Hi everyone– happy Monday!
In my last post, I shared a great video from Coordinated Health that provided a great overview of the different causes of low back pain, and how SI joint dysfunction fits in to that bigger picture.
Here is one of the later videos in that series; this one focusing exclusively on SI joint dysfunction.
In this video, Dr. Brian Goldberg (I believe he is a physiatrist) talks more about the SI joint, how it can be injured, and how it can be healed.
Like I do every time I find a great resource, I wanted to take a few notes down for myself to revisit, as well as for you:
Dr. Goldberg starts out by explaining a bit about the anatomy of the joint.
“It is predominantly a pelvic structure, and therefore can be injured during any rapid force that the pelvis sustains.
The joint serves to transmit the force between the leg and the rest of the body, or between the low back and the leg. So anything that would jar your lower back, and then (the force would) be transmitted to your leg, or anything that would jar your leg and then be transmitted to the back, could injure your sacroiliac joint.”
An example of force being transmitted from leg to back would be someone who is in a car accident while driving– if they’re holding their foot down on the break during impact– that force can travel up the leg, through the SI joint, into the low back, and injure the SI joint.
Another potential cause: if someone has chronic low back pain and they’re compensating for that, it can also throw off the sacroiliac joint.
Injuring muscles that connect near the SI joint can also affect it, such as a hamstring strain.
2:45 He explains that some of the diagnostic tests he uses involve putting the person into positions that temporarily make their pain worse– it’s uncomfortable, but worth it for diagnostic reasons.
History and physical exam are not accurate enough to rule SI joint dysfunction in or out, the gold standard for diagnosis is to inject the sacroiliac joint under x-ray guidance with a combination of lidocaine (numbing) and steroid (anti-inflammatory). If that injection makes the pain disappear, even if it’s temporary, then it’s clear the joint was the source of pain.
3:40 Radiofrequency ablation: a treatment technique in which some of the nerves with sense pain from the SI joint can be destroyed, so they no longer send pain signals. (I haven’t written about this on my blog at all yet because I’m not very familiar with it).
Also mentions physical therapy, chiropractic, and prolotherapy (injecting sugar water into the joint to cause the ligaments to tighten back up– it’s a relatively new therapy. You can read more in it in my post here).
He also mentions acupuncture as helpful for reducing localized pain.
Physical therapy and chiropractic should be education-based— not just about alleviating symptoms, but teaching you to be more mindful of your overall posture and movement patterns.
This was NOT my experience with any of the chiropractors I saw, who only wanted to focus on adjustments and had no time to talk.
It was also not the case with the first four physical therapists I saw, who seemed to have no understanding of the SI joint at all.
Most of it I had to figure out myself, which is a big part of why I started this blog.
Can be helpful to do balance training, so you are less likely to trip and fall and re-injure the joint. (I personally have found it’s helpful to stretch after every workout to keep my muscles loose and limber– I’m much more likely to trip if my calf muscles get tight!).
Anyway, that’s all for now!
As I said in my last post, I really think this entire 8-video series is great, so I’ve created a playlist with all of the videos on my Youtube channel.
Hope you check it out!