In my last post I spoke about some of the common misconceptions about sciatica and some other causes of back and leg pain. In this post I am going to focus on one of these, sacroiliac joint dysfunction. As you can see in the picture, the sacroiliac joint and sciatic nerve are anatomically very close to each other. The sacroiliac joint forms a vital bony connection between the hip and the spine allowing for movement, stability and the appropriate transmission of forces generated from the ground up and the head down. When irritated, strained and inflamed the sacroiliac joint can refer pain into the back, buttocks and lower leg in much the same way that sciatic nerve damage can. Therefore sacroiliac joint injuries are often confused for sciatica and consequently treated incorrectly
The most common causes of a sacroiliac joint injury confused for sciatica that we see at Better Health are:
1) Traumatic injuries such as bumps, slips and falls.
2) Weakness of the gluteal and core stabilising muscles. The sacroiliac joints rely on a degree of what we call FORCE CLOSURE. What this means is that the inherent anatomy of the joint is unstable without proper muscular support. Properly timed contraction of the core and pelvic muscles create the stability required in the joint to tolerate the force. Simple forces such as those generated from the ground up (for example when walking and running) and the head down (such as simply supporting the weight of the upper body on your legs) place a lot of load through the SIJs on a daily basis. With increased sedentary practices adopted by us all the muscles that support the sacroiliac joints become de-conditioned, weak and imbalanced leaving the joint increasingly vulnerable to damage.
3) Leg length inequalities causing pelvic tilt and rotation. As you can see on the x-ray on the left this person has what is measured as a right pelvic tilt of 12 mm at the level of the hips. BUT, when we take into account the way the pelvis has twisted up to try and compensate for this (putting all that extra stress on the SIJs) the difference is actually more like 16mm. You will also note that the tilt has created another compensation, scoliosis of the low back. In this case without addressing the leg length difference no amount of care directed towards the injured SIJ is going to give a long term result.
4) Unstable foot biomechanics (excessive pronation and supination). The picture on the left is is a very good example of someone with excessive pronation causing a rolling in of the ankles and subsequent transmission of uncontrolled forces into the knees, hips, sacroiliac joints and spine. This client actually presented with left SIJ and knee pain which could have been mistaken for sciatica. He was an very keen trail runner and was no longer able to enjoy this activity due to the pain he was having. Again here the key is to treat the underlying cause of the sacroiliac and knee stress, unstable feet not the region of pain itself
5) Poor posture. Postural alignment is the foundation to the health of all your muscles and joints. Certain postures preferentially add excessive stress and strain to the joints of the lower back and pelvis. A whole body approach to treatment is essential when the underlying cause of your sacroiliac joint problem is poor posture. In this case we have what is called a kyphosis-lordosis type presentation. This is where there is excessive curvature of the mid-back and low back and in this case all made worse by a significant forward body shift which you can see by the difference between the ideal green plumb line and the actual red plumb line.
If you have had sciatica type pain and not responded to treatment it may be worth taking a step back and a bigger view of the nature of your problem. At Better Health we have a team of chiropractors, physiotherpists and podiatrists ready to review your case and set you in the right direction. Call us on 02 9518 0722.
Yours in Better Health
Dr Andrew Richards (Chiropractor)