Pain in the pelvic region ( around the waist line ) and dull aching in the low back is thought to be caused by sacroiliitis, an inflammation of one or both of the sacroiliac joint(s), which can also be a common cause of low back pain. With sacroiliitis, the individual may experience pain in the low back, buttock or thigh, depending on the amount of inflammation. Common problems of the sacroiliac joint are often called sacroiliac joint dysfunction (also termed SI joint dysfunction; SIJD). Sacroiliac joint dysfunction generally refers to pain in the sacroiliac joint region that is caused by abnormal motion in the sacroiliac joint, either too much motion or too little motion. It typically results in inflammation of the SI joint, or sacroiliitis.
The following are symptoms/signs that may be associated with an Sacroiliac joint (SIJ) problem:
l Dull low back pain.
l The pain is often a mild to moderate ache around the dimple on the back.
l The pain may become worse and sharp while doing activities such as standing up from a seated position or lifting the knee towards the chest during stair climbing.
l Pain is typically on one side or the other (unilateral pain), but the pain can occasionally be bilateral (both sides).
l When the pain of Sacroiliac joint dysfunction is severe (which is infrequent), there can be referred pain into the hip, groin, and occasionally down the leg, but rarely does the pain radiate below the knee.
l Pain can be referred from the Sacroiliac joint down into the buttock or back of the thigh, but rarely to the foot.
l Low back pain and stiffness, often one side, that often increases with prolonged sitting or prolonged walking.
The hormonal changes of menstruation, pregnancy, and lactation can affect the integrity of the ligament support around the Sacroiliac Joint (pelvis region) which is why women often find the days leading up to their period are when the pain is at its worst. During pregnancy, female hormones are released that allow the connective tissues in the body to relax. The relaxation is necessary so that during delivery, the female pelvis can stretch enough to allow birth. This stretching results in changes to the joints, making them hypermobile - extra or overly mobile. Over a period of years, these changes can eventually lead to wear-and-tear arthritis. As would be expected, the more pregnancies a woman has, the higher her chances of Sacroiliac joint problems. During the pregnancy, micro tears and small gas pockets can appear within the joint.
Muscle imbalance, trauma (e.g., falling on the buttock) and hormonal changes can all lead to Pelvic Joint dysfunction. Sacroiliac joint pain may be felt at the front, however, care must be taken to differentiate this from hip joint pain.
My experience has been that I quite have to refer patients to my colleagues in General Medicine in order the patient can reduce the inflammation prior to any manual approach. That is to patients GP or if needed to a consultant at the Fitzwilliam hospital. However I would always ask patients to take the self help approach first which I urge patients to undertake as a matter of course and it costs less than private appointments. There is very very little movement in the pelvic joints so taking the correct medical approach for pain relief is important and, as I say can with perseverance be done quite easily,
The first thing we want to do is release the two muscle groups that often play a major role in yanking your sacroiliac joint out of position and causing your pain. And we’ll be doing this on BOTH sides of the body.
Your big outer thigh muscle called your vastus lateralis is a common culprit for s i joint pain. When it’s tight it torques the head of your femur (thigh bone) and yanks on your sacrum (tailbone) via a your sacrotuberous ligament that attaches to both bones. It literally yanks your sacroiliac joint out of position all the way from your thigh, which makes it hurt. This thigh muscle is very difficult to access with stretching, and it’s a muscle that’s used a lot, so it’s a common cause of your pain.
The second focus will be on the muscle and its tendon run down the outside of your thigh. When they are tight they pull your sacroiliac joint apart by yanking your hip bone downward and away from tailbone.
Here’s what we’re going to do:
A. Outer Thigh Muscle Release
Sit in a chair or on a stool. If you are going to work on your right leg, take the tips of your fingers on your right hand and put them on the top outer third of the top of your thigh (vastus lateralis muscle).
