3 Steps to Permanent Relief for SI Joint and Pelvic Pain
Today we are going to cover the 3 steps topermanent relief for pelvic and SI joint pain. Now what is SI joint painé The SI joint, ifyou do have SI joint pain, is pain on either side of the tailbone where the tailbone connectsto the pelvis. So this is a drawing of the pelvis. This is your tailbone. This isyour lumbar spine or your lower back, the bones in your lower back called vertebraesitting on top of your tailbone. Then on either side of that you have your right hip or yourleft hip if we are looking at a person from the front. When we see somebody with SI jointpain, they will typically have pain on that given side. 70% of the time, it is on theright side. Don't ask me why that is but
70% of the time we know it is on the right. You canalso get shooting groin pain, buttocks pain and symptoms down the outside of the leg thatis affected. It might be pain, numbness, tingling, burning. Typically, that personsuffers from a heaviness as well. It can also cause some incontinence and leaking issuesas along to effect sexual performance as well. It can be absolutely devastating ifthe pelvic problem is bad enough. Fortunately, most people just have pain on one side. Sowhat can you do about ité That person who has SI joint problems typically has troublerolling over in bed, getting in and out of a car, crossing one leg over the other. Usuallythey have trouble sitting for long periods
of time especially if it is on a couch or a softsurface. So it can be absolutely devastating. Now what are the steps to permanent relieffor thaté Number 1 is this. Most people when we seethem if they are going to try exercises on their own and they only have a little bitof SI joint pain or pelvic pain, they are doing stretches. Yes, there is a very basic stretchwhich most people show me on Day 1. It is a piriformis stretch which is where you grabthe knee and pull it up and across to the opposite shoulder. It will give the personwho suffers pelvic or SI joint problems and pain temporary relief. However, long termwe don't want to stretch. We want to
strengthen or stabilize. Why is thaté Whensomebody has an SI joint problem, so the center of gravity of your entire body is inthe center of your pelvis. That needs to move the right way and it needs to be stable whenyou are doing day to day activities. If it is not stable enough, what will happen is thejoint will move so far that it becomes stuck. So if we are looking at the tailbone, we havethe tailbone and we have the pelvis and you get a normal gliding day to day. If morestress, more force is put through the pelvis than the pelvis itself can handle, that SIjoint can handle, what will happen is you actually become stuck. Now that creates allsorts of problems for the muscle around it.
What most people do is try to stretch theirway out of it. The problem is not stretching and it is not flexibility. It is actuallya stability issue. If we want to stabilize, we need to do strengthening exercises. If you go on ourYouTube channel, on the Madden PT official YouTube channel, there is a tutorialcalled Top 3 Exercises for SI Joint and Pelvic Stability. They are very low grade, kindergartenlevelexercises where you can at least begin stabilizing the muscles that controlyour pelvis. But we don't want to stretch, we want to think stabilize. Step 2 is we want to take a look at our habits.So what are some habits that lead to
pelvic instability and problemsé Number oneis standing with the weight shifted. So if I'm standing like this with my weight shiftedside to side for long periods of time, what that does is over years and years and yearsit weakens the ligaments which are tissue that hold joints together that we can't control.Think about somebody with an ankle sprain. They sprained a ligament. They stretchedthe ligament but it is not a muscle. It is different than a muscle. There are littlehabits that we do. If I stand like this and let's say I weigh 175 pounds and if I'm standinglike this, I have 150 pounds on one side and 25 pounds on the other. Where if I'm standingbalanced, I have 87 Â½ pounds on each
Top 3 Exercises for SI Joint Pain
Straighten the left leg down and bring theright knee up. What you are going to do is interlock your fingers like this and pushyour knee down into your hands. This is called a single knee to chest isometric and whatit does is it actually uses muscles in your rear to rotate your pelvis. Great for people thathave pain on either side of the back, right here on either side of the tailbone. In CentralPennsylvania, many times people call it their sciatic and what they mean is theirsacroiliac but it helps move the pelvis. What we do here is we push down into the hands.5 second hold and in our we do it 10 times. This is a ball squeeze but we are going todo it with core stability and a core isometric.
