I’m not going to start this post out with my normal “Hi, everyone!” because I’m not feeling cheerful right now. I’m annoyed.
I just went on Twitter and saw, for what feels like the hundredth time, someone claiming that SI joint dysfunction isn’t a real thing.
Originally, I wanted to screenshot the tweet and share it here, but really, I’m not into alienating people or picking fights on this blog. But for any of you who have come across some of these claims as well, I wanted to address this issue.
A larger context
There has been a movement within physical therapy, in the last few years, away from looking only at structural causes of back pain. That is to say, we’ve made great understandings in our advances of how our psychology affects pain.
In a nutshell, if a patient thinks something’s wrong with his or her back, it’s going to hurt more. So if you tell someone they have a slipped or a bulged disc– even if it isn’t necessarily serious, and may get better on its own– those words are very loaded. You, as the PT, can actually increase someone’s level of disability if you increase their level of fear.
A really good book that addresses this is Back Sense. A doctor recommended this to me once, long before I developed SI joint problems, and it was actually very relevant to my life at the time.
The gist is that our spines are often stronger than we think they are, and that abnormal findings on an MRI aren’t always a cause for alarm.
This philosophy is very real, and very valid.
So there’s been a movement in physical therapy, away from using terminology that is likely to scare patients unnecessarily, and instead, towards focusing on ability, and what they can do.
But, like any good thing, it’s possible to take this idea too far.
This is such an awkward subject for me, as a hopeful future PT, because I find everything I described above to be super interesting.
But.. some of the PT’s who could be considered pioneers in this area of the field have, for some reason, decided that SI joint dysfunction isn’t real.
Instead, they believe it’s the same thing I described above– that the patient experiences pain in their low back, and a PT or doctor tells them it’s SI joint dysfunction. This then increases the patient’s level of fear, and then they start imagining all of these experiences of their SI joints moving in and out of place. But really, according to these PT’s, it’s the patient’s fear talking. That their nervous system is actually creating the sensation of their joint is getting stuck, because it’s tensing all the nearby muscles up in an effort to protect them.
I feel very well qualified to tell you, based on my personal experience, that I think this is overly simplistic and wrong.
I have lived through the experience of fear creating pain, and a sense of injury. I struggled with it for years before discovering pain neurophysiology education. Long before I developed SI joint issues, I had to come to terms with the fact that my nervous system is hypersensitive, and is constantly “turning up the volume” on pain.
Pain neurophysiology education helped me learn how to turn the volume back down. It’s not a permanent process– this hypersensitivity can’t be completely reversed– but instead it becomes more of a way of life. You know your nervous system is hypersensitive, so you begin to work around it.
But in the school of thought that I learned, it’s never about denying the very existence of a possible injury. It’s not supposed to be 100% black and white. Patient and physical therapist together are still supposed to take each new instance of pain and potential injury seriously. Even though you know it’s likely to be your nervous system acting up, you don’t assume.
This is totally contrary to the belief system I often see floating around on social media.
Quite frankly, I don’t really understand why certain individuals seem so hell-bent on denying that SI joint dysfunction can be real. I suppose they believe they’ve seen patients hurt by the diagnosis, when it didn’t really apply.
But it honestly blows my mind to see the certainty with which someone will write out a tweet, or a Facebook post, about how there’s “no” evidence to support the existence of SI joint dysfunction.
This completely makes no sense to me, because there are more and more peer-reviewed studies coming out every day (I cite a few of them on this blog, but definitely want to start reading more!).
Although these studies don’t always say the same thing, or identify one clear treatment for SIJD as superior to the others… that’s very different from saying SI joint dysfunction isn’t real.
At this point, it seems like the people who feel they can proclaim SI joint dysfunction isn’t real are willfully ignoring the evidence. Because it most certainly is there.
Again, I try not to get too angry because I do believe that their intention is to help people.
But… come on. Seriously.
It would be one thing to read through some of these studies and then make a logical argument about why you agree or disagree with the methodology. That’s fine… that’s science.
But to refuse to acknowledge them, to me, is just… being a bad scientist. No one gets to ignore the evidence. No one. No matter how well-worded your tweet, or how strong your analogy.
I am so, so tempted to screenshot the best response I saw to one of these comments.
However, I’m not going to… not quite brave enough. But I will tell you what it said.
Basically, a very well-respected physical therapist — who actually does do a lot of great work helping people overcome their fears regarding their pain and injury– sent out a strongly worded Tweet about how strong the SI joint is, and how it’s virtually impossible to injure it.
And it’s really the last sentence of the Tweet that got to me, a big criticism to physical therapists and doctors treating SIJD. He wrote “If someone tells you you have SI joint dysfunction, run away.”
I really just found this so harsh, and uncalled for.
Fortunately, someone else was annoyed by it as well– an orthopedic surgeon who’s familiar with the latest research on the SI joint.
This surgeon stepped in to the conversation, and linked to this peer-reviewed article: Biomechanical analysis of reducing sacroiliac joint shear load by optimization of pelvic muscle and ligament forces.
And the surgeon joked, “Okay… we can continue the conversation in the comment section on that blog.”
This was obviously not so much a joke, as making a very strong point. Because this article was not published on someone’s personal blog… it was published in the scientific journal Annals of Biomedical Engineering.
I really thought this was the perfect response, because it completely highlighted the ridiculousness of people making proclamations about the SI joint on social media, versus actual scientific research.
After all, you can’t just “leave a comment” on an academic journal. You’d have to submit a comment that would have to pass a review by other researchers, before it would be published! There are certain standards your writing must pass before a journal will publish it.
To me, this conversation really drove the point home that there is a lot of scientific evidence out there that the medical community does not have fully sorted out.
Now, to be fair, I don’t think we have a consensus on how to diagnose SI joint dysfunction, what the symptoms are, and how to treat it. All of these things are, unfortunately, still up for debate. We need a lot more research.
But acknowledging the limitations of our current knowledge base is very, VERY different than suggesting that SI joint dysfunction does not exist.
So, if you have come across any social media comments that have made you question yourself, or feel disempowered, take heart.
Know that the people who made these comments are, ultimately, making them with good intentions.
But also know there are plenty of people out there who do believe SI joint dysfunction is real, and are doing the research to prove it.