By Dr. Mark de Anda
In the last few weeks, we’ve been discussing the common causes of sciatica and lower back pain. We have described two of the three common causes that we see in the physical therapy clinic, which were herniated disc and stenosis. Now we are going to cover the third and final cause: sacroiliac or SI joint pelvic problems.
Can you recall the game Jenga? That right, the block game commonly found at local coffee shops or bars. Well, when we talk about pelvic problems it’s a lot like this game. In the game, when blocks are stacked on top of one another, which block is the most important? Of course, it’s the block on the bottom! If you displace or disturb the block on the bottom, the rest of the blocks also begin to move out of place.
We can look at the pelvis as the block on the bottom, but more specifically the bottom block is called the sacrum. Try to imagine looking at the hips from the back view. The hips are comprised of three bones. Bones on the two sides are called iliac bones and the one in the middle is called the sacrum. Remember the sacrum is the, “bottom block.” The joint between the two iliac bones and the sacrum is called the sacroiliac joint or SI joint. This joint commonly gets offset which causes big problems in the back! Now we understand what we are looking at, so let’s talk about how this problem that presents itself and what kind of patient suffers from SI joint pain.
Patients that suffer from SI joint pain can vary. I have seen patients as young as 18 to as old as 95 years old with SI joint dysfunctions. SI joint displacement is also tricky see. It’s really difficult to see SI joint issues with MRI imaging. Patients usually arrive at our clinic that have tried everything such as surgeries, fusions or injections. In the physical therapy clinic the pain presents itself as pain in the groin or one leg may feel heavier than the other. Typically pain runs down one leg or the patient may have pain putting on shoes or socks. Pain maybe worse when sitting for long periods of time. Some patients may complain of pain getting in and out of the car or getting out the car after longer drives. However, even with all these problems there is hope.
Physical therapists help in three ways. First, I move the SI joint back into its proper place. I do this by a hands-on technique which realigns the sacrum between the two iliac bones. Next, I look for tight and weak muscles that may contribute to the SI joint displacement. I perform many physical test during the examination to find and pinpoint the muscles that are involved. Once I have determined the muscles involved, I focus on strengthening and stabilizing the pelvis during movement such as squatting down or lifting. Finally, I am a movement specialist, so we figure out which movements you are doing at home and work that are putting the most stress on your back. We may need to look on how you are sitting, or ergonomics.
Again, it is very important not to ignore sciatica and lower back pain. Altering it with medications or injections are temporary relief. If you are truly suffering, schedule an appointment with me. My name is Dr. Mark De Anda, and I’m a doctor of physical therapy located in central San Antonio. Call (210) 314-6725 today. I can conform exactly what the cause of your pain is and I will also give you a written plan of exactly what a successful treatment looks like.