes
and feed the joint,
we can perform a procedure where you put a probe
between the hole where the nerve exits
and the joint itself,
and destroy that by creating a tract.
This uses thermal energy,
where we actually use heat to destroy the nerve.
The name of the procedure is called
a radiofrequency ablation procedure of the sacroiliac joint.
Beyond the injection,
other treatment options for sacroiliac joint dysfunction
are a combination of either physical therapy
or chiropractic care to mobilize the joint
or to stretch out the ligaments
or reinforce the ligaments around the joint.
Medication-wise, we use anti-inflammatories
to address the pain in this region.
Coordinated Help has two alternative treatments
for sacroiliac joint dysfunction that are very effective.
One is called Prolotherapy.
In patients whom the ligaments are too loose
around the sacroiliac joint,
injecting a sugar-water solution into the ligaments
can cause some inflammation and tightening
of the ligaments,
and stabilize the joint.
Another treatment that we offer
is traditional Chinese medicine with acupuncture,
as this can very much affect local pain in this region
as you address the energy and balance in channels
in the low back and pelvic region.
- There are two goals in treating your back pain.
The first is to treat your acute pain,
and the second is to address the functional limitations
that are causing you pain.
You can't treat just your symptoms
if you don't know what's causing them.
Chiropractic care is in an important tool
in reducing the acute pain,
while physical therapy addresses
your functional limitations or impairment.
But both therapy and chiropractic care
are education-based.
They focus on your ability to move in all planes,
as well as to maintain correct posture.
Maintaining that correct posture alignment
includes keeping your feet straight,
your hips tucked in,
your shoulders back, and your chin tucked.
Individual comprehensive progressive
physical therapy programs focus on four areas.
The first is to improve functional core strength.
This provides you a firm base
so your limbs can generate force and motion.
The second is functional stretching.
This is to regain or improve the range of motion
and flexibility of the muscles in your back
in all directions.
The third is functional endurance.
This is to improve your muscular endurance
and your ability to maintain correct postural alignment.
And finally, the last area is functional balance
and proprioception.
This proprioception means improving your ability
to maintain balance in all planes.
At Coordinated Health, we work as a team
in your education and treatment,
but you're the key member of that team.
Maintaining a pain-free back means working hard
to understand and apply the principles which we teach you.
Stretching and strengthening your back
on a daily basis will help prevent
recurrences of back pain,
allow you to move better,
and improve the quality of your life,
and that's The Art of Medicine.
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