Treatment for Sacroiliac Joint Pain
What is the Sacroiliac Joint?
The joint is comprised of the area in which the sacrum and iliac bones meet.
Stabilization of the SI Joint: Two Types
Form Closure
Form closure is the stability that happens when the tight fitting joint surfaces of the SI joint are close together. This is very much dependent on the size and shape of each person’s structure.
Force Closure
Force closure is the support offered to the SI joint by the ligaments and muscular systems.
Most research is is clear that no muscles directly move the SI joints, but its important to understand how their dysfunction can promote sacroiliac joint dysfunction.
Addressing Sacroiliac Joint Pain
Sacroiliac joint treatment options beyond medical interventions are quite simple, in fact. They need to be separated into 2 different scenarios:
What to do when the sacroiliac joint is OUT:
As mentioned previously, there are not any muscles in particular that move the SI joints. However, there are some movements that are useful in assisting the mobilization of the sacroiliac joints.
Unfortunately, sometimes its not possible to get the joints back into balance on your own. Many times with patients, I have to help them by anchoring certain parts of their pelvis or sacrum while they perform movements in order to re-balance the area. Therefore, its recommended to see a trained professional to help with this.
The good news is, on more than a number of occasions, someone walks into my office with sacroiliac joint pain of a 9 on a 10 scale, and within 5 minutes, I can get them down to a 2 or a 3. This just demonstrates how much potential to cause pain these joints have, AND how quickly it can be resolved by doing the right steps to resolve it.
What to do when the sacroiliac joint is IN:
Once significant pain is resolved, and sacroiliac joint inflammation is reduced, corrective exercises and stretches must be implemented in order to effectively restore balance to the muscular “slings” that support the area.
Sacroiliac joint exercises need to focus on two areas. Some of the key muscles that need to be addressed are found in two different “layers” of muscles.
The Inner Unit:
The inner unit muscles are a deep set of muscles that help stabilize your entire core and are frequently shut off, or possess inappropriate activation patterns during periods of pain. They include:
-The muscles of the pelvic floor
-The transverse abdominus
-The multifidus
-The diaphragm
These muscles must be isolated to ensure proper activation and sequencing, then integrated with the next group of muscles, called the Outer Unit.
The Outer Unit:
The outer unit is further segmented into 4 systems, but in essence, involves the following muscles:
-The gluteals (all of them)
-The spinal erectors
-The abdominal wall
-The groin muscles
-The hip flexor and quadricep muscles
The real trick to resolving any problem with back pain seems to always come back to the correction of the deep muscular stabilizer systems of the body, then re-integrating them with the larger, more powerful muscles.
If you don’t follow this sequence, your results will be limited to symptom relief for the short term. I have seen this time and again in my practice with patients who have progressed their programs too quickly just to “get stronger”.
When I end up seeing them after the many therapists they have seen prior to me, I have to take them back to the beginning anyway. In this situation, unfortunately, they have been taught to OVER activate the larger muscles, and I have to re-train them to focus on the micro-movements that need to be done.
Lesson here: Whats worth doing is worth doing RIGHT the first time!
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Inflammation and Back Pain
Pelvic Tilt Measurement
A common email question I receive is about measuring pelvic tilt. The best way to measure pelvic tilt is with a specialized set of calipers that were developed by neuromuscular therapist Paul Chek. These can be quite pricey, and are only usually found in the offices of skilled therapists.
The other way to measure pelvic tilt, which is quick, cost-free, and easily done is home is by looking at your belt line in the mirror. Usually, the front of your belt line rests either slightly above, or slightly below the Anterior Superior Iliac Spine, which is the small bony protuberance just above your thigh. The backside of your belt line usually rests again just above or below the Posterior Superior Iliac Spine, which are found about 2 inches to the side of the spine.
When you look in the mirror at your side view, you will look at the angle of the belt line. For men, the line should be parallel to the ground, with neither the front or the backside higher than the other, with normal measuring 0-5 degrees. For women, the angle should be slighter lower on the front side than the backside within approximately 7-10 degrees being normal.
It is important to note, that these are the “textbook” normal values for pelvic tilt. It should not be the ONLY evaluation for normal function and balance of the core muscles. You should also evaluate the range of motion and strength of all the associated muscles in order to really test total function of this area. You do NOT have to be perfect, but close enough to be out of pain!
