Sacroiliac Joint Pain
Many of us have experienced lower back pain at some point in our lives. Whether that is after a fall, running or simply sitting down for too long most days. SIJ is short for ‘sacroiliac joint’, and SIJ pain contributes to around 15-30% of back pain. But most of us don’t know much about it, so today we are delving into SIJ pain and how we can help!
What is the SIJ?
The SI joints are located either side of the lower spine, in between your pelvis, specifically, they connect the sacrum to the iliac bones — hence the name sacroiliac! The joints themselves are pretty immobile and only allow for a few degrees of movement, BUT they serve an important purpose as shock absorbers. They also help reduce the pressure on your spine by distributing weight across your pelvis, so it’s important that your back pain is diagnosed correctly!
What causes SIJ pain?
SIJ pain or SIJ dysfunction occurs when the SI joints are inflamed and are either restricted or moving too much. If they are restricted, they may be stuck in a slight rotation from their ideal position, which can wreak havoc on your pelvis and the rest of your body. SIJ pain could be triggered from:
- Injury or trauma, such as a fall or car accident.
- Persistent impact from running or climbing stairs.
- Loose ligaments due to hormones in pregnancy.
- Abnormal walking patterns.
- Certain medical conditions such as arthritis.
- One leg being shorter than the other.
Symptoms
SIJ pain is typically felt in the lower back and buttocks, but can also present around the hip, groin and extend down the leg to the knee. It usually feels like a sharp, dull or a stabbing pain. In most cases, SIJ pain is typically felt on one side of the body but may present itself in both joints as well (but this is much less common).
Other common symptoms are:
- Difficulty sitting for long periods of time.
- Feeling of instability in the pelvis.
- Difficulty sleeping on the affected side of the body.
- Increased pain when walking or running.
- Pain with certain movements e.g. sitting to standing, bending, twisting.
We can help!
Sacroiliac pain is often misdiagnosed as another back injury, so we will perform a thorough examination to ensure we correctly diagnose and treat your body. This may involve checking where your pain is located, your posture, how you walk and even muscle strength.
Once correctly diagnosed, we can use a range of soft tissue massage and manipulation (if needed) to help release tight muscles and realign the pelvis. This will also be accompanied by some stretches and strengthening exercises for your glutes and core muscles.
In some instances, we may recommend a sacroiliac belt to help stabilize the area, especially when the joint is moving too much and is very painful (commonly seen in pregnant women when their ligaments begin to relax).
If you are currently experiencing SIJ pain, we recommend avoiding running and limiting movements that inflame the joints, such as lifting and jumping. Even sports such as cycling and golf may cause pain and discomfort.
Below are a couple exercises to try at home to strengthen your core and glutes:
Bridge: Lie down on the ground with your knees bent and feet on the floor. Place your palms either side of your body and slowly raise your hips. Hold for 5 seconds, then slowly lower your hips. Repeat 8-10 times.
The bird dog: Start on your hands and knees, make sure your hips and shoulders are square and you are looking towards the floor. Slowly extend one arm and the opposite leg. Hold for 5 seconds before releasing down and changing to the other arm and leg. Repeat 8-10 times.
If you think you may be suffering from SIJ or lower back pain and want to avoid experiencing it in the future then give us a call on (416) 546-4887to book your appointment!
