Updated: Mar 29, 2022
Low Back Pain is the most common type of orthopedic musculoskeletal condition in existence with the highest rate of disability, as well as the biggest reason why people miss work in the United States. As this is 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 because of back pain does not seem to be going anywhere.
I have had many patients tell me that they have pain which they feel stems from their back but seems lower on the body. They would tell me, "I feel it near my tailbone." When asked to point to it, most times the area they are referring to would be too high to be the actual tailbone.
As a trained physical therapist, I’m able to get a sense of what they have going on. The pain is somewhat back-related, and can sometimes even refer to the hip, as pain in this area results in compensation and extraneous movement throughout both the low back and the hip. Still, 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 (i.e., from about the top of your pant line to about the top of your butt crack is where this lives).
Causes of Sacroiliac Joint Pain
There are many causes of sacroiliac joint pain. Here are just a few that I have seen been the causes of pain in past clients:
Obesity sacroiliac pain is a common consequence of being markedly overweight. Obesity creates many dire health issues in its victims.
Pregnancy sacroiliac pain can occur from hormonal changes while carrying the baby or during birth itself.
Postural sacroiliac pain might be contributed to by different leg lengths, sacrum misalignment, scoliosis or functional issues that create poor anatomical form. Sacroiliac pain from different leg lengths can be further divided into structural and functional case profiles. Foot pronation sacroiliac pain is a controversial theory that suggests specific postural changes have occurred and are now affecting the SI joint.
Sacroiliac infections can cause sacroiliitis and pain from some forms of local and systemic contamination.
Myths and Misconceptions About This Area
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 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 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 treatment can be provided within 1-3 sessions with complete relief of the pain associated.
Misconception #1: This Joint Does Not Move
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 elusive to researchers as far as ability to fully assess how much movement there 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 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.
Misconception #2: This Joint can Dislocate
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 to do so. Shifting this joint would only occur 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 that are present and effectively stabilize these joints.
The issue why pain develops in this area is due to either 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 cannot only reside in the hip or lumbar spine region but can also result in some nerve compression, such as the sciatic nerve resulting in radiation of pain or numbness and tingling down your leg.
Misconception #3: Rest, Injections, Medications and Surgery Will Fix the Issue
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 either cover up your symptoms, or in the case with rest, cause you to become weaker and/or develop more pain when you restart your normal activity.
Additionally, surgery around the sacroiliac joint is never something I would recommend unless it was ABSOLUTELY necessary as you may have gross instability (very very very rare) of the joint. Surgery at this joint would involve fusion and in time, and as such, you will develop further back and hip pain as 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.
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.
Best Treatment for Sacroiliac Joint Pain is……(you guessed it) Physical Therapy!
Physical therapy for sacroiliac pain is one of the most common and effective treatments for several sacroiliac pain diagnoses. In fact, physical therapy might be the very best approach to care for virtually all cases of sacroiliac joint dysfunction that are caused by ligament and muscle imbalance problems. While physical therapy is often considered a symptomatic treatment for most forms of back pain, it certainly qualifies as a curative intervention for many SIJ scenarios.
Effective and long-lasting, pain free healing and living first requires accurate diagnosis as to YOUR specific cause to your pain and 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 should be achieved.
For example, if you need to be able to lift your 50+ lb. child from the floor, then you need to train, practice, and execute the ability to lift a 50+ lb. object (and then some) from the floor in multiple positions and fashions so you are prepared to go throughout life without worrying about hurting yourself.
Additionally, if you are an athlete, you want to be able to train in both education and practice appropriate movements, as well as be exposed to forces as you would be exposed to during sport. Therefore, if you are a runner, you should perform plyometric drills and work on running form with gradual exposure to force like training and racing conditions to ensure there is no recidivism (chronicity) of your condition. If you are a cyclist, you should educate yourself on correct posture on the bike, fitting, and even training and exercise targeted at getting to a specific power level .
If you, a loved one, or a 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 click the link HERE to fill out a webform to learn more about how we can help you. Lastly, don't forget to give us a follow on Facebook at Ascent Physical Therapy, PLLC and on our Instagram Page HERE.