Sam Visnic–
Free Program: Strategies For The Correction Of Anterior Pelvic Tilt
Anterior pelvic tilt is the most common postural dysfunction affecting back pain sufferers. I’ve created a brief report and intro program for assisting in the correction of anterior pelvic tilt.
Download it by clicking here: Enjoy!
4-essential-strategies-for-the-correction-of-anterior-pelvic-tilt
Thoracic Kyphosis: The “Hunch-back” Posture
What Is Thoracic Kyphosis?
Kyphosis refers to a natural curvature of the portion of the spine called the thoracic spine. The opposite curvature, called the lordosis typically occurs in the cervical and lumbar spine.
Since kyphosis is natural in the spine, we have to identify what excessive kyphosis is, which is generally the problem. Generally speaking, a normal for a thoracic kyphotic curve measures between 30 to 35°. In excessive kyphosis would be greater than 35°.
Many times, however, it’s important to realize that the thoracic curvature is only greater than 35° when you’re slouching, and in many cases corrects into the normal range as you stand upright. So a quick test involves this: stand sideways in the mirror, and look at your curvature in your thoracic spine. Now, imagine that you have a look attached underneath your sternum and it is pulling up to the sky. As you perform this motion, notice what happens to your thoracic curve, when you look in the mirror.
A second test can be performed, which may determine whether there is a lack of mobility in the thoracic spine. In this test, you will perform the exact same movement, with the exception that you will lift your arms up and behind your head and as far as you can comfortably go, and notice what happens to your curve. Typically, the thoracic spine, should decrease in curvature by approximately 14°, or be straight. Oftentimes this is difficult to eyeball, that is when the clinic to use special calipers to measure this. However, since you don’t have these, eyeballing it will have to do.
If you are not able to reduce your curve enough, there may be some rigidity in your thoracic spine and may need mobilization work.
Pic of excessive thoracic kyphosis
What Causes Kyphosis?
Excessive thoracic kyphosis can be caused by some random things such as nutritional imbalance as a child, such as vitamin d deficiency, or problems with growth plates. The majority of excess kyphotic postural problems occur frankly from slouching! Bad postural alignment today is rampant, particularly since we spend so much more time on the computer.
Another cause for kyphosis involves a strong mental-emotional component. Emotional states such as depression, worry, anxiety, lethargy, and hopelessness lead to a slouching of posture. Many times, however, if the kyphosis can be completely corrected by standing upright, and these emotions are present, they may need to be addressed as the root cause.
Treatment for Kyphosis:
Excessive thoracic kyphosis can be treated in a number of ways naturally. Its important to realize, however, that correction of kyphotic posture takes time. It involves exercises, stretches, mobilizations, as well as continual postural correction. You’re looking at anywhere from 3 months to 1 year to make significant progress on reducing excessive postural kyphosis.
Kyphosis Exercises:
The Prone Extension: This is a drill that I include in the “End Your Back Pain Now!” DVD set. It is a lying down exercise that focuses on strengthening the muscles of the upper back, which over time, can reduce the excess kyphotic curve in the thoracic spine.
Brugger Relief Position: The Brugger relief position is essentially a combination of postural “cues” that can assist you in getting into good postural alignment, which can reduce strain on muscles, and give you temporary relief from pain. Here is how to do it:
1. Sit at the edge of a chair.
2. Move your knees apart a bit, and make sure your feet are under your knees.
3. Perform a slight anterior pelvic tilt.
4. Externally rotate your arms so that your palms face forward.
5. Separate your fingers and point your thumb backward.
6. Retract your head so that it is in alignment with the rest of your body.
7. Hold this position for as long as possible, while breathing naturally.
8. Do this throughout the day on a regular schedule, such as every hour on the hour.
Kyphosis Stretches:
While it is essential to strengthen the muscles that are causing the slouching of the thoracic spine to occur, it is also important to stretch the muscles that are holding the postural dysfunction in place. Two muscles that can significantly contribute to excess thoracic flexion include the abdominals, as well as the diaphragm.
Abdominal stretching: Stretching your abs can help tremendously in reducing thoracic kyphosis, because at the same time you stretch them, you are mobilizing your spine. One of the best ways to stretch your abs is by laying over a swiss ball. Its important to make sure you relax as you do this stretch, and breath naturally, as this will serve to improve the release you get.
Foam rolling the thoracic spine: This technique involves laying over a foam roll, like what you find in the gym, for the purpose of mobilizing your spine. Basically this means stretching it backwards over the roll. This technique can be quite tender on your spine at first, particularly at those spinal segments that are not moving very well, but can improve quickly over about 2 weeks with consistent work on the roller.
