SI joint Dysfunction: Part One

One of the most common types of pain that brings patients into our office looking for relief is pain in the low back/sacroiliac joint/glute pain. (Sometimes they describe the pain as hip pain, but true hip joint pain is actually in the front and I'll save hip joint pain for another day). Quite often patients with pain in this area also have radiating pain into the leg usually not below the knee, but on occasion it can radiate into the foot indicating a compression of the sciatic nerve. This pain can be severe at times, difficult to manage with pain medicines or anti-inflammatories and sometimes there is no comfortable position which can lead to many restless nights. In this post I want to go over some of the common causes of SI joint dysfunction and in the next post maybe offer some insight into how chiropractic treatment can help.

First some basic anatomy. The sacroiliac joint lies next to the spine and connects the bottom of the spine (sacrum) with the pelvis (Ilium). The joint is supported by a very strong set of ligaments.This joint is very strong and is able to:

1. Transmit all the forces of the upper body to the lower body.


2. Absorb the shock forces of the lower body, thus limiting stress to the low back (lumbar) structures


3. Provide minimal motion to help with a smooth gait pattern.


 

There are many large muscles surrounding the SI joint but one in particular usually goes hand and hand with SI joint dysfunction, and that is the piriformis. The piriformis muscle sets over the sciatic nerve and in about 1 in 5 people the sciatic nerve actually runs through the muscle. This is why it is a common cause of nerve compression. Both the sacrum and the ilium have a certain range of motion but at times the joint becomes fixed or subluxated to the point where motion is decreased or absent all together. In this case hip flexion ( raising your knee while standing) causes a great deal of pain and gives the patient a sense that the joint is locked up. When this happens, as in euchre, certain muscles must follow suit. The first to be affected is the piriformis muscle, then the Iliotibial Band (IT band) and finally if left untreated the Iliopsoas (hip flexor). Piriformis pain can best be described as an "ice pick stabbing your butt cheek." This type of pain can often be confused with discogenic pain such as a bulge or herniation. IT band pain is on the side of your hip and along the outer portion of your leg sometimes even causing lateral knee pain. Iiopsoas or hip flexor pain is basically groin pain/back pain. Have you ever gotten up from a seated position and were unable to stand up straight for a few seconds and walked like you were 80 years old? (no offense to the 80 year olds out there). Well if you have you most likely have tight hip flexors.  I talked about this in a previous post /blog/2012/08/the-best-low-back-stretch-you-may-not-be-doing/ .

Some of the most common causes of SI joint dysfunction are:

1. An altered gait due to an injury in the foot, ankle, knee or low back. For instance if you have ever had a sprained ankle or knee you most probabaly limped around for several weeks and this causes certain muscles to over compensate. Basically everything above a crooked foundation is crooked. 

2. Pregnancy. (Go ahead and start blaming your child now.) During pregnancy the body releases hormones to relax the ligaments in preparation for childbirth. An unfortunate consequence is the increased motion in the SI joint causing dysfunction. Pregnancy and sciatic pain go together like peanut butter and jelly, coffee and doughnuts, pickles and ice cream....pregnant cravings are weird. (On a side note my wife craved DQ blizzards while pregnant with all three of our children. As I recall brownie mix was her favorite :-) For more on chiropractic and pregnancy click http://alexandriachirocenter.com/injury882.html

3. Arthritis. Degenerative osteoarthritis causes the cartilage in the SI joint to become worn down and creates pain and inflamation causing dysfunction. The SI joint is a common place for arthritis.

Click on the following link to watch a short (about 1 minute) video regarding chiropractic treatment and SI joint pain http://alexandriachirocenter.com/injury785.html

In the next post I will talk about the types of treatment we offer and also give some stretching and strengthening exercise examples that you can do at home. If you have any questions regarding SI joint dysfunction, piriformis pain or hip pain feel free to contact our office through our contact page or better yet give us a call. If you are looking for a chiropractor in Campbell County or would just like a second opinion on a condition call Alexandria Chiropractic Center at 859-635-6666. Have a great day :-)