SACROILIAC PAIN
One of the commonest causes of low back pain is pain from a subluxation (a slippage) of the sacroiliac (SI) joint. This pain is usually felt on either side of your sacrum, the triangular bone at the base of your spine, or just above this area in the space between the spine and the illium, your pelvic bone. It can radiate around your body to the abdomen, into your buttocks or down your legs The pain can be very severe and incapacitating, can last days or weeks and keep you awake at nights.
What causes SI joint pain?Your pelvis has to support your whole body. It is composed of three bones: in the middle of the lower back, the sacrum which is joined to the iliac bones on either side of it. The iliac bones are joined together in front by a fibrous joint called the symphysis pubis. In childbirth, the baby which was supported by the pelvis throughout pregnancy has to go through the pelvis in order to be born. As the baby's head is large, the bones of the pelvis have to separate a bit during childbirth to be able to let the head through. In order to prepare for this difficult passage of the head, the pregnant woman's body secretes a hormone called relaxin. This hormone relaxes the ligaments which hold the iliac bones on either side of the sacrum together with the sacrum and in front its relaxes the symphysis pubis which joins the two iliac bones together. After childbirth the pelvis may not regain its original strength and the SI joints may slip. Other causes for SI slippage include injuries which can tear the ligaments that hold the joint together and certain movements, such as using your thigh to help you lift a heavy weight which can overstretch or tear the ligaments, and, of course, old age which weakens all ligaments. Ligaments are made up of collagen, the same substance that holds up your skin. Just as your skin sags with age because the collagen under it wastes away, your ligaments also sag as you get older. When the ligaments are not able to hold the sacrum together with the Ilium, the iliac bone tends to rotate forward. Because of this, the spine of the iliac bone (ASIS), which is the hard knob you can feel in the front of your pelvic bone is going to be lower on the side that is giving you pain than on the other side. This movement of the iliac bone overstretches the ligaments that are trying to hold the joint steady and this overstretching is the cause of the severe pain you experience.
What can be done about SI subluxation? First, try an exercise that will help rotate the Ilium backwards to its original position
This exercise can be very effective in replacing the Ilium correctly back into the sacroiliac joint. Physiotherapy can teach you stretching exercises for your thigh muscles to stop them pulling the Ilium forward as well as Pilates type core exercises that will help your muscles control the movements of your pelvis. Unfortunately, it cannot restore the strength of the sacroiliac ligaments and the joint is likely to become displaced again.
There are several belts on the market which can help hold your pelvic bones together. Unfortunately, when you remove them, the ligaments are just as loose and the pelvis is likely, once again to become subluxed.
Acetaminophen, Tylenol, which is a COX3 inhibitor, has a mild anti-inflammatory effect. It, and the NSAIDs aspirin, ibuprofen, Advil, Motrin, diclofenac, Voltaren, have, until now, been the mainstay of treatment to relieve pain. They all relieve the symptoms that occur with overstretched and worn ligaments and tendons. They work by stopping inflammation which is a cause of pain through inhibiting the enzyme cyclooxygenase (COX) which promotes the formation of inflammatory substances. Unfortunately, inflammation is the mechanism the body uses to repair itself, and using these medications interferes with the process which would help regrow the affected ligaments and tendons. All NSAIDs can cause bleeding of the stomach, high blood pressure, and kidney failure, and the COX 2 inhibitors, such as Celebrex, also increase the risk of heart attacks. Anti-Inflammatory References
Narcotics have been given to people with severe pain who, because of liver or kidney failure could not tolerate acetaminophen or NSAIDs.
Cortisone shots in the SI joints being even more powerful anti-inflammatory substances, unfortunately interfere with healing even more than other anti-inflammatory medications. Steroid references.
Surgery as a last resort, the iliac bones can be fused with the sacrum. This puts added strain on your hip joints as well as your back and your neck as the sacroiliac joint moves a bit whenever you make a step, acting as a shock absorber.
Prolotherapy, by helping regrow the ligaments that stabilize the sacroiliac joint, prolotherapy is extremely effective in preventing the recurrent subluxation of that joint. Dr. Bertrand herself was treated with prolotherapy to her sacroiliac joint six years ago and has been pain free since. A retrospective study published in 2009 of 145 patients with low back pain for more than four years treated with prolotherapy showed that 89% had more than 50% pain relief, 75% were able to completely stop taking pain medication, more than 80% showed improvements in walking, exercise ability, anxiety, depression and overall disability.
Ross A. Hauser, MD, Marion A. Hauser MS RD Dextrose Prolotherapy for Unresolved Low Back pain: A Retrospective Case Series Study Journal of prolotherapy 2009; 3:145 – 155
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