SI Joint Pain… What is it and what to do about it?

Holy smokes. This is a big one. As a Chiropractor, it is no surprise that I see a lot of lower back pain. The SI Joint (the Sacroiliac Joint) can be notoriously tricky to identify and treat. My colleague, Dr Alex Hueston, a chiropractor from Duncan, BC, wrote this great article all about SI Joint pain.

Written by Dr. Alex Hueston. Chiropractor at Young Health Management in Duncan, BC (Vancouver Island). www.younghealthmgmt.com

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Sacroiliac joint pain is something I see as a chiropractor on a daily basis. It is a common condition that affects many people over the world of all ages. The sacroiliac joint is the joint between your sacrum at the base of your spine and your ilium (one of three parts of your pelvis). It connects to make up what's called the “posterior chain” and is a focal stabilizer for your body when you walk, bend or move. Unfortunately, this often results in pain for millions of people that are then not able to perform simple daily tasks without pain. In this blog post we will discuss how to identify, manage and hopefully eliminate your sacroiliac joint pain!

The pathway through this topic will be the following (so feel free to jump around!):

1. What is sacroiliac pain

2. How to identify the sacroiliac joint

3. Causes of sacroiliac pain

4. Symptoms of sacroiliac pain 

5. Solutions for managing sacroiliac pain

Important Note: Before diving into the rest of this article, it's important that none of this information should be construed as medical advice and should not replace seeing an appropriate healthcare provider. If you are in severe pain please see a healthcare provider to be properly assessed, diagnosed, and treated.

Let’s get started!

What is sacroiliac joint pain?

Sacroiliac pain is essentially inflammation of the sacroiliac joint. The pain is usually over the joint but can also be felt in the low back, buttocks, or hips. The pain can be sharp or a dull ache, typically on one side but can be present on both sides or even shift from one side to the other.

How to identify the sacroiliac joint

To find the sacroiliac joint, start by putting your hands on the top of your hips. This area is called your iliac crest. With your thumbs, move around the edge of your hips toward your back until you find a small dip. This dip is called your posterior superior iliac spine (PSIS) and connects your sacrum to make up your sacroiliac joint (sacrum+ilium).

Causes of sacroiliac pain

There are a wide variety of mechanisms that can lead to sacroiliac pain but commonly they break down into one of these three categories:

Acute trauma: this is the easiest type of pain most of us to understand (i.e. this event happened and now I have pain). This could be a direct force such as a fall on your butt but could also be indirect such as picking up an object or a misstep while walking down some stairs.

Repetitive loading/Postural stress: the silent assassin! The sacroiliac joint is closely connected to movement at the hip and low back. When we are only exploring a portion of the range of motion available for longer periods of time we induce repetitive stress on the joints in an unbalanced manner. Typical examples would be:

Long periods of being seated: when sitting the hip and low back are typically in a flexed position and this puts stress on the sacroiliac joint. Though this stress is not high at any given time the low amount of stress over a long period of time can fatigue the joint to the point of injury.

Bending forward/rotating strenuous activities: Decide to chop some wood for the first time in a while? Did you pull weeds for 4 hours or shovel all that soil that’s been on your driveway for a month?

Instability: the least known about and consequently can lead to many people finding it difficult to get more than temporary relief. Joint instability/lack of stability occurs when the surrounding structures (ligament, tendons, muscles) are unable to maintain the ability of a joint in a safe and stable position. People that are susceptible to stability issues in their SI joints are:

Females pre/post-pregnancy: around pregnancy hormones are released to create laxity in the body which allows the body to move into a greater range of motion.

Highly flexible individuals: with an increased range of motion comes an increased demand to control that range of motion and if that demand is not met that joint can then move into unstable areas.

Symptoms of sacroiliac pain

There are a few ways you can identify whether your discomfort could be related to SI joint dysfunction:

• Sharper pain when changing positions (rolling, twisting, bending, moving between sitting and standing)

• Dull aching pain with prolonged positions (driving, standing, etc.)

• Pain on palpation (touching), tenderness over specific bony landmarks like the PSIS (posterior superior iliac spine).

• Pain with transition movements (rolling, sit to stand, getting out of car)

Solutions for managing sacroiliac pain

As a chiropractor I usually approach conservative care from four angles:

1) Damage Control: Healing is much easier when we mitigate aggravating factors. Simple strategies that I always recommend to start with on your own are:

Be cautious of friendly advice. Your family and friends mean well but just because a certain stretch helped them does not necessarily mean it will help you. If you are looking for help seek out a local healthcare provider.

Take micro-breaks from aggravating positions. Pain and aggravation build up over time in many cases so changing positions will mitigate stress over time. If you work at a desk, find a reason to get out of your seat and move around at least every hour

Using lumbar support pillows can be life-savers when driving and are usually dramatically more effective than cranking up the lumbar support in your truck. Click here to grab a pillow.

Using a sacroiliac belt is a temporary strategy that should only be used if aggravation activities are unavoidable but can be very effective in the short term. If you get almost instant relief it is likely there is a stability issue present. Click here to grab a belt.

