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Why Does It Hurt By My Tailbone? - The Misconceptions & Myths Existing Around Sacroiliac Joint Pain


Low Back Pain (LBP) is the most common type of orthopedic musculoskeletal condition in existence with the highest rate of disability and biggest reason why people miss work in the United States. If this was so prominent, you would assume that health care providers would do their best to target and address this major issue. The same thing goes for the obesity issue that is still majorly present in the country. However, with the continued push and early jump to things like injections and surgery on top of providing medications and telling you to rest (not helpful), disability as a result of back pain does not seem to be going anywhere.

I have had many patients tell me that they have pain that feels like it is in their back but seems kind of low. They would tell me, "I feel it near my tailbone." When I would ask them to point too it, they would actually be too high for their tailbone most times, however, but still tells me about what they have going on. It is back related pain as it does refer up to the back and can sometime refer to the hip as pain in this area results in compensation and extraneous movement throughout both the low back and the hip. The area I speak of is the sacroiliac joint which is the bone that exists on the back of your pelvis and is the connecting point at the bottom of your spine with your tailbone right below (from about the top of your pant line to about the top of your butt crack is where this lives).


There are plenty of myths and misconceptions about this area of the body that continue to allow people to remain in pain. The research and the assessment of the sacroiliac joint is not as robust as it needs to be in order to accurately diagnose and then treat the pain associated. The current "gold standard" assessments through physical examination require testing through other joints instead of assessing directly over the pelvis as described in the Hesch Method as described by creator Dr. Jerry Hesch, DPT, MHS, PT. This assessment technique involves a unique and specific but at the same time accurate way of defining motion about the pelvis and sacral region while also determining if there is an issue that is the specific cause of your pain. Once accurately identified through gentle springing of the joint surfaces in specific ways, appropriate gentle and effective can be provided within 1-3 sessions with complete relief of the pain associated.


One of the main misconceptions of this area of the body is that after a certain age or even in general that this joint DOES NOT MOVE. This area does move, it has just been illusive to researchers as far as ability to fully assess how much movement their actually is. The amount of movement is only millimeters but there is movement. The back of your pelvis irrespective of the side bones (ilia) of your pelvis, will be able to bend forward, backward, rotate left, rotate right, side bend left, side bend right, and even forward and backward on a diagonal plane. All of these motions occur in the opposite direction of your lower or lumbar spine where if your spine bends forward then your sacrum or back of your pelvis goes backward.


A second misconception is that there is a "going out" or "dislocating" of this joint. Just the same as with your lumbar spine or even your neck, you need A LOT of force in order to do so. Shifting this joint, especially, would only be involved in a high energy car accident or a high fall and would generally be combined with fracture of the pelvis. This is due to the highly robust and prevalent ligamentous structures, fascia, and muscles are present that stabilize these joints really effectively. The issue where pain develops in this area is the result of either side or both sides of these joints becoming stiff or restricted. The restrictions cause compression of the joint surfaces which has specific sensitive nerve endings generating pain while also altering movement patterns in the hip, lumbar spine, and surrounding muscles resulting in pain elsewhere. This pain can not only reside in the hip or lumbar spine region but can also result in some nerve compression like the sciatic nerve resulting in radiation of pain or numbness and tingling down your leg.


One last and major misconception about this area is that this can be fixed with rest, injections, medications, or surgery. This is far from the truth. More than half of these are passive treatments that either cover up your symptoms or cause you to become weaker (rest) and then when you return to the causative activity you develop pain at the same intensity or before that because resting allowed you to get weaker. Additionally surgery around the sacroiliac joint is not something I would recommend for anyone unless it was ABSOLUTELY necessary because you had gross instability (very very very rare) of the joint. If you have surgery at this joint which would involve fusion you will, in a few years, develop further back and hip pain because you have interrupted the natural movement patterns that exist and force translation through this joint. As a result of increases stress to these other joints, pain and dysfunction through the hip and the lumbar spine will persist.


Effective and long lasting pain free healing and living requires first accurate diagnosis as to YOUR specific cause to your pain whether there is restriction in movement or you have muscular instability of your spine, placing increased stress on this area. Once the corrections have been made manually (if needed), graded and progressive exercise therapy progressing to a level in which incorporates all of your movement patterns and loads that you would generally experience in a day are achieved....not when your insurance company says it is enough. If you need to be able to lift your 50+ lb child from the floor, then you need to be trained, practice, and execute the ability to lift a 50+ lb object (and then some) object from the floor in multiple positions and fashions so you are prepared to go throughout life without needing to worry about hurting yourself when you go to do so. Additionally, if you are an athlete, you want to be able to trained in both education and practice appropriate movements and exposed to forces in relation to those exposed during sport. Therefore, if you are a runner, performing plyometric drills and working on running form with gradual exposure to force similar to training and racing conditions and beyond to ensure there is no recidivism (chronicity) of your condition. If you are a cyclist, educating on posture on the bike, fitting, and even training and exercise targeted at getting to a specific power level is optimal to do the same as I mentioned for running.


These are just some of the few other misconceptions out there that exist around the sacroiliac joint that continue to allow back pain, pelvic pain, and even "tail bone" pain to exist. Specific tail bone pain does exist and you should keep your eyes peeled for future posts I will present about this topic. If you, a loved one, or colleague are dealing with low back pain or sacroiliac joint pain that does not seem to go away completely, please reach out to us today so that we can go over what has been done in the past and what can still be done to alleviate what you have been dealing with. If interested, please call 516-387-4669 or check out our website at www.ascentptny.com.


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