Mountain View, Missouri (West Plains / Willow Springs / Winona / Cabool / Summersville) ---- Spinal Decompression Doctor, Russell Schierling, presents another blog article on Spinal Decompression Therapy.
CHRONIC SACROILLIAC PROBLEMS,
PIRIFORMIS SYNDROME,
&
SCIATICA
I've heard it about a million times in my twenty plus years of treating patients. "My sackariliyack is killin me doc! Kin ya fix it ?" If any of you have ever experienced a Sacro-Illiac problem before, you know all too well just how miserable it can be. And yes, contrary to what you may have experienced, most of the time Sacroilliac problems can be effectively dealt with without DANGEROUS AND DEGENERATIVE INJECTIONS or SPINAL SURGERY! But it's not always as easy as a few CHIROPRACTIC ADJUSTMENTS.
The Sacroilliac Joint is just that ---- an articulation between the Sacrum (tailbone) and the Illiacus or Illium (the bone you put your hands on when you put your hands on your "hips"). The SI Joint looks like an earthquake fault-line on either side of the Sacrum. Here are two pictures of Pelvis / Sacroilliac Joints and a corresponding x-ray.
The Sacroilliac Joint is just that ---- an articulation between the Sacrum (tailbone) and the Illiacus or Illium (the bone you put your hands on when you put your hands on your "hips"). The SI Joint looks like an earthquake fault-line on either side of the Sacrum. Here are two pictures of Pelvis / Sacroilliac Joints and a corresponding x-ray.
 Photo by Amongesle |  Image by Nevit Dilmen |
SACROILLIAC FUNCTION
&
SACROILLIAC DYSFUNCTION
If you stand up and feel at your belt line just above and lateral to the very tip top of the crack of your rear end, you will notice a bony bump on either side. These are the Sacroilliac Joints (SI's), and these bony bumps are called the PSIS's (Posterior Superior Illiac Spine's). Sacroilliac Joints are incredibly strong because they are held together with lots and lots of heavy duty ligaments that cover both the front and back of the SI Joint, as well as the inside of the joint. Because of the great number of ligaments, sprains and strains of the SI is a fairly common problem.
Pictured below are the ligaments that cover the SI Joints. Understand that the huge ligament at the lower portion of the sacrum (the Sacro-Tuberous Ligament ---- it runs from the Sacrum to the Ischial Tuberosity or "butt bone") is so strong that in over 50% of the population, there are actually large muscle groups that anchor themselves to it --- namely the long head of the hamstring muscle (pictured below in red). This means that chronic hamstring problems can contribute to chronic pelvis or Sacroilliac problems, and vicea versa.
Pictured below are the ligaments that cover the SI Joints. Understand that the huge ligament at the lower portion of the sacrum (the Sacro-Tuberous Ligament ---- it runs from the Sacrum to the Ischial Tuberosity or "butt bone") is so strong that in over 50% of the population, there are actually large muscle groups that anchor themselves to it --- namely the long head of the hamstring muscle (pictured below in red). This means that chronic hamstring problems can contribute to chronic pelvis or Sacroilliac problems, and vicea versa.
RIGHT SACROILLIAC JOINT: FRONT VIEW  | RIGHT SACROILLIAC JOINT: BACK VIEW  |
 | Depending on whose research you read, the Sacroilliac Joints have about 3-7 degrees of movement in them. The bottom line is that anything which causes the Sacroilliac Joints to move either too much or too little tends to cause an irritation / inflammation of the joint called "Sacroilliitis". People who are experiencing mechanical dysfunctions of the SI Joint will typically have a range of symptoms that include low back pain, buttock pain, and PIRIFORMIS SYNDROME. Over a decade of experience with our Tissue Remodeling Treatment has taught me that huge numbers of cases of chronic SI pain are really a problem with the Piriformis Muscle. Bear in mind that because PIRIFORMIS SYNDROME and Saroilliac Problems can look so similar to each other (they both cause SCIATICA as well), they are frequently mistaken for DISC HERNIATIONS or DEGENERATIVE DISCS. Part of this confusion is created by the fact that if you were to shoot MRI's of the adult population --- 50-75% of these MRI's will show these two problems ---- even though they have zero pain or symptoms (HERE). This is what has led the great sports surgeon James Andrews of Birmingham Alabama to proclaim, "If you want an excuse to do surgery, just do an MRI." And he was actually talking about ROTATOR CUFF PROBLEMS when he said that --- the number one most common problem we treat with our Tissue Remodeling. |
Due to abnormal gait patterns, old injuries, falls, pulled hamstring muscles, obesity, sedentary lifestyles, hormonal changes, poor posture, pregnancies, or just being female, the Sacroilliac Joints can begin moving and functioning improperly. Bear in mind that there are several disease process that can also result in Sacroilliac Dysfunction (Gout, Rheumatoid Arthritis, Ankylosing Spondylitis, etc). These are not the thrust of this article.