References
- Dydyk, AM., Forro, SD., Hanna A. 2021. Sacroiliac Joint Injury, StatPearls, Treasure Island (FL). Available from: https://www.ncbi.nlm.nih.gov/books/NBK557881/
- Yeomans, S. 2018. Sacroiliac Joint Dysfunction (SI Joint Pain). [Online]. Available from: https://www.spine-health.com/conditions/sacroiliac-joint-dysfunction/sacroiliac-joint-dysfunction-si-joint-pain [Accessed 24 Nov 2021]
- 2013. 6 Best Sacroiliac Joint Pain Exercises, and 5 to Avoid. [Online]. Available from: https://www.braceability.com/blogs/articles/sacroiliac-joint-pain-exercises [Accessed 24 Nov 2021]
- Danisa, O. 2018. Exercise for Sacroiliac Joint Pain Relief. [Online]. Available from: https://www.spine-health.com/wellness/exercise/exercise-sacroiliac-joint-pain-relief [Accessed 24 Nov 2021]
- York Morris, S. 2018. Is Your SI Joint Causing Your Lower Back Pain?. [Online]. Available from: https://www.healthline.com/health/si-joint-pain#treatment [Accessed 24 Nov 2021]
Imaging and Low Back Pain
If you’ve been alive on planet Earth for any amount of time, chances are you have experienced back pain at some point. 84% of adults experience back pain at some stage of their life according to research. In some cases, pain may come from an obvious source, a fall on an icy surface or a sport related injury. For a lot of people, however, pain can sneak up and appear for unknown reasons.
It’s only natural and logical to want to know why the pain is there and what caused it so you can avoid it in the future and hopefully correct or remedy the current issue. You would imagine that the use of medical imaging, such as X-Ray, MRI, CT scan etc. would be useful in this scenario. But what if the opposite was true. According to research this is absolutely the case for low back pain.
It turns out that imaging the back in hopes of diagnosing a pain causing issue produces many false alarms.
Signs of spine degeneration, including disc herniation are present in very high percentages of healthy people that don’t experience pain at all. These changes seen in imaging (degeneration and herniation) are best understood as just a part of the normal aging process of everyone.
Getting an MRI or X-Ray for back pain can give patients the idea that their back might be broken, crooked, out of place or fragile. When in fact most backs all contain these features. This can produce a lot of fear and prevent people from partaking in activities and exercise and may make their pain worse.
The reality is that low back pain can be greatly multifactorial, and the one or two “abnormalities” (but likely normal changes) found on imaging are just one small factor in a complex situation involving a patient’s habits, beliefs, stress factors, biomechanics, injury history etc. that can contribute to their pain.
Imaging such as MRI and X-Rays can be important and very useful, but it is now recommended that when dealing with back pain, imaging be reserved for severe and persistent back pain where there is weakness in the extremities or where cancer or an infection is suspected.
Osteopaths can help make sense of back pain and explain what might be causing your symptoms. They can help relieve pain through manual therapy techniques and give lifestyle and rehabilitation advice on the best strategies to overcome it.
Speak to an Osteopath today!
Written: Jared Cox
References
An online investigation into the impact of adding epidemiological information to imaging reports for low back pain
Yasmin Medalian 1, G Lorimer Moseley 1, Emma L Karran 1
Iatrogenic Consequences of Early Magnetic Resonance Imaging in Acute, Work-Related, Disabling Low Back Pain Barbara S. Webster, BSPT, PA-C, Ann Z. Bauer, MPH, YoonSun Choi, MA, Manuel Cifuentes, MD, MPH, ScD, and Glenn S. Pransky, MD, MOccH
Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations
W. Brinjikji, P.H. Luetmer, B. Comstock, B.W. Bresnahan, L.E. Chen, R.A. Deyo, S. Halabi J.A. Turner,A.L. Avins, K. James, J.T. Wald, D.F. Kallmes, and J.G. Jarvik
Spondylolisthesis
Spondylolisthesis is a spinal condition that in the sports world most commonly affects cricketers and gymnasts, but in reality, can affect anyone! Pronounced ‘spon-di-lo-lice-thee-sis’, it most commonly affects the lowest segments of the lower spine region.
What is spondylolisthesis?
Spondylolisthesis is the slipping forward of one vertebra on another. This most commonly occurs at the L5 segment (the lowest vertebrae in the lumbar spine), which slips forward on the S1 segment of the sacral bone. The runner up? L4, which is also a commonly affected area.
