SACROILIAC JOINT
GENERALSacroiliac joint pain (or sacro-iliac joint or simply SIJ) is unique because it's a most unusual joint, like no other in the body. Thus it comes as no surprise that the diagnosis and treatment of the sacroiliac joint requires specialized tests and training.Medicine has long doubted that a joint that moves as little as the SIJ can cause so much lower back pain. In fact early medicine denied there was any movement in the SIJ. This doubt was ultimately proved quite wrong by an innovative Swiss chiropractor Dr FW Illi who did research on fresh human cadavers, proving that the SIJ is indeed a moveable joint. The symptoms of back pain emanating from the SI joint are difficult to distinguish from other types of low back pain. Specialised testing of the SIJ is required.
FROM THE COAL-FACE"Doctor, I have pain down here in my buttock.' Mrs Thompson was an attractive thirty year old woman, obviously in the last trimester of her pregnancy.'Is your pregnancy otherwise routine? No problems?' 'Yes, I'm fine. My doctor says it's part of pregnancy, and there is nothing to be done. He said it will go away after the birth.' 'Yes, and no. A hormone is released around this time making you vulnerable to sacro-iliac pain. No, because there is much to be done. We have various techniques that can treat you quite safely. And no, because there is no guarantee it will go away after your baby is born.' 'What should I do?' 'Let's start with an examination to see if this is a chiropractic problem or not.'
ANATOMY
The skilled doctor has little difficulty in detecting SI joint motion or, rather a lack thereof, during the normal physical examination. One of the big problems is that the SIJ may also lock in other syndromes. For example, it often fixates in the patient with an arthritic hip. Which is the primary problem remains open to debate and further research. Could a chronic fixated SI joint be a major contributing factor to arthritic degeneration in the hip? It's a distinct possibility, but damn difficult to scientifically prove!
CAUSESCommon causes of sacroiliac joint pain are injuries: a direct fall on the buttocks, as in skating, a motor vehicle accident, or even a blow to the side of your pelvis, as may happen in a fall in the kitchen. A fall on the sacrum is particularly dangerous. The force from these falls can further strain the tough bands of ligamentous tissue that hold the ilium and the sacrum tightly together. Tearing of these ligaments can lead to excessive motion in the joint, eventually leading to wear and tear of the joint.However, it is considered that degenerative arthritis is even more likely to be caused by joint locking, which starves the joint hyaline cartilage of nutrients and oxygen, and causes the build up of waste products in the joint.
HYALINE CARTILAGE ...
However, in some children, the bones that make up the sacrum never fuse together properly, creating a malformed lumbo-sacro-iliac joint; a false joint occurs. This is sometimes called a "transitional” segment, possibly causing a greater likelihood of low back pain. In the X-ray above, on your reading right you can see how the uppermost segment of the sacrum never fused properly. On your left, it has a normal transverse process (TP) but on the other side, there is a very large amorphous TP that has formed an abnormal joint with the sacrum. This may not be important to the medical doctor prescribing anti inflammatory drugs, but at a more specialist level, this X-ray has provided vital information. For example, this patient has another anomaly. Notice the little joint marked sagital joint? Look on your reading right - it's quite different. That is vital info for your chiropractor. PREGNANCYWomen 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 "hypermobile" - extra or overly mobile, and 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 sacro-iliac joint. Fairly commonly too pregnant women suffer from pubic bone pain that may continue long after the pregnancy ...Chiropractors believe that fixations or ‘locks’ in the SIJ are great contributor, whether primary or secondary, to lower back pain. ANKYLOSING SPONDYLITIS symptomMany other diseases sometimes can lead to degenerative disease in the SI joints. A man with Ankylosing Spondylitis symptoms has recently responded particularly in our clinic well to Chiropractic Sacroiliac joint management. He can now walk normally again ...ANKYLOSING SPONDYLITIS symptom ... LEG LENGTH INEQUALITYA short leg is another major cause of SIJ pain. And arthritis too. It's a bit of chicken and egg: perhaps the hip arthritis causes the SIJ fixation, we certainly know that a short leg usually causes a SIJ fixation on the opposite side.LEG LENGTH INEQUALITY. SYMPTOMSSacroiliac joint fixations cause numerous symptoms:
Sitting is often difficulty and painful, especially in the car. Using the clutch and accelerator may be painful. Often there is a confusing pattern of back and pelvic pain making diagnosis of SI joint problems more difficult.. DIAGNOSISThe diagnosis usually begins with a history of the problem. Your health care provider will want to ask you questions such as:
It's well known that a careful and thorough history can often pinpoint the problem. Is it a sacroiliac joint fixation. Or a hip arthritis? Or a Maignes syndrome? Perhaps a Meralgia paresthetica or a Femero Acetabular Impingement syndrome.
