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Sacroiliac Pain

Symptoms

Sacroiliac pain tends to be low down, often more to one side, and often extends into the buttock, the back of the thigh and sometimes the calf. It can start suddenly, but tends to persist as a dull ache, on & off, often with a feeling of pins & needles in the buttock.

This is normally made worse by side bending toward the affected side or extending the spine (backward bending).

The back will generally feel stiff in the morning.

In some cases there may be irritation of the sciatic nerve which emerges from the pelvis, causing pain to refer further down the back of the leg. This is known as sciatica.

Often this problem is made worse by prolonged sitting or standing in one position or lying on a soft surface.

The diagnosis can usually be made based on the history of the condition, and the presence of the signs and symptoms listed above. If there is any doubt, or if the pain does not reslove with treatment, it may be necessary to have an x-ray of the spine. A CT scan or MRI scan may also show the problem.

Treatment

Follow R.I.C.E protocol. The nearby muscles may tend to spasm for the first two or three days after injury. Alternate hot and cold compresses can help to ease the spasms. Avoid over-working the back for several days but do try to continue with as near to normal activities particularly walking to keep the area actively healing.

It is important to keep the region warm to relieve back pain and muscle spasm, but preferably using clothing, a pad or pillow avoiding hot water bottles or similar as these tend to cause congestion of the area.

Rest, non-steroidal anti-inflammatory (NSAIDs) drugs e.g. paracetamol, aspirin or ibuprofen should help settle the problem in a week or two.

Massage may help to ease the pain but care should be taken not to relax the surrounding muscles too quickly as this may lead to more severe reflex spasms as the back is attempting to protect the joints form further injury.  

Gentle osteopathic mobilisations help to clear the inflammation from the joints and ease the tenderness.  If the joint is strained, manipulation may be used to free the joint.

A warm shower or bath, especially with Epsom salts will help to ease the stiffness. See the Hydrotherapy page.

Memory tape strapping or a SI Strap can provide reassurance and support to the lower back.

It is fairly easy to loosen up a tight joint, but much harder to tighten up a loose, or hypermobile joint.

 Due to their position in the body, the SI joints are under constant stress: standing, sitting … even just turning in bed. It takes time and rest for the ligaments to tighten up.

The Serola SI Belt is designed to give specific, gentle but firm support to help the repair process, as well as giving welcome pain relief.

Pre- & Post-Partum Hypermobility: During pregnancy the hormone Relaxin acts to loosen the ligaments of the pelvis, allowing the SI joints to loosen, and thus the birth canal to widen. After childbirth, the ligaments should spontaneously re-tighten over a period of months. However, certain one sided strains & activities, e.g. holding the child on one hip, can lead to continued hypermobility.

About

The lowest disc, facet joints and the sacroiliac joints are very close together, and share many muscles, ligaments, and, importantly, nerves. It can be very difficult to identify just where most of the pain is coming from.

if the pelvis becomes distorted, due to a fall or postural stress, the “foundation” of the spine can become tilted. The spine has to compensate, in order for the upper body to be carried upright. Clearly, some of the lumbar muscles have to do extra work, and some of the joints have to take extra loading. The result is extra wear & tear. Sooner or later something has to give. Although an attack of back pain may occur suddenly, for no apparent reason, usually there have been minor niggles or aches for some time.

On the other hand, a minor twist or sprain in the lumbar spine can also go little noticed for a long time. However, irritation in the strained muscles or sprained joints can cause a reflex contraction of major pelvic muscles (e.g. the gluteus maximus). The result is a distortion of the pelvis (as above) adding another stress to the lumbar spine.

In the long term, these stresses can cause torsion & weakening of the lumbar discs, and this mechanism is thought to be one of the main causes of disc degeneration, with resultant sciatic pain. Whichever came first, the lumbar problem or the sacroiliac, the important thing is to get your back and pelvis lined up correctly and working properly as soon as possible.