There are a few different causes of this condition, and so it has been classified into different types. There are five categories of spondylolisthesis. These are:
- Degenerative: Occurs due to degenerative changes to the spinal facet joints and discs
- Isthmic: Occurs due to a bone defect in a part of the vertebrae known as the ‘pars interarticularis’
- Traumatic: Occurs following a trauma that results in a fracture of either the spinal facet joints or pars interarticularis.
- Dysplastic: Occurs due to a developmental defect of the vertebrae which alters the direction of the spinal facet joints, leaving the segment(s) open to slippage in the area where they are partially held in place by the facet joints.
- Pathologic: Occurs secondary to a medical problem such as infection or cancer.
In theory, any process that leads to the weakening of the supportive structures of the spinal segments (i.e. the bones, ligaments, discs, muscles) can lead to abnormal movement of the spine.
Grades of spondylolisthesis
Spondylolisthesis is further classified based on the amount of slippage that has occurred:
- Grade 1: Between 0-25% of the vertebral body has slipped forward on the vertebrae below
- Grade 2: Between 25-50% has slipped forward
- Grade 3: Between 50-75% has slipped forward
- Grade 4: Over 75% of the vertebral body has slipped forward
The most commonly reported grade of this condition is grade one, accounting for approximately 75% of all cases.
Signs and symptoms
These vary depending on the cause, but can include any or all of the following:
- Low back pain, including pain in the buttocks
- Pain along the back of the thigh which rarely goes lower than the knee
- Tight hamstring muscles
- Changes in walking pattern
- Pins and needles and/or numbness down the legs
- Bowel and bladder dysfunction (in more severe cases)
If you come to us with low back and/or leg pain, we are trained to work out exactly what is going on based on your symptoms and medical history. We will ask you lots of questions to begin with to dwindle our list of potential diagnoses to just one or two. Then we’ll get you to move and through a thorough movement assessment, will be able to come to a specific diagnosis that we will work with you to treat.
Sometimes we may require the help of imaging to rule in or out spondylolisthesis, depending on the severity of symptoms and how much it is impacting your life. In these cases, we will send you off for an x-ray which can detect this issue.
Treatment
Most cases of spondylolisthesis can be managed conservatively, meaning non-surgical options are chosen over a surgical one. When this injury occurs, the instability of the particular spinal segment can lead to many of the signs and symptoms mentioned above. One of the main goals of treatment is to increase stability around the affected area and offload the forces that are acting on the injured area.
We will spend time educating you on the mechanics of the spine. If you understand what is happening to your spine, you will know how to protect it, without adding unnecessary stress to the area. We will also advise on appropriate footwear, as well as standing, seated and sleeping postures. Being obese or overweight is also a risk factor for developing, as well as maintaining this problem. If you need to lose weight, we can help you formulate a plan to get there.
Exercise to increase core stability, as well as flexibility of tight muscles is a very important part of therapy as this will reduce the need for external supports such as braces in the long term. And of course, not forgetting our wonderful hands which will get to work on your muscles and joints to reduce tension and tightness, while increasing range of motion. Our osteopaths can help you manage your spondylolisthesis.
All of the above treatments will help you to manage pain, increase function and get you back to work or sport or gardening… Whatever your goal is! Call us today on (416) 546-4887 or book online at beachealth.janeapp.com if you have low back pain, or even if you already have a diagnosis of spondylolisthesis, and we can help you formulate a recovery plan to get you on the road to better health.
References
- Chila, AG. et al. 2011. Foundations of Osteopathic Medicine. 3rd ed. Lippincott, Williams & Wilkins: Philadelphia
- Tenny, S. and Gillis, C. 2020. Spondylolisthesis. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430767/
Dead Butt Syndrome
If you sit at a desk all day, you may experience vague discomfort and pain where you sit. Doctors may call this lower cross syndrome, gluteal amnesia or gluteus medius tendinosis, but another term is more memorable: “dead butt” syndrome. In this syndrome, muscle tightness and weakness combine to create an imbalance. Constant sitting weakens the gluteus medius, one of the three primary muscles in the buttock. It also tightens the hip flexors.
