Have you heard of the SI joint? It’s a tricky one.
What is the SI joint?
SI stands for Sacro-iliac. Sacro = sacrum, the big wide bone at the base of the spine comprised of 5 fused vertebrae. Iliac = ilium, aka the pelvic bone, aka “the hip bone”, aka os coxae. You have two os coxae, a right and a left. The os coxae bone actually starts as 3 bones that become fused in adulthood. The ilium, the pubis and the ischium. The intersection of all 3 make up the “hip socket”, the acetabulum where the head of the femur articulates.
The articulation between the sacrum and the ilium make up the SI joint! This joint is a large joint that is planar in nature, meaning the two surfaces slide against one another to create motion. However, it’s not that simple. The SI joint is multi-planar, and simultaneously rotates and translates along three axes of motion! The degree of movement of the SI joint in those plans is very small.
All together the two os coxae and the sacrum create a continuous ring known as the pelvic basin. This along with the low back is our foundation of stability!
What does SI joint pain typically feel like?
For starters, just because you are pointing to your SI joint to identify where you are feeling pain, does not mean that is the structure that is causing the pain!
SI joint pain is typically described as dull, achy stiffness. This does not mean that if you describe your pain differently, that you do not have SI joint pain or dysfunction. Patients usually point to the area around the dimples you might see at the base of the spine. Pain can refer elsewhere in the lower back, pelvis and hip as well. Typically not associated with tingling, numbness, or sharp shooting pain traveling down into the legs or feet (although there is always potential for multiple diagnoses present simultaneously).
SI joint pain can be caused by misalignment, abnormal gait, muscle imbalances, traumatic events such as a fall or car accident, pregnancy related, being overweight, lower crossed syndrome and anatomical difference in leg lengths. SI joints often are not the main culprit, but are affected by compensation caused by another problem area such as a disc issue in the low back.
Muscular imbalances or dysfunction can present like SI joint pain as well. Referral patterns trigger points within dysfunctional muscles can be very painful and can be felt at areas away from the actual sit of the problem.
It is critical to assess muscular imbalances around the SI joint.
There are OVER 30 muscles that attach to the bones that make up the SI joint!
TFL (Tensor fasciae latae)
Rectus Femoris (vastus medius, vastus lateralis)
Biceps femoris (short head) Hamstrings
Biceps femoris (long head) Hamstrings
ITB ( Iliotibial band)
The abdominal muscles:
External abdominal obliques
Internal abdominal obliques
Low back muscles:
and the pelvic floor muscles contained within the pelvic basin!
WOW, that's a lot of muscles!
Sacro-iliac joint pain referral pattern is depicted in the image below.
-How might you assess an SI joint?
Clinical evaluation of SI joints can include palpation, range of motion, and orthopedic exams. Studies have not shown great reliability between practitioners for assessment of these joints. Therefore treatment approaches can also vary greatly from provider to provider.
We believe it is critically important to address not only the SI joints and lumbar spine, but the muscles supporting the joint as well.
Adjusting the joints feels good, of course. However, if there is muscular imbalance the effects of the adjustment will be short lived. Instead evaluating which muscles are weak, lengthened, or tight and short, and working to regain balance and normal function supports proper alignment of the joint. Muscles were designed to support and move the joint. We also believe it is important to consider if any ligament damage or laxity is present.
Here's a few go-to's to check the function of the SI joints:
As mentioned before, identifying pain coming directly from the SI joint is challenging. Evidenced by the long list of orthopedic tests above. Due to the complicated nature, an approach was developed to increase effectiveness and reliability when diagnosing SI joint dysfunction and pain. The approach is called Laslett's criteria and you can learn more about it by following the link below!
Depending on the individual treatment may include:
Adjusting- Chiropractic manipulative therapy- diversified, Thompson drop table technique
Muscle work, manual, instrument assisted, trigger point therapy
Modalities- Ultrasound, Cold laser
Rehabilitation- stretching, strengthening
Heat or Ice depending upon phase of healing
This information is not all inclusive! If you are suffering from what you think might be SI joint pain or low back pain, call the office and schedule a visit. We can determine the root of your problem and give you an idea of what treatment would look like, and whether it would be beneficial for you!
Fix your swing, decrease low back pain!
There are 26 million golfers in the U.S. and rising. The number 1 injury sustained by golfers is low back pain. Most golfers report back pain developing over time rather than one incident, and the average injury last about 2-4 weeks. Prevention is managed by addressing movement patterns, muscle imbalances, and type of swing used. These factors directly impact the spine during the golf swing, therefore need to be addressed to prevent or rehabilitate the low back injury.
Sports Health Journal identifies early extension of the low back, reverse spine angle during back-swing and reverse -C finish as the top 3 swing faults related to low back pain.
Images: Finn C. Rehabilitation of low back pain in golfers: from diagnosis to return to sport. Sports Health. 2013;5(4):313–319. doi:10.1177/1941738113479893
Core strength, scapular and hip stabilization are important foundations for the swing. Rehabilitation and prevention start with addressing the function of the above-mentioned areas.
Core muscles should be engaged during the swing to stabilize the spine during postural changes and loads. Diaphragmatic breathing is a large component of core stabilization during a golf game, even putting. The multifidus, quadratus lumborum, transverse abdominis, external obliques, hip abductors, all contribute to core stability.
Training of these muscles should be integrated early in rehab and transitions well to on-course application. Exercises that isolate the target muscles are a great starting point and can be prescribed and demonstrated by a health care provider. Core stability training can be heightened by performing on unstable surfaces such as bosu balls, balance discs or physio balls.
The shoulder blades, shoulder mobility and thoracic range of motion in extension/rotation, hip mobility, ankle mobility, balance can all causes compensation patterns to arise. Therefore, should also be assessed and addressed in prevention/rehabilitation.
You can do all of this by working with a professional in the medical field such as a chiropractor or physical therapist to identify faulty mechanics. A golf pro can help you to identify problems you might have in the sequence of your swing for functionality. The medical professional will help to identify and rehabilitate muscular compensations that have occurred and work to establish balance and increase mobility and strength where needed.
Don't let low back pain keep you from playing your best game!
The plantar fascia—most people have heard the term—but what is it and why are so many people complaining about it? Why can the plantar fascia become so painful and irritating? The answer is because the plantar fascia is a structure that is crucial to a human’s ability to walk, and well, we walk a lot.
To break the term down to its root parts: Plantar is the sole of the foot and Fascia is a band or sheet of tissue, primarily collagen, that connects, supports, or separates. The plantar fascia is a structure that supports the sole of the foot, the connections from the heel to all five toes, and separates the layers of muscle. Plantar fasciitis is the inflammation of this structure.
Plantar fasciitis is the most common cause of heel pain but can also cause midfoot pain. It is usually a result of cumulative trauma. It is very common in those who have a flattened medial arch, placing more tension on the plantar fascia, and repetitive micro-traumas. Tight and weak calf muscles, known as the gastric and soleus also contribute to increased strain on the plantar fascia. Hamstring tightness is also associated in high rates with this condition.
Dr. Allison Fleming and