Back injury can be a pain in the… Sacroiliac
Robert A. Hayden, DC, PhD, FICC
Question: I recently hurt my back while lifting my child from the backseat of my car. The pain is mostly in the back of my pelvis about 2 inches to the right of the base of my spine. What is the likely source of this pain, and how can I treat it?
The location of your pain sounds like a sacroiliac joint. This is very common. While 80% of the population suffers from low back pain at some time in their lives, sacroiliac joint dysfunction (SJD) accounts for likely 15 to 25% of these cases. SJD can be painful, bothersome, and debilitating, but it is usually easily treated conservatively and does not require surgical intervention.
The sacroiliac joints are the largest joints in the spine. If you look at someone's back, you will find two small dimples on each side of the lower back at about the level of the belt. This is the location of the sacroiliac joint. As the name implies, it is the joint between the sacrum, that triangular bone on which you sit, and the Ilium, the large bone on each side of the sacrum that hold up your pants and contains the hip joint lower down. These joints are richly supplied with nerves and supported by large, broad ligaments that provide stability. The joint is designed to move in a way that absorbs shock as you walk, which relieves stress on the spine and hips with weight-bearing.
SJD presents with low back pain, typically at the belt line, sometimes radiating into the buttock or thigh. It is most common in adults, but can happen in teenagers with athletic activity. It is sometimes associated with leg length inequality, abnormalities in the gait, prolonged exercise, or more serious conditions, such as fracture, dislocation, infection, or inflammatory arthritis. This condition is very common in pregnancy because there are hormone induced changes in the sacroiliac ligaments during the third trimester which caused this joint to loosen in preparation for childbirth.
My experience with SJD is that the frequent cause is unknown. There are minor movements that can be very stressful to this joint, such as getting into or out of your car, which involves placing all of your weight on one foot, twisting, and leaning as you aim yourself to a car seat. Certainly, bending and twisting to lift a child is enough to cause SJD.
Diagnosis of SJD is made with a combination of a good history, a physical examination that includes orthopedic and neurological testing, gait analysis, and sometimes imaging to rule out any serious pathology. It is usually successfully treated by adjusting the sacroiliac joint or joints. Occasionally the adjustment is augmented with physiotherapy, such as ultrasound, to decrease swelling of the sacroiliac ligaments, or electrotherapy to control reactive muscle spasms. During the acute phase (first 72 hours), ice compresses are better than heat, and will ease the soreness. Your chiropractor may also suggest some stretches to keep these joints moving and supple.
Occasionally, SJD is stubborn. There is a special belt, a trochanteric belt, that can be used to augment the adjustment. It holds the sacroiliac joints together by applying pressure just above the hips. I have used them on occasion with good results. I have also had significant success in correcting the underlying cause of SJD with customized orthotics, which I use to correct gait problems and leg length inequality.
The sooner you get appropriate care for your SJD, the better your prognosis. Don't wait and let it become chronic, because it might be harder to treat. However, for the vast majority of people, while it is a pain in the "sacroiliac," it is easy to control.