The job of the gluteus medius is to stabilize your hips and pelvis. When it’s weak and can’t function properly, you may experience varying levels of hip and lower back pain when you sit and sometimes when you move. Muscle weakness can also compress, pull or pinch the nerves, leading to the numbness related to dead butt syndrome.
What causes ‘dead butt’ syndrome?
Not surprisingly, sitting for long periods in front of a desk or in a car is the most common cause of dead butt syndrome. The weakness is gradual, happening over time, and most patients have no idea what they did to cause the pain. But the problem also strikes those who are active. Athletes, especially avid runners who forgo cross-training and strength training, can also develop this syndrome
Simple exercises that help
1. Side-lying leg lifts
Repeat 15 to 20 times, in sets of three, every day:
- Lie down on your right side.
- Lift your left leg with your big toe pointing toward the floor, and lift.
- Repeat on your left side, lifting your right leg.
Once you are comfortable doing this exercise regularly, you can work with a band or an ankle weight for extra resistance.
2. Clamshell
Repeat 30 to 40 times, in sets of three, every day:
- Lie down on your right side with both knees bent.
- Keeping your feet touching, lift your bent left leg toward the ceiling.
- Repeat on your left side, lifting your bent right leg toward the ceiling.
3. Hip Flexor Stretch
Hold for 30 seconds for each side, repeat twice a day.
- Kneel down on your affected leg and stride the other one out in front. There should be a large space between both legs.
- Add a pelvic tuck ie. tuck your tail under
- Push your hips forward and raise one arm up above your head reaching up towards the ceiling while you push your hips forward. Make sure you keep your chest up. You should feel this stretch through the front of the hip.
Simple changes that head off pain
Making adjustments in how you work at your desk can also relieve dead butt syndrome — or prevent the problem before it develops. For example, try sitting for 40 minutes and then standing for 20 minutes. Use the standing time to talk on the phone or even better use a sit to stand desk. Variety is the take-home message.
Pandemic Posture
It has been, and continues to be, uncertain times for many of us as the virus pandemic continues to sweep across the globe. Lockdown has meant many of us have had to batten down the hatches and re-discover what it means to be ‘at home’. We ask you the question “how is your body being affected?” Let us take you on a scan of the body, focus on some potentially problematic areas, and give you some advice to avoid any long-term issues.
Head and neck
First stop is the very top! For all of you that normally head out to the office every day, the pandemic might mean you’ve had to start working from home. Not having your usual desk set up can place a great deal of stress on the neck region. Are you now working on a laptop instead of a desktop computer? Are you sitting on the sofa instead of an adjustable chair? Close your eyes for 30 seconds and hone your thoughts in to your neck. Move it around… How does it feel? Is it tight, restricted or does your head feel heavier than usual? It could be that your new ‘desk’ set up’ is causing some strain in places it doesn’t usually. Think about the effect of having your head looking down at a laptop for 8 hours a day compared to straight up at a monitor set to the ideal height… Your poor muscles must be feeling the strain too. We recommend trying to recreate your office space as close as possible to the real thing. If you don’t have a desk at home, a dining table may be more suitable than sitting on a sofa or armchair. You also need to ensure you are moving your neck and shoulders more regularly to avoid them being in a strained position for too long. Take a break every 30 minutes and move into a different position.
