Approximately 90% of adults experience low back pain at some point in their life and it is the second common cause for primary care visits in the United States. The number of people who suffer from back pain is staggering and the effect it has on quality of life is immeasurable. Before we can address this problem we need to first understand the cause of low back pain. There are numerous cause of back pain, but in this post I am going to look at one particular cause, the Sacroiliac (SI) joint dysfunction.
In this picture we are looking at the pelvis from behind. The two bones that look like elephant ears are called the Ilium and the bone that resides between the Ilium is called the Sacrum. On each side of the Sacrum is a joint that articulates with each of the Ilium. This joint is named for the two bones on each side of it’s articulation, the Ilium and the Sacrum, therefore the name of the joint is the Sacroiliac or SI joint.
When we are born the SI joint is smooth and becomes irregular and roughened in order to support the weight of the body. It was once believed that this joint was fixed with no movement but with the development of advance imaging studies we have learned that this joint does in fact moves and can lose it’s normal movement pattern, which is called a joint dysfunction.
Typical symptoms associated with the SI dysfunction are sharp pain on either side of the spine at the very lowest part of the low back. This pain is often exacerbated by stressing the joint with activities such at rolling over in bed, getting up from a seated position and getting out of the car to name a few. Most often the pain is local to the area over the SI joint, but it can radiate down the back of the leg and typically around the front of the thigh. If you experience these types of symptoms it is likely that you might have an SI joint dysfunction, but there are a number of other conditions that can also create similar symptoms. It is important to make sure you have been properly diagnosed in order to determine the cause of your symptoms.
If it is determined through an examination that the cause of your low back pain is an SI joint dysfunction the next step is to determine the proper treatment and lifestyle modifications. Typically when someone is suffering from an SI joint dysfunction the joint is either malpositioned or not moving correctly. The initial treatment involves restoring the alignment and movement to this joint, which is accomplish by adjusting or manipulating the SI joint. Often times the first attempt to move the SI joint is met with resistance from the muscles that protect the joint. In this case we use massage or electrotherapy to relax the area in order to restore movement. A series of adjustments are used depending on the severity of the dysfunction to restore the normal motion and bio-mechanics of this joint.
Any time there is an injury to the body it becomes weakened and subsequent injuries are more likely. In order to prevent future injuries we work on restoring the strength and stability of the joint and surround muscles. These is accomplished through specific exercises that are designed to maintain functionality and increase stability. The exercises are simple and and can be performed with minimal equipment and space.
Once we have corrected the underlying problem we address what caused this problem in the first place. Sometimes the answer to this question is very simple and straight forward, ie slip and fall on the ice. Other times to causative factor may not be as cut and dry, ie getting up out of a seat accompanied by sudden back pain. Most times we can find specific activities of daily living that contribute to the low back pain you’re experiencing. We work to find ways to modify these behaviors in order to prevent the return of the condition.