Now curve your fingers on your hand a little bit, and take the palm of your other hand and place it over the fingers already on your leg. We call this the hand-on-hand technique - it allows you to apply pressure without tiring out your hands. You will simply press on the tissue with your finger tips, and press on your finger tips with the palm of your other hand. It’s amazing how much easier it is to work on yourself using the hand-on-hand technique.
Use your fingertips to press along the entire length of the outer third of your quadriceps on all the soft tissue (from your knee to your hip bones) and notice any tender spots.
Now......with your hand-on-hand” position......we’ll do it continuously, with your finger tips using the hand-on-hand” method into the tender spots until they become less tender.
Now do the other leg in exactly the same manner.
Notice how much sacroiliac joint pain relief this technique creates for future reference. It is often the case (70 percent of the time) that if you have pain in your right s i joint then working on your left leg in this manner releases the pain….And if you have pain in your left s i joint then releasing the right leg in this manner provides immediate lower back pain relief. Knowing this can save you or your friends and family from a lot of pain and can be a great “quick fix.”
Notice how much sacroiliac joint pain relief this one technique provides for future reference.
B. Side of Leg Release
Now do the exact same hand-on-hand technique except on the very side of your leg (iliotibial band). You can sit to do this technique or lie on your side while you do this with the side you are working on facing the ceiling.
From your knee to your hip bone, all the way up the side of your leg notice any tender spots. Press on the tender spot, while still pressing pull on that tissue a bit like you are trying to stretch it with your fingertips, and then slowly release it. Repeat that a number of times on each tender spot as you move up your leg.
You may notice at the very top to the side of your leg, there is a small muscle (tensor fasciae latae). Pay extra attention to this muscle, and do a few extra rounds.
The second group of muscles that could be causing your sacroiliac joint pain are actually on the “front of your back.” One muscle called your iliacus wraps the inside of your pelvis. The second muscle called you psoas (the filet mignon in a cow!) runs along each side of your spine.
Here’s what we’re going to do:
A. Inner Hip Muscle Release
We’re going to release a muscle called your iliacus that attaches to the inside of your hip bones. It’s a muscle, just like any other muscle, so when it’s tender it means it’s too tight. When you release it you may find it’s your instant lower back pain remedy.
Lie on your back with your knees up and your feet flat on the floor. Reach down and find your hip bone at the lower side of your abdomen. Come to the inside of your hip bone and press using the hand-on-hand technique on any tender areas.
Repeat this entire process on the other side of your body.
Notice how tender the tissue was in this area and how much sacroiliac joint pain relief you experience from doing this inner hip release. This one muscle can often be the sole cause of your pain!
B. Front Side of Spine Release
Now we’re going to release a muscle called your psoas that runs down the sides of the front of your spine. It too is a common cause of lower back pain. It’s a very strong muscle so releasing it is often the lower back pain remedy you’ve been looking for.
While still lying on your back with your knees up and your feet flat on the floor, take the tips of your fingers and find your pubic bone. Move up about an inch from your pubic bone and about an inch to one side of your midline (your belly button is a good midline marker) and gently, but firmly, press into your belly.
Now “tuck your tailbone” up and down a little bit. It’s important that you do NOT engage (tighten) your abdominal muscles while you do this or you’ll push your fingertips out of your belly. It seems to help if you push into the floor with your feet just a bit when you tuck as it seems to make it easier not to engage your abdominals.
Try to find the place where you can feel your psoas muscle moving under your fingertips. It may or may not be tender where you are pushing but I want you to at least locate the psoas muscle by making it move.
Now you just do it with a modified, gentler hand-on-hand technique and release your psoas muscle on both sides.
Notice how much tension you found in this area and how much sacroilliac joint pain relief you experienced from doing it.
If you would like any further details or clarification as to what or how to help yourself then please feel free to call me at The Bourne Osteopath Clinic, West Street, Bourne. Call 01778 426000 or e-mail firstname.lastname@example.org