Spine
Our spine sits at the core of the body, and we need good function throughout to ensure our limbs can also function with minimal effort and maximum efficiency. Are you used to an active job and now you find yourself homeschooling the children, or trying to break the day up with a bit of reading, gaming, TV or doing a crossword? Life is suddenly much more sedentary for most of us, so it’s important to avoid getting stiff. Sitting with poor spinal posture for extended periods, day after day can wreak havoc. Our spines curve ‘out in the mid-back and ‘in ’ in the lower back. If we don’t look after those curves carefully by protecting our posture from excessive strains, then we leave ourselves open to sore backs and poor functioning limbs as a result. We recommend avoiding long periods of sitting or lying down. Save it for bedtime! Try some standing spinal twists or bends (gently, of course), go for a walk around the garden, or do a session of yoga, Pilates or simple stretching through the day to mobilize your spine. If you have kids, get them to do it with you. They will enjoy a break from their school work, no doubt.
Hips
Anyone who works in a seated position knows what effect this can have on the hips. Having your hips in a ‘flexed’ or in a seated position for long periods of time can leave your hip flexor muscles tight and short. This decreases your ability to open the body out into a fully straight position, reducing flow of fluids through the central part of your body and leaving the back chain of muscles in a lengthened state, which can eventually result in the weakening of the chain. We recommend lots of upright exercises for this one. Counteract the time spent seated working or binge watching a TV series with some standing-based exercise. Jumps, skipping, walking, running or bridging is a nice way to open those hips and get the blood flowing. Our underlying message through all of this is to move, move, move! You are a movement machine, so regularly start the ignition and go for a spin. Look after yourselves and please get in touch today on 416-546-4887 if you need help keeping your pandemic posture in check!
Proper posture at your office
Most postural issues are caused from everyday habits from everyday activities such as sitting in office chairs, staring at a computer, prolonged use on your mobile phone, especially smart phones and iphones, carrying a purse or bag over your shoulder, driving and repetitive physical activities.
If your job involves prolonged sitting, like so many individuals that work in an office space or corporate environment, you may experience the pain and discomfort caused by poor posture.
Prolonged sitting for desk work can lead to muscular and skeletal imbalances. Your skeletal system gets used to the hours of sitting in an unnatural position, wreaking havoc on your body, posture, and causing more serious long-term issues. Continuous daily sitting affects posture and can also cause physical pain, strain, and discomfort.
Here are some basic tips to improve posture and ergonomics, especially for people who sit for most of most of the day.
- Sit up straight
- Align the ears, shoulders, and hips in one vertical line.
- Sitting in the one position for a prolonged period of time, even a good one, can be tiring. Shifting forward to the edge of the seat with a straight back and alternating with the support of the chair can help add some variety.
- Take regular breaks and get up and move around. Get up every half hour for two minutes to stand, walk or stretch.
Improve your set up at your desk:
- Head is level and inline with the torso. Beware not to draw the head forward towards the computer screen as this can put a lot of stress on the neck.
- Shoulders are relaxed, not shrugged, and upper arms hang normally at the side of the body.
- Hands, wrists, and forearms are straight, inline and roughly parallel to the floor.
- Keep your elbows close to the body, ideally at your sides, this will take stress off the back of your shoulders and your mid back.
- Keep your back upright and not slouched.
- Keep the knees and hips at the same height
- Keep your feet on the ground and if you cannot touch the ground use an elevated footrest.
If you are still finding that you are having a very hard to sitting for long periods of time, talk to your HR to request a sit stand desk. A simple and affordable sit stand desk, such as veridesk, can be a good solution.
Try to keep an active lifestyle. This can help reduce the impact of poor posture on your skeletal system and improve overall health. Try to incorporate more physical activities into your routine, such as going for a walk with your pet or taking advantage of a gym membership. Being active doesn’t necessarily have to mean an intense gym workout or marathon, although those are great too. It can be as simple as taking some time to stretch and do low impact yoga or taking a walk in your neighbourhood or local park.
Try these simple tips and you will notice a difference. If you are still experiencing pain, such as neck or back pain, feel free to call us on (416) 546-4887 to speak to one of our osteopathic manual practitioners or book online at beachclinic.janeapp.com and we can help you become pain free.