Low back pain is the most common condition we treat in our office, and we improve or resolve over 90% of those cases. Low back pain is challenging to treat because it can come from many different sources. What surprises me the most is how often the source of the low back pain is misdiagnosed. There are many causes of low back pain, but by far the most common cause is dysfunction of the sacroiliac joint.
The Sacroiliac joint (SI) connects to the base of the spine to the pelvis. It has two connection points and a hefty network of ligaments because it is a weight-bearing joint. The two SI joints support the entire weight of the upper body when we stand. The connection points have a kind of interlocking mechanism that limits movement at the joint.
The two SI joints, the two hip joints and the last vertebrae in your spine (L5) all move in unison when we walk and move around. Therefore, dysfunction of one of the joints in this complex of five will affect all the others. When one of the SI joints 'gets stuck' it forces the other joints to move abnormally. This explains why the pain from SI joint problems may radiate to different parts of the pelvis, low back and leg.
It is important to understand that the position of the pelvis and the position of the spine do not change overnight. It takes time, often many years to your joints, ligaments and muscles being out of balance in relation to each other for this to happen. Eventually, if the muscles, bones and SI joint are not working together as they should, this will result in problems in all or any of the components.
Sacroiliac joint sprain occurs when the ligaments, which are the strongest ligaments in the body, are pulled beyond their limits. This can happen due to:
Poor posture is essentially 'micro trauma' over long periods of time and is the most common cause of SI subluxation. The SI joints can be subluxated by too much sustained flexion, extension or torsion. Sitting in a car or at a desk for hours at a time creates too much flexion, which causes straining of posterior ligaments. Sleeping prone, or face down, often creates too much extension, which causes compression in the SI joint. Leg-crossing while sitting or laying supine, or face up, often creates too much torsion, which strains ligaments and misaligns the SI joint surface.
Unexpected jarring-type accidents, such as slips and falls or tripping, are the most common traumas leading to SI subluxation because of the compression force transmitted into the joint, which either slightly misaligns or 'jams'. Car accidents can cause SI subluxations, but this force is usually of a shearing nature. Sport injuries, depending on the nature of the impact, can cause subluxations due to either compression or shearing forces. A subluxated SI joint can affect surrounding blood flow, nerve function and muscle tension.
Women are at risk for developing SI joint problems in pregnancy and after childbirth. During pregnancy a female hormone is released that allows the ligaments in the pelvis to relax. This is necessary so that during a normal birth, the female pelvis can stretch enough to allow the baby through the ring of the pelvis. This stretching results in changes to the SI joints, making them 'hyper mobile' - extra or overly mobile, thus vulnerable to injury. During pregnancy, the SI joints can cause discomfort both from the effects of the hormones that loosen the joints, and from the stress of carrying a growing baby in the pelvis, and from fixations that may form in the sacroiliac joint. Fairly commonly too pregnant women suffer from pubic bone pain that may continue long after the pregnancy.
Both osteoarthritis---the 'wear and tear' type, and inflammatory types of arthritis such as gout, psoriasis, rheumatoid arthritis and ankylosing spondylitis cause SI joint destruction. Joint destruction invariably causes misalignments and dysfunction. SI subluxations created from mild to moderate arthritis can become unstable with movement and often create popping or clicking sounds, although severe arthritis often leads to complete SI fusion.
Any condition that causes an abnormal walking pattern increases stress on the SI joints. This includes having one leg shorter than the other, a previously fractured femur (thigh bone), chronic leg-crossing; obesity; and any sort of limping due to pain in the hip, knee, ankle or foot.
The piriformis muscle is a small muscle in the middle of your buttock. If the piriformis muscle goes into spasm and becomes inflamed it will affect the sacroiliac joint and cause extreme SI joint pain. Also, since the sciatic nerve runs underneath the priformis muscle, when the piriformis muscle becomes tight and inflamed it can irritate the sciatic nerve and cause severe pain in the buttocks and down the leg. This pain is commonly mistaken for 'sciatica' related to a disc bulge (slipped disc).
SYMPTOMS OF SI PROBLEMS ARE ANY OR ALL OF THE BELOW:
- Pain located either to the left or right of your lower back. The pain can range from an ache to a sharp pain which can restrict movement.
- Sideways motions are accompanied with pain (like getting in and out of the car)
- The pain may radiate out into your buttocks and low back and will radiate to the front into the groin.
- Putting on socks and shoes is a struggle
- Occasionally pain may radiate into the genital area in males.
- Pain may be referred into the leg which is commonly mistaken for sciatica.
- Classic symptoms are difficulty turning over in bed, struggling to put on shoes and socks and pain getting your legs in and out of the car
- Stiffness in the lower back when getting up after sitting for long periods and when getting up from bed in the morning.
- Aching to one side of your lower back when driving long distances.
- It is certainly involved in a heap of conditions from pulled hamstrings to groin pain.
- There may be tenderness on palpating the ligaments which surround the joint.
HOW IS SACROILIAC JOINT DYSFUNCTION DIAGNOSED?
The first step in diagnosis is typically a thorough history and physical examination. This can help differentiate pain coming from coming from the SI joints, lumbar spine, or hips. There are various tests during the physical examination that can help isolate the source of the pain. Other portions of the examination are to exclude certain possibilities that could mimic sacroiliac disease. The next step in diagnosis is often plain radiographs (X-Rays).
TREATMENT AND WHY TRADITIONAL TREATMENTS FAIL?
Most traditional treatments fail because they simply address the symptoms and fail to address the cause of the condition. As we have explained, Sacroiliac Joint Dysfunction is a physical problem brought on by your SI Joints, related ligaments and muscles being out of balance. While injections and medication can help the inflammation and remove the pain, they do not address the imbalance.
The goal of chiropractic treatment for sacroiliac pain is to utilise a method that is best tolerated by the patient with the goal of yielding the best outcome. Patients respond very differently to different approaches, so we may adopt several different techniques to treat sacroiliac joint problems.
Sacroiliac joint injuries are treated through the use of spinal manipulation (spinal adjusting) to re-position the joint to its optimal bio-mechanical position in order to promote healing in proper spinal alignment. A typical course of treatment involves 8-10 visits over 3-4 weeks. Treatments in the first 1-2 weeks usually consist of spinal manipulation in conjunction with the use of therapy modalities in order to reduce inflammation and aid in pain recovery. Treatments may be changed after the first 1-2 weeks to incorporate stretching and strengthening of the muscles surrounding the joint in order to promote the best possible recovery.
For additional information please call Three Lamps Chiropractic Ph: 09 378 0069
BSc, MChiro, MNZCA
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