PHYSICAL EXAMINATIONFollowing this, your doctor will examine you personally to try to find the source of your back /buttock /coccyx /thigh /groin/ and even scrotal sac pain. Many of the tests will be trying to determine whether the problem is coming from the spine or from the SI joint, or even the hip joint. Proding around in the groin may be awkward and embarrassing. Take a family member with you perhaps.What complicates the diagnosis of the SIJ is that fixations are often accompanied by a different clinical condition, the lumbar facet syndrome and the even slipped disc symptoms may often mimic all of the above. Yes, it's true, a nightmare! A group of top lumbar scientists, orthopedists, surgeons, anatomists believe that less than 50% of the time can they be ABSOLUTELY sure what the source of your lower back pain could be. I wouldn't argue.
Your clinical exam may include the following orthopedic tests used to determine if the SI joint is indeed the primary problem. TESTS
The joints in the lower leg are vulnerable if the SIJ is fixated. Ankle sprain for example may occur. For more information about an ankle joint pain case file, click here:
ANKLE JOINT PAIN CASE FILE ... MOTION PALPATION
These accessory movements of the sacroiliac joint are not under voluntary control; they are necessary, however, for full painless function of the joint and full range-of-motion of the joint. Sacroiliac Joint dysfunction signifies a loss of JOINT PLAY movement. The existence of joint play movement is necessary for pain free voluntary movement to occur. If the JOINT PLAY movement is found to be absent, this movement must be freed before functional voluntary movement can be fully restored. This is best done by skilful manipulation. X-raysX-rays may be recommended by your chiropractor to determine if there are abnormalities of the sacroiliac joint or a malposition due to injury or a short leg.This is also to rule out other disease, and degenerative change in the pelvis which is common as we age.
"A picture is worth a thousand words." TREATMENTIf your MEDICAL doctor feels that your back pain is coming from sacroiliac joint, you will likely be presented with two completely different treatment options which may appear to be exact opposites - MANIPULATION or STABILISATION. Why would the two treatments for one joint be so different?No one really knows what causes the pain from an sacroiliac joint that is not suffering from severe degenerative arthritis. In some cases, it appears that the joint is "too stiff" or "locked" and needs to be more mobile to function correctly. In these cases, the pain seems to respond to mobilization and manipulation of the joint. In other cases, especially when there are definitely arthritis changes noticeable on X-rays, reducing the mobility of the joint for a period may decrease the pain. The appropriate treatment is still hotly debated by many health providers. Your CHIROPRACTOR is more likely to take the mobilization/ manipulation approach but the stabilization approach using a belt is favoured by some cases. MOBILISATION of the joint may include exercises and manipulation. This type of therapy is directed to loosening up the joint ligaments, allowing the joint to move in a normal fashion. Stabilization of the joint may TEMPORARILY find benefit in a corset, but muscle strengthening and pelvic stabilization exercises are in the LONG TERM of more benefit. Today, the surgical fusion of the Sacroiliac joint is not a common operation, except after extreme trauma to the pelvis.
Pelvic FloorBecause the muscles of the pelvic floor attach to either the sacrum or the iliac bones, a chicken-and-egg situation often exists in which one or more of these bones, and especially the pubic bones become very sensitive, usually associated with a Sacroiliac Joint subluxation. This is particularly true in pregnancy.
Go from SIJ to Pubic bone pain Go from SIJ to CHIROPRACTIC HELP home page … SACROILIAC JOINT CASE FILECase files should really be treated with a pinch of salt. They are anecdotes without scientific value. Nevertheless, they illustrate a point. Sacroiliac Joint case file.Monthly Newsletter. Signed up yet?You will then have access to these newsletters, and more as they become available:Chiropractic Help, Issue #06 - Safety-on-the-Stairs/ Ginger Chiropractic Help, Issue #05 - Safety-in-the-home/ Red foods Chiropractic Help, Issue #04 - Whiplash-and-the-Joints-of-Luschka/ Parsley Chiropractic Help, Issue #03 - How to stop falling/ Danger of low fat diet Chiropractic Help, Issue #01 - Tingling the arms and hands/ Apples Sign up here:
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