All Back Pain is Not the Same

Tim Redfern, PT
Marcus Daly Rehabilitation
A service of Marcus Daly Memorial Hospital
1200 Westwood Drive
Hamilton, MT 59840
375-4570


All Back Pain is Not the Same
What is your sacral iliac joint? Also called the SI joint, it is located between the sacrum, the large wedge shaped bone at the end of your spine, and the ilia, the bones that make up the top portion of your pelvis. The primary purpose of these joints is to transfer the weight of the upper body to the lower extremities. There is a small amount movement at this joint, 1-2 degrees, but basically it is very stable. The joints are held together by massive ligaments and one muscle, the piriformis. It has long been thought that due to the weight of the body, the small amount of movement at the joint, and the large muscle and ligaments that hold it together, that nothing much could go wrong. Therefore, the SI Joint could not be a primary source of low back pain.

This does not seem to be the case. Studies over the last few decades estimate that between 15% and 40% of acute and chronic low back pain is coming from the SI joint. Symptoms of SI joint dysfunction can be felt at the bottom of the spine and off to either side. There may be pain radiating into the side or front of the thigh, yet not as commonly, the back of the thigh. SI pain rarely extends below the knee. There may also be pain in the groin area. The pain is usually worse with standing, walking, twisting or going up stairs. Pain usually improves with sitting or lying down.

The causes of SI joint dysfunction or injury to the SI joint are many. The most common cause is a slip, usually on ice, and falling straight down on your buttock. Other trauma such as a motor vehicle accidents or twisting with a load in your arms, can also contribute to SI joint dysfunction. Systemic disease such as rheumatoid arthritis , ligamentous laxity (loosening of the joints), during pregnancy, and childbirth are also common causes of SI pain. Due to the demand for increased mobility in surrounding joints, lumbar fusion can also increase the mobility of the SI joint, and thus also be the cause for increased SI pain and dysfunction.

Diagnosis of a sacral iliac dysfunction can be difficult. Unless there is a fracture of the sac rumor of the ilia, an x-ray gives little information about the state of the SI joint. Likewise, a CT scanner an MRI will give minimal information about the position or the function of this joint. Professionals with training in the evaluation and treatment of the sacral iliac joint include physical therapists, chiropractors and osteopaths. These trained individuals use the description of the patient's problem, and observations of anatomical land marks around the SI joint and pelvis to help make a diagnosis. Sacral iliac dysfunction may vary from a joint that ishypermobile, (moves too much), to a joint that is fixed in position, causing irritation to the joint and the surrounding tissues.

Treatment of sacral iliac dysfunction depends on type of discomfort. A "locked-up joint" may be treated with mobilization of the ilium and or the sacrum. A joint that is hyper mobile will need to have motion restricted. An SI belt around the hips and SI joint worn for up to six weeks, will often solve this problem. In extreme cases, the patient may need to be referred to a surgeon for a fusion of the joint.

If you have had a fall, twist or other trauma to your back, you may also have symptoms from your SI joint. Persistent, one sided low back pain, or pain moving from side to side, may be a sign of SI joint dysfunction. If there is no evidence of injury to the lumbar spine you may have asacral iliac dysfunction. Most of these problems are treatable with conservative measures.See your SI trained health care provider for an evaluation.

Questions and or comments regarding this week's health column please contact, Marcus Daly Rehabilitation, a service of Marcus Daly Memorial Hospital, 1200 Westwood Drive, Hamilton,MT 59840.
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