Vail Health Insights column: Is your sacroiliac joint in a jam?
October 25, 2016
Many are familiar with the proverb: "Give a man a fish and you feed him for a day. Teach a man to fish, and you feed him for a lifetime." We understand we are more empowered by becoming self-sufficient than by taking a handout. What if we applied this same concept to our bodies? When it comes to pain, we often accept handouts.
Take, for instance, a sticky sacroiliac joint, the joint that links your pelvis to your spine. These are the "dimples" bracketing the base of your spine. As the buffer between your upper body and the lower extremities, they are subject to massive amounts of stress. Naturally, they take a beating. In fact, according to an article authored by Steven P. Cohen et al. published in the Expert Review of Neurotherapeutics in 2013, 30 percent of chronic low-back pain stems from the SI joint.
Common treatments for SI joint pain include manipulation, dry needling, muscle energy, taping, injections, mobilization with movement, active release and thrusting of the leg. I have been on the receiving and administering end of all of the above. These techniques each have their merit. So why does the pain return?
Perhaps we are myopic in our approach. We look at the joint as the source of the problem, as if it went bad on us. It hurts, so it must be to blame. Most assessment and treatment takes place on a table. What happens the next time we take a step? What if we try to figure out why it hurts instead of that it hurts? What if we broaden our lens?
From personal and professional experience, I have found that SI pain is typically a byproduct of something else. A vast majority of the time, one will find a forward rotation of the pelvis, which can happen on one or both sides. Our front hipbones are meant to be level with each other, as well as with the "dimples" on our back. When this doesn't happen, we are said to be anteriorly rotated. Being in this position locks the SI joint in every possible dimension. A locked joint is inefficient and, in due course, painful.
We can unlock the joint on the table and manually correct the rotation. We can inject the joint to decrease inflammation and help lubricate the joint. Though the pain is addressed, the problem remains. We didn't retrain the brain, nor did we look at all of the connections. A forward-rotated pelvis is usually tied to a turned-out leg. A turned-out leg is typically seen with a flatter or more rigid foot. What happens in our big toe when we walk can make an impact all the way up to the skull. Nothing moves in isolation.
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We can daisy chain the pain and look at a stuck SI joint, groin pain, a torn meniscus in the knee and a bunion on the foot. By treating pieces, we miss the mark. The body is a closed system. If something isn't moving, or doing its job, another structure has to take up the slack. If a muscle isn't working, the brain will find another to do the job.
By assessing the whole body, we can address the root of the problem. We need to redistribute the workload. The body needs to be given access to forgotten options. Re-create opposition and mobility in the foot; each has 33 joints. Load the gluteus muscle in the buttock in all three planes. Stretch the psoas muscle in the pelvis in three dimensions. Rather than just doing exercises, expose the body to new movement experiences. Give the body a solution, not a handout.
Julie Peterson, MPT, is the owner of Concierge Physical Therapy Colorado. She is a certified neurokinetic therapy specialist with a strong background in manual therapy. She can be reached at 970-306-3006 and firstname.lastname@example.org. For more information, visit http://www.conciergeptcolorado.com.