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Sacroiliac Joint Pain

Pelvis (French labels)

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Sacroiliac joint (SIJ) pain is often confused with low back pain.  Patients may complain of low back pain but then will move their hand lower onto the sacrum.  Most patients will have pain with transitional movements such as moving from sit to stand or raising from bending forward.  Also, as I watch people stand, they may use their arms to walk up their legs or while bending forward may not have the normal curve reversal that we usually see in the lumbar spine.

The sacroiliac joint is formed from the meeting of 2 bones, the sacrum and the ilium.  The ilium is the hip bone.  The sacrum lies between the two hip bones and the end of the lumbar spine and just above the coccyx or tail bone.  The sacroiliac joint is very complex to some as there are two SIJs and as therapists we must look at the relationship of the sacrum moving forward and back on the fixed ilium when both legs are planted and the ilium moving on the sacrum with one or both legs moving.

Many things can go wrong with this picture.  The ilium can become fixated on the sacrum, or the sacrum can become fixated on the ilium.  According to the schooling the therapist takes, many of us learn about dysfunctions of the sacrum called torsion, rotation, flexed or extended.  When I evaluate the SIJ, I look at the lumbar spine from behind.  I palpate the top of the hip bone and watch the way the sacrum and the ilium move as the patient bends forward and back, then raises one leg and the other.  I look at their leg length while they lay on their backs then I look at the height of their hips to see if one is higher than the other.  While laying on their stomach, I look at the levels of their lumbar spine and various bony spots on the ilium and sacrum.  All of these positions allow me to determine if their sacrum is in torsion, rotation, flexed or extended.

For me, the treatment of choice is an Osteopathic approach called muscle energy technique.  I use this to rotate the patient’s spine from above and below the affected joint.  I then use the leg  which I position according to the type of sacral dysfunction.  I ask the patient for a #3 contraction of the leg which I resist.  I this way I am able to use the muscle contraction to pull the sacrum back into the proper position.  Usually this treatment causes little pain and is quite effective.

Mary Boyd, Ms, PT is a member of the Sandpoint Wellness Council and can be reached at 290-5575 or on the web at www.SandpointWellnessCouncil.com or www.MtnViewPT.com.

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