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.
Question: My sister has been withdrawn recently. She appears depressed. She has been in poor health, but her mood has really darkened in the past few weeks, especially as Christmas gets closer. Is she depressed?
"Tis the season" to be jolly, but many people struggle at this time of the year. There are some good reasons for this, and it is quite common. I heard in a sermon once, "While the orchestra proclaims celebration and joy, if you listen closely enough, you will hear the melancholy sound of the French horn, reminding us that someone somewhere has need of consolation." I found the thought so profound and expressive that I have remembered Bruce Morgan's words ever since.
There is a well-known condition known as "Seasonal Affective Disorder", or SAD, that occurs in winter months. Your sister may be more prone to it related to her state of overall health, since there is a nearly 100% correlation between chronic pain and depression.
There is a gland in the brain that secretes substances that affect mood, and the gland is stimulated into action by ultraviolet light from the sun. When the sun is behind clouds in cold weather, or when there is less of it because the days are shorter, the gland is less active. If you are teetering on depression, this can send you over the edge.
Like with other depression states, you may notice changes in appetite; loss of energy and ability to concentrate on tasks later in the day; slow, lethargic body movement; withdrawal from social activities; and, irritability or unhappiness. It can be extraordinarily frustrating for the family, coworkers, and friends who may not understand what is happening to your sister.
There are some conservative measures that may help. Since lack of exposure to light is contributory, take your sister on walks during the daylight hours. You can also use very bright fluorescent lights in the home to mimic sunlight. If light exposure is going to help, it should work in three or four weeks. Of course, if your sister is taking any medications that increase sensitivity to light, this is not a good option, and you would need to consult your doctor first.
Talk to your sister about her feelings. SAD can usually be turned around with time and understanding, but if she is bipolar or has a history of other forms of depression, it is particularly important to identify any suicidal thoughts. If she has any thoughts of harming herself, get her to her doctor as soon as possible.
Take the initiative to get your sister out of the house and involved in the events of the Christmas season. She needs stimulation from family and friends. Help her decorate her home, or take her to musical productions.
If these conservative measures do not help the condition within a month, consider taking your sister to her doctor to discuss whether she needs mediations to help her. Medications should never be your first option, but they are helpful in some cases where conservative measures do not succeed.
Most of us have been touched by a serious illness or death of a loved one during a major holiday, so the very happy events that make it memorable can be a problem for people who are reminded of those losses. All of us should remember that while there is much celebration going on at Christmas, it is a SAD time of the year for some. As you hear the happy sounds of the orchestra of Christmas, listen closely for the mournful French horn. Reach for whoever is blowing it, and hug them.
Question: Flu season is close. Should I get a flu shot?
This question comes up every year, and the season may start in October and go until May. Here are some quick facts so you can make up your own mind.
First, influenza, or "flu," is horribly over-diagnosed. Everyone who has fever is told they have flu, and very few actually do. Flu is a virus that infects the lungs primarily. You may have it if you have fever or chills, cough, sore throat, sinus congestion, muscle/body/joint aches, headaches, and fatigue. Nausea, vomiting, and diarrhea are more common in children. Diagnosing flu on symptoms alone is tricky, however, as these symptoms can occur in the common cold as well. There are lab tests to confirm a diagnosis.
Question: I have wanted to quit smoking cigarettes for years. I know they're bad for me, but quitting the habit is tough. What is the story on the electronic cigarettes? Do they work? Are they safe?
As a non-smoker, I have to rely on experience of other folks sometimes. I have learned to be thankful for my smoke allergies that removed all temptation to either smoke or associate with smokers, as they only made me sneeze and cough more. Seriously, it affected my choices of friends because my allergy was that bad.
Question: What will be the impact of ObamaCare on my ability to get the care I need? Will I still be able to get to my physician?
President Obama came to office with many promises that remain unresolved, including firm assurance that under ObamaCare, you would still be able to see your doctor and keep your private health insurance. The latter promise was made despite his stated goal of eliminating the private insurance option by creating a single payer system, which translates into government-controlled, socialized medicine.
Question: My hands and fingers keep going numb when I use my computer. I have to find a way to keep my hands working. It is especially bad when I am using the mouse. What can I do?
This is a VERY common issue nowadays. I did an interview with a reporter on this topic not long ago who was writing on this very topic. The comment she really liked found its way into page one of the Wall Street Journal: "The personal computer is to chiropractic what sugar has always been for dentists."