Although there are plenty of people whose SI problem creates a sharp and severe type of pain, a far more common scenario is having a dull, nagging ache in the area of the buttock and PSIS. In my experience, the majority of these cases are actually relieved with activity and movement (walking, stretching, horseback riding, etc) ----- while sitting or lying down often seems to trigger it and make it worse. As is the case with virtually any Joint Dysfunction, the longer it goes on, the greater the chances of wearing the joint and developing JOINT DEGENERATION. Loss of normal joint function causes deterioration, and deterioration causes loss of normal joint function.
Just like PIRIFORMIS SYNDROME that we dealt with in the last blog article, Sacroilliac problems DO NOT respond to Spinal Decompression Therapy. I bring this up because SI problems are frequently mistaken for various Spinal Disc Issues and then treated with Corticosteroids by MD's, or Spinal Decompression Therapy by chiropractors.
DIAGNOSIS:
The medical community's "Gold Standard" for diagnosing a Sacroilliac Problem is to put either one or two injections into the Sacroilliac Joint (often guided in under a CT scan) and see if it relieves the pain. If so, you can officially say that you have an SI problem. At Schierling Chiropractic, LLC, we rely on Physical / Neurological Examination Findings, Patient History, as well as imaging (SIDE NOTE: I will warn you that hundreds of scientific studies have conclusively shown that with these types of problems, Diagnostic Imaging does not correlate well to patient symptoms, and I would have to concur).
Although there are plenty of people whose SI problem creates a sharp and severe type of pain, a far more common scenario is having a dull, nagging ache in the area of the buttock and PSIS. In my experience, the majority of these cases are actually relieved with activity and movement (walking, stretching, horseback riding, etc) ----- while sitting or lying down often seems to trigger it and make it worse. As is the case with virtually any Joint Dysfunction, the longer it goes on, the greater the chances of wearing the joint and developing JOINT DEGENERATION. Loss of normal joint function causes deterioration, and deterioration causes loss of normal joint function.
Just like PIRIFORMIS SYNDROME that we dealt with in the last blog article, Sacroilliac problems DO NOT respond to Spinal Decompression Therapy. I bring this up because SI problems are frequently mistaken for various Spinal Disc Issues and then treated with Corticosteroids by MD's, or Spinal Decompression Therapy by chiropractors.
DIAGNOSIS:
The medical community's "Gold Standard" for diagnosing a Sacroilliac Problem is to put either one or two injections into the Sacroilliac Joint (often guided in under a CT scan) and see if it relieves the pain. If so, you can officially say that you have an SI problem. At Schierling Chiropractic, LLC, we rely on Physical / Neurological Examination Findings, Patient History, as well as imaging (SIDE NOTE: I will warn you that hundreds of scientific studies have conclusively shown that with these types of problems, Diagnostic Imaging does not correlate well to patient symptoms, and I would have to concur).
PELVIC TORQUE SEEN ON X-RAY
(All X-Rays on this Page are by Nevit Dilmen and were found on Wikimedia)
(All X-Rays on this Page are by Nevit Dilmen and were found on Wikimedia)
If you look at the x-ray below, notice the amount of "torque" in the pelvis. This pelvic torque puts an incredible amount of mechanical stress on the lumbar spine as well as the pelvis and SI Joints. Mechanical Dysfunction always leads to DEGENERATIVE CHANGES.
NOTICE THE "EYES" OF THE PELVIS AS WELL AS THE "PELVIC BOWL". YOU CAN SEE A FAIR BIT OF MECHANICAL TORQUE IN ALL THREE OF THESE X-RAYS THAT WERE LABELED "NORMAL"
Not sure what is going on with your hip / back / buttock / leg? Why not visit Dr. Schierling? Chronic Sacroilliac problems and associated PIRIFORMIS SYNDROME are just two of dozens of reasons that he will not begin a DISC PROTOCOL without first making the DETERMINATION AS TO WHETHER OR NOT YOU ARE A GOOD CANDIDATE TO DO SO. If there is a better way to deal with your particular problem, he will tell you. If you take a look at our corresponding VIDEO TESTIMONIAL PAGE, you quickly notice that many people who have been struggling for decades with Chronic SI / Piriformis issues, get relief quickly ----- once the problem is addressed in a logical manner. Call (417) 934 6337 today to set up a Free, No-Obligation consult with Dr. Schierling.
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