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The Diagnosis of Sacroiliac Sprain - A Review

By popular demand Dr. Young, in the following article, summarizes briefly the content of the full, four page published article.

There is an extremely common pain pattern including one-sided low back pain and pelvic pain, and often upper leg symptoms, that is frequently misdiagnosed within the medical community as of spinal origin when, in fact, it is of sacroiliac joint origin. The pain pattern is deep and aching and most prominent over the PSIS bone. This is the bone that is felt on each side of the low back when you stretch your shoulders by placing your palms on your upper buttocks. This persistent pain is the result of a true joint sprain, not a pinched nerve. A sprain is the result of LIGAMENT failure.

Because the sacroiliac (SI) joint ligaments are micro-torn on one side that joint is not being held together well, so the low back and especially the pelvic muscles are extremely tight. These muscles are working overtime to attempt to stabilize the SI joint. Even the upper leg, low back, and groin muscles can be tight and achy on the pain side and even on the opposite side in some cases. But holding a joint together is not the normal function of muscles, which are meant to move joints. So after a while these muscles fatigue and the SI joint separates causing that ache to increase. Sitting in the car on a soft chair may not hurt much at first but the longer this continues the more the discomfort.

Since this condition is a sprain we can ask why there frequently does not seem to be a severe trauma associated with its’ onset. This is explained by understanding the anatomy of the pelvis. We can simply represent this by making a “C” with your left hand and a “backwards C” with your right hand. Now push these two together so they meet and there you have it. Now twists the hands slightly so that one twists one way as the other twists the opposite way. This represents the normal movement that occurs in both SI joints during walking and even in breathing. Now increase the amount of twisting of your hands and notice that eventually the fingers separate, overlap, and get stuck in that distortion. Thus, the sacroiliac joint typically sprains not all at once but in a slow, cumulative fashion. The final act that brings about the initiation of pain may be trivial.

The treatment of sacroiliac sprain must include joint approximation and stabilization to be successful. Just relieving the stressed muscles will not work. For an acute SI sprain pelvic adjustments and specific exercises may do the job. But these sprains are frequently bad actors and become more chronic. The SI is a large and powerful joint and can be difficult to stabilize. For these cases prolotherapy may be the answer because this treatment is all about re-introducing connective tissue and ligaments, and thereby, healing the joint.