Treat the Nerve: If you find that simply grabbing the skin over the joint and lifting it away from the SI joint significantly decreases or fully eliminates the pain it is possibly a sign of superficial nerve irritation of what are called the cluneal nerves. Cupping and Taping can be helpful strategies in this case. The good news is there might not be anything wrong with your SI joint!

Treat the Muscle: Your massage or stretching routine might seem like it will work, but if your pain is only temporarily relieved or even seems to get worse afterward this may be a sign that something else needs to happen. If the problem stems from a lack of stability, relaxing/stretching muscles could actually make things worse!

Treat the Joint: Mobilizations of joints including chiropractic adjustments to the SI joint, lumbar spine, and hips can reduce pressure on the joints but by itself may only be a part of the solution. Again, if there are stability issues present, more motion is not the answer.

If these strategies have not worked then, what is the missing piece?

The answer is to start establishing stability through specific exercises. We want to be masters of our movement whether we move a lot or only a little. How do we get started?

• Abdominal bracing and breathing exercises 3-5 minutes at a time.

• Cat-Cow mobilizations for 3-5 minutes at a time. I prefer doing it in the morning while I wait for my coffee to cool down!

• These movements are designed to build awareness of movement (proprioception) from an unloaded position, where the body does not need to maintain our balance like we do when we are in an upright position.

With the two exercises above in play, we can now add additional exercises to the mix.

Curl-up

Birddogs

Side Planks

Click on the links above for some great videos of how to perform these exercises.

Here is an example of how you could start using them:

1. 10-second holds at the position of highest tension

2. Return to starting position

3. Immediately go back to position of highest tension

4. Perform three repetitions on one side, then on the other side, then rest

5. The next set you will only need to perform two repetitions on each side, then one repetition on the last set.

We will dive deeper in future posts to the benefits of each of these exercises, how to progress them and how to use them to explore other movements. But for now, when doing these exercises, it is essential to challenge yourself only to the point where you can maintain the proper form for the entire exercise. Going to fatigue is not the purpose of these movements and will most likely not create long-term benefits.

Wrapping it up!

Now that you understand what sacroiliac pain is, the causes of it, and how to get started on your road to recovery, are you ready to book an appointment? If so, click here or give us a call. We’re happy to answer any questions or concerns over email at any time if needed too!

Author:

Dr. Alex Hueston is a Chiropractor in Duncan, BC at the Young Health Management clinic. www.younghealthmgmt.com

The First 5 Questions to Ask your Chiropractor

Choosing a Chiropractor can be difficult. Many doctors use outdated treatment methods and are using the best treatment methods for their patients. My friend and colleague, Dr. Alex Hueston, is here to help.

Here are the FIRST 5 questions to ask when you are looking for a Chiropractor.

If you live in Vernon, BC or are near the North Okanagan and are looking for YOUR chiropractor than this post is for you! At Base Camp Sport and Spine, we provide the most personalized treatment possible before booking an appointment with our team. We want to make sure that you are a good fit for us and vice versa. Our friend, Dr. Alex Hueston, has put together this list of 5 questions that we think everyone should ask their local chiropractor as they prepare for an initial consultation:

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Written by Dr. Alex Hueston. Chiropractor at Young Health Management in Duncan, BC (Vancouver Island). www.younghealthmgmt.com

1. What is the most common type of injury you see in your office on a regular basis?

2. How do you feel about different types of treatments, such as acupuncture and massage therapy?

3. What should people know before they go to see a chiropractor for the first time?

4. What is a chiropractic adjustment or manipulation?

5. What are some other ways I can keep my spine healthy while still at home (exercises, nutrition)?

*Disclaimer: Content on this blog should not be construed as medical advice.

1. What is the most common type of injury you see in your office on a regular basis?

Most people think to come see their chiropractor when they have pain near the spine, but what many don't realize is that a visit with your chiropractor can also help treat conditions related to nerves and joints in extremities (knees, ankles, feet).

Chiropractic care has also been helpful in treating conditions such as headaches, menstrual cramps, and emotional stress.

2. How do you feel about different types of treatments, such as acupuncture and massage therapy?

At our clinic we have an integrated team of practitioners trained in many different treatments, including acupuncture and massage therapy. We also incorporate forms of active care such as exercise and diet modification.

It is important to know that there are many different types of treatments for helping you stay healthy - some work better for you than others depending on what condition you're working with and how severe it is. We'll take a look at all the options together so we can find out which one is the right fit for you.

3. What should people know before they go to see a chiropractor for the first time?

The first thing people should know going into their appointment with a chiropractor is that it's often not as painful as they expect. You may feel some heat and pressure, but nothing too intense or unbearable. The goal of the treatment at your initial visit will be to find out where you're experiencing pain and what might be causing it so we can find a treatment strategy that is best for you.

The other thing to keep in mind before your appointment with a chiropractor is that they are trained experts and have experience working on people from all different backgrounds, ages, and physical abilities--so there's no need to be nervous!

4. What is a chiropractic adjustment or manipulation?

A chiropractic adjustment or manipulation is a safe, low-risk form of manual therapy that involves the application of controlled thrusts to joints, ligaments and muscle tissue.

