Pain in the Ass-umption!
Dealing with sacroiliac joint pain?
Sacroiliac joint pain seems to be a very common diagnosis among active patients, women, and even elderly patients. Injections are often utilized here but I have also seen SI fusions in ages from 30 to mid 60s. So basically there seems to be no consistency across the boards and anyone could catch this diagnosis by walking too close to someone with SI pain. The kicker is that research has started to identify referral patterns that send pain from other locations to the SIJ. This means that without a thorough understanding of how to perform a mechanical assessment you may be treating the wrong area of the body. One recent article found that out of 124 patients that complained of at least 50% of their pain emanating from the SI joint area, between 3 and 6% had true SI pathology.
Another problem with identifying any true SI joint pathology is that there is not enough consistency with the special tests used. There is a set of tests that can be performed and if you have multiple positive tests it does increase the likelihood of pathology. When looking at these tests it is important to recognize that the forces applied do not solely affect the joint in question. Any time you apply a stress to the pelvis you will by default affect the forces going through the lumbar spine and hip joints.
My wife is the perfect example of this, she was told that her pain was coming from her SI Joint. She was a competitive cheerleader all through HS, a soccer player, and was very physically fit. We spent multiple years treating this area through therapeutic exercise, manual therapy techniques, and self-adjustments. Some things would provide temporary relief, such as an SIJ adjustment, but the pain always returned. She was told to discontinue heavy squats and other similar movements, which was never going to happen. It was not until I became a Doctor of Physical Therapy that was certified in The McKenzie Technique of Mechanical Diagnosis and Therapy that we figured out that her SI joint was fine. Now she rarely has pain there and even when she does, she is able to adjust her body mechanics and centralize her pain back to the true pain generator, her lumbar spine.
There are a few specific manual therapy techniques that can be used to address true SI joint pathology. Manipulations and mobilizations are common pain management tools used by Physical Therapist, Chiropractors, and Osteopathic Docs. These techniques are capable of providing temporary pain relief but when used as stand-alone treatments are of very little benefit as there is no way to maintain the correction. As with any other manual therapy technique you MUST follow up these treatments with therapeutic exercise to ensure you train your body to maintain any relief obtained. One main area of concern is the hip musculature which provide the hips, pelvis, and spine with stability. Core work is also an important aspect to implement with any spinal issue. Core does not mean do sit ups and leg lifts; it means working the deep muscles that are responsible to stabilizing the spine during functional movements.The moral of the story is that you cannot assume that location of pain means anything, always clear the spine before moving out to the SI joint and hips. If you are not sure what kind of exercises you need please reach out for advice.
As a side note: DO NOT get an SI joint fusion until you have exhausted all other options please. I have yet to see a successful outcome from this operation and they usually lead to more problems for these patients than they started with. Just like with any fusion, you are taking motion away from a segment of the spine and your body will have to adapt. This often occurs through implementing faulty body mechanics.