Washington Post Article That Back Pain Sufferers Should Exercise…
Hey, it may not be much, but its about time people REALIZE exercise for back pain relief is ESSENTIAL!
Lower Back Pain in Sitting vs. Standing
Does sitting really cause back pain? In my opinion…NO!
Here are two different scenarios:
- Hurt more standing and get relief upon sitting
- Hurt more sitting and get relief upon moving around or standing
What are the possible reasons for these situations:
In number one, bad posture and muscle imbalances may be causing the pain. Particularly when there is excessive anterior pelvic tilt, such as when the psoas and/or quadriceps muscles are too tight, pain in the standing posture can be present.
Another issue that can be the cause of pain while standing, especially when there is no pain for a short time, then the pain gradually comes on, is due to ischemia. That is, lack of blood flow to muscles. This is usually due to the type of situation that I just described about anterior pelvic tilt, but there can definitely be biochemical causes of ischemia.
Either way, in this situation, you are likely to say “When I get off my feet, whether that be sitting or laying down, my pain goes away.”
In the number 2 situation, there can also be issues with ischemia, particularly if you have a desk job and sit “hunched” over a computer for 8 hours per day!
Another potential reason is that there may be a structural problem with the spine itself. When a disc bulge is present, sitting can make you feel worse than standing. Why? Because pressures on the spine are significantly higher during sitting than standing.
When I work with patients with disc bulges, I suggest that if possible, they transition their sitting work stations into standing work stations. Yes, it does suck to stand all day, but it’s FAR less painful, and can dramatically speed up the healing process.
The other thing that can cause you to have more pain in the sitting position that relieves upon standing is either spinal disc degeneration, or spinal stenosis. Both of these situations can be related, since they both involve loss of height in the spinal discs, thus increasing pressure on the nerves that exit the spine.
However, just as well, you can have no pain in the seated position, but still have one of these conditions. I have seen patients with other types of spinal derangements, who have no pain sitting, because they sit in such a way that does not increase the pressure on the area that which is dysfunctional!
Bottom line…
Neither is “bad” for you if you have back pain, but either of which CAN make you hurt more depending on what is causing your pain.
–Sam Visnic
Sam Visnic Now A “Medical Expert” On Ehealthforum.com!
Very cool news!
I have just been selected by Ehealthforum.com to be a medical expert on their website. This website allows you to ask questions about all sorts of health problems, and specialists answer the questions.
I am very happy to have this opportunity to serve others, and help back pain sufferers from all other the web! Check it out!
–Sam Visnic
Mechanical Low Back Pain
One of the more challenging aspects of the “lower back pain enigma” is determining if the root cause stems from one of the 3 areas:
1. Structural/Mechanical
2. Biochemical
3. Mental/Emotional
Any of the above 3 can contribute to chronic back pain, but there are a few solid indicators that can point to mechanical origins of the pain:
- Pain is cyclic
- Lower back pain is often referred to the butt and/or thighs
- Morning stiffness or pain is present
- Pain when starting movement
- Pain rises when bending forward and also on returning from a bent over position
- The pain can be made worse by extension, side bending, rotating, walking, sitting, or many forms of exercise
- The pain becomes worse as the day goes on
- Changing positions can make it better
- Laying on your back relieves the pain
These factors lead me to point the finger at mainly structural causes of lower back pain. However, as I have mentioned in other posts, the other 2 areas of health, biochemistry and mental-emotional stress can contribute to some of the reasons why the mechanical dysfunction exists!!
Sam Visnic–
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"Having someone like Sam to refer my patients to who is as comprehensive, brilliant and caring as he is makes my job so much easier!! I feel assured that my patients are in good hands and are going to get the results they so desperately want. I highly recommend Sam to anyone who is looking to resolve their back pain easily and effectively!”
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“I've used Sam on more than one occasion to help me with back pain issues. As a full time web designer I often spent too many hours sitting behind the pc which led to chronic back pain. I started working with Sam a few years ago and his knowledge and insight helped me to alleviate my back pain issues and even improve my posture. Whenever I start to have back pain issues I just re-implement the tools and techniques he showed to me and in no time my back pain goes away. He really is the back pain specialist!”
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-Dr. Matt Costantino
HealthSource Chiropractic and Progressive Rehab