by Dr. Michael Baranov, PT, August 26, 2015
You’ve got intense low back pain radiating into the leg. It gets worse when you walk or stand, but gets better when you lie down. Does that mean you need sciatica treatment? Maybe sciatica isn’t your problem. It could be your sacroiliac joints. Our specialists provide sciatica treatment in Ditmas Park but before they do so, they complete a thorough evaluation of your problem to make sure it isn’t a sacroiliac problem.
This lesser-known inflammation is often confused with sciatica or a herniated disc because this joint refers pain into the buttock and into the thigh just like sciatica. You need an accurate diagnosis of SI joint pain to pinpoint the problem, and good physical therapy to keep you mobile.
What causes SI joint pain?
The sacroiliac joints connect the triangular bone at the bottom of the spine with the pelvis. These joints don’t move much on their own, but act as a “shock absorber” that directs the motions of the upper body into the hips and legs. The cartilage between those joints can get worn away or damaged, which causes the pain.
Because these joints are “load bearing,” your upper body weight applies stress to them and arthritis can occur in these joints as well. Pregnant women also can experience SI joint pain when hormones cause the ligaments around the joints to relax. Oddly enough, pain can be caused by either too much motion or not enough motion in the joints.
Here’s some details about symptoms and muscles affected with SI problems right from Wikipedia:
Common symptoms include lower back pain, buttocks pain, sciatic leg pain, groin pain, hip pain (for explanation of leg, groin, and hip pain, see referred pain), urinary frequency, and “transient numbness, prickling, or tingling.” Pain can range from dull aching to sharp and stabbing and increases with physical activity. Symptoms also worsen with prolonged or sustained positions (i.e., sitting, standing, lying). Bending forward, stair climbing, hill climbing, and rising from a seated position can also provoke pain. Pain is reported to increase during menstruation in women. Patients with severe and disabling sacroiliac joint dysfunction can suffer from insomnia and depression.
Affected muscle groups
Many large and small muscles have relationships with the ligaments of the sacroiliac joint including the piriformis (see “piriformis syndrome”, a condition often related with sacroiliac joint dysfunction), rectus femoris, gluteus maximus and minimus, erector spinae, latissimus dorsi, thoracolumbar fascia, and iliacus. Any of these muscles can be involved or spasm with a painful and dysfunctional sacroiliac joint.The SI joint is a pain-sensitive structure richly innervated by a combination of unmyelinated free nerve endings and the posterior primary rami of spinal segments L2-S3. The wide possibility of innervation may explain why pain originating from the joint can manifest in so many various ways, with different and unique referral patterns (see “referred pain”) for individual patients. Patients with sacroiliac joint dysfunction can also develop tightness and dysfunction in the hamstring, quadriceps, iliotibial tract (see “iliotibial band syndrome”) and hip flexors, including the psoas muscle. Individuals with severe and long-standing sacroiliac joint dysfunction can develop muscle deconditioning and atrophy throughout the body due to limitation of activities and exercise that bring about pain in the low back.
Diagnosing SI Problems
SI joint pain is hard to diagnose because it mimics other conditions. Your doctor will try moving the SI joints, to discover if they’re causing your lower back and leg problems. If they are, your doctor will most likely give you an injection of an anesthetic plus an anti-inflammatory like a corticosteroid for immediate pain relief. You may also need an X-ray or MRI; but, before you go through all of that time and expense, you can come directly to a specialist at MBF Rehab.
When the pain subsides, you should start physical therapy to avoid future recurrences. This is important, since you need to strengthen the muscles around the SI joints and increase the blood flow to speed the healing. You can learn gentle exercises and stretches to keep you moving and pain-free.
If you have back and leg pain, contact us for an appointment. We will help you understand the problem and we can provide conservative treatment on the same day.