Many times when we are talking about the core,a lot of people will do crunches. I don't think we have ever had a patient that we haveever helped to focus their exercise program on crunches. What we are going todo here is you are going to slightly arch your back and the way that you do that isyou stick your bottom into the mat, into the table. Slightly arch, pull your belly buttonin and up. Do you feel how that gets tight right thereé Then we are going to add a ball.You are going to slightly arch your back, pull up and in and this is about a 50% contraction.It is not all out, you are not bearing down, you are not trying out for the Olympicgames. We are just getting a little
contraction there. Slightly arch, pull thebelly button in and up and then squeeze the ball at the same time. It is actually fourthings. Arch the back, pull the belly button in and up and squeeze the ball and number fouris remember to breathe. As we are doing this it is going to be a 10 second hold, 10times. This exercise is core isometric with Theraband,a red piece of Theraband. You can also use Theratubing. Red is the lightest and youcan progress up through green, blue, black and there is a heavy grey band as well.Just about anything will work. The idea is this: you are using this movement and theband to challenge the pelvis and the low
back. We want stability here as we are firingthe muscles down here. Slightly arch the back, pull the belly button in and up andthen spread the knees and then back together. In the , we do 20 of those and you canbuild up to 30 or you can do more than that. If it is too difficult in the beginning, backit down to 10 or 15 times.
Diagnosis and Treatment of the Sacroiliac Joint Charles Harvey MD
My name is Charles Fredrick Harvey, MD. I'ma neurosurgeon in Kankakee, Illinois, employed by Riverside Medical Group. I'm going to betalking about the diagnosis and treatment of the sacroiliac joint. I first became interestedin the sacroiliac joint as a spine surgeon because I had patients coming and tellingme that they had pain in their back going down their leg. I couldn't account for thatpain easily with the MRI findings that I saw. The sacroiliac joint is the main joint connectingthe spine with the pelvis. It allows energy transfer between the torso and the legs.I see three major categories of patients with sacroiliac pain. One category is patientswho've had trauma, for example, a fall on
the buttock, a twisting injury or even a caraccident. A second category is women who have pain that's persistent in the back of thepelvis after pregnancy. In my personal experience, out of my first 100 patients with sacroiliacsurgery, 24 of them have previous lumbar spine surgery. About 20% of patients who come totheir with lowback pain actually have pain coming from the sacroiliac joint. Studieshave shown that patients who have persistent back pain after lumbar surgery frequentlyhave sacroiliac joint disorders as a source of their pain.Patients with sacroiliac joint pain have disability and pain comparable to lumbar stenosis, kneearthritis or hip arthritis. The degree of
disability can be worse than asthma, heartfailure or COPD. The diagnosis of sacroiliac joint pain requires care and attention. Thisisn't something where simple xrays or an MRI or a CAT scan clearly demonstrate thediagnosis. Symptoms of SI joint pain can include lowback pain radiating into the buttock orleg, hip pain, groin pain, a feeling that the leg is giving away, trouble with sleepingor pain rolling over in bed, trouble with sitting especially putting pressure on theaffected side and pain going from sitting to standing.The pattern of pain can be similar between facet pain, sciatica, disk herniation or sacroiliacjoint pain. Careful physical exam by a trained
physician can help determine whether painis coming from the hip, the low back or the sacroiliac joint. Some patients find thattheir pain is worse when they stand on the affected leg or with prolonged walking. Otherpatients complained of pain with sexual intercourse or changing positions. Patients sometimesdescribe that their pain is better if they shift their weight away from the affectedside, they lie on the unaffected side and some patients have relief from a back braceor sacroiliac belt. A set of five physical examination maneuversthat put specific stress on the sacroiliac joint help us narrow down the diagnosis anddemonstrate that the sacroiliac joint is the
cause of the pain. If the patient's history,physical examination and pain provocation tests suggest the SI joint is the source ofthe pain then we consider diagnostic SI injections. A diagnostic injection is done under Xrayguidance to make sure that the injection is in the right place. We use Lidocaine or Novocainelike when you go to the dentist's office. If there is 50 to 75 percent improvement inthe pain, even briefly, that's the sign that the sacroiliac joint is the source of thepain. The patient is asked to keep track of theirpain before the procedure and after and sometimes keep a pain diary for the first few hoursafter the injection. If they have significant
improvement then we like to think that's thespot that's causing the pain. Most patients with sacroiliac pain do not need surgery.The range of treatment options available to a patient include medications, physical therapy,external support like a brace or a sacroiliac belt, therapeutic SI injections where Cortisoneis added, radio frequency ablation is another possible treatment that is given by some painmanagement physicians. Traditional open sacroiliac fusion is a bigsurgery, relatively bloody and has a long recovery. Recent advances in minimally invasivesacroiliac fusion offer a new option. The iFuse implant system is a technique for minimallyinvasivestabilization and fusion of the sacroiliac