The purpose of this treatment is usually to reduce pressure and inflammation in joints that causes pain and reduces mobility.

5. What are some other ways I can keep my spine healthy while still at home (exercises, nutrition)?

One of the most important things you can do to help keep your spine healthy is exercise. It's been shown that exercising regularly not only strengthens and promotes flexibility in the muscles surrounding your spine but also reduces stress, anxiety, depression and back pain.

Here on Vancouver Island, BC adventure is never far away. You can find beautiful trails stretching across the island, like the West Coast Trail and the lesser known Juan De Fuca Trail. Just make sure to pack a lunch and plenty of water!

In Conclusion . . .

We hope you found this post informative and that it has answered a few of your questions about the type of services we provide here at Young Health Management. If you’re interested in making an appointment with one of our mental health professionals, please don't hesitate to book online today!

*Disclaimer: Content on this blog should not be construed as medical advice.

Author:

Dr. Alex Hueston is a Chiropractor in Duncan, BC at the Young Health Management clinic. www.younghealthmgmt.com







Disclaimer: This blog is intended for general informational purposes only and is not intended for the delivery of medical advice. No doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user's own risk. The content of this blog and website is not intended to be a substitute for medical advice.

The Truth about Posture

As a Chiropractor in Vernon, one of the most common questions I receive is, how can I improve my posture while sitting at my desk?

My colleague and friend, Dr. Kurtis Gryba, has lots to say on this one:

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Written by Dr. Kurtis Gryba. Chiropractor at E3 Chiropractic and Wellness in Saskatoon, Saskatchewan. www.e3chiropractic.com

Many factors contribute to proper posture when sitting at a desk. Most commonly discussed are the strength and mobility of your neck and mid-back along with the ergonomics of how your desk is set up. While these all play a very important role in limiting the development of low back pain, or neck pain while sitting, they still do not answer the question, “What is the best posture?”

“What is the best posture?” is a trick question. It is not a static position, but rather the best posture is to move around and frequently change positions to allow your body a chance to reset.

“Perfect posture” is typically described as sitting up straight, with your shoulders pulled back and your head tall. The problem is, if you are sitting in “perfect posture” for 8 hours a day, there is a pretty good chance you will still feel low back pain or neck pain by the end of it. The reality is that even in “perfect posture” the body does not tolerate being immobile for long.

A truly perfect posture cannot be static, instead, we need a more dynamic strategy. Performing exercises to build strength and increase mobility is essential to helping your body tolerate extended periods of static sitting, however, the key to feeling better at the end of a long workday is simply getting up and moving around.

Hierarchy of Posture 

I often talk about a “hierarchy” of posture. 

1. Dynamic Posture 

   • Take frequent breaks throughout the day to stand up and move. 

   • Movement encourages fluid movement within our joints, which transfers nutrients to the bones. This keeps our bones healthy! 

2. Good Posture 

   • If you’re not and move throughout the day, a tall posture is better than a slumped posture. 

   • This may be the case during a flight or a long drive. 

   • Consider taking a rolled-up towel and placing it along your low back just above your belt line.

3. Poor Posture 

   • Avoid this posture as much as possible for extended periods of time! 

   • Poor posture stretches our ligaments and tendon. If they stay stretched for a prolonged time, it can eventually lead to injury. 

When is Posture Important? 

Although a static posture is the most ideal posture throughout the day, there are 2 circumstances that having good posture is ideal. 

1. Weight Lifting 

   • This is more so referred to as having proper form for your lift. 

   • Proper form will ensure that your bones, muscles and joints are sharing the load equally. 

   • The equal sharing of forces will reduce your risk for injury. 

2. Long Drives or Flights 

   • Poor posture is notorious for stressing and stretching our ligaments and tendons. 

   • Our ligaments have an elastic nature to them, and if elastic materials are stretched for too long, a phenomenon called “creep” can occur. 

   • “Creep” is not referring to your weird neighbour. Creep is when something elastic is stretched too far, for too long, that it begins to lose its elastic properties. 

   • Creep of ligaments can result in joint laxity. 

Micro Breaks

Good “dynamic posture” does not require long breaks throughout the day that disrupt your workflow. Instead, we recommend performing “microbreaks” throughout the workday. This may include incorporating simple neck stretches every 20-30 minutes or taking a posture break. These microbreaks are designed to take place every hour or so, for only 30 seconds to a couple of minutes. I recommend setting an alarm to remind you to get up and move around once every 20-30 minutes

A simple posture reset is the most powerful tool you can use against the pain that begins after a long day of desk work. 

If you can’t seem to shake the low back pain or neck pain you develop while sitting for long periods of time,  schedule an appointment! Base Camp Sport and Spine can provide anyone in Vernon with further strategies to help you work pain-free!

Author: Dr. Kurtis Gryba, Chiropractor and Founder at E3 Chiropractic and Wellness in Saskatoon, Saskatchewan.

Instagram: @E3chiro.yxe

Disclaimer: This blog is intended for general informational purposes only and is not intended for the delivery of medical advice. No doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user's own risk. The content of this blog and website is not intended to be a substitute for medical advice.