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SI Sprain - Areas of Pain Referral

To help the chronic or recurring sacroiliac sprain, which the patient may describe as one-sided low back pain or hip pain, we must first understand how the SI joint works. Each of us has two sacroiliac joints, right and left. Each side of the pelvis, right and left, connects with the sacrum in the middle. This is the bone that ends in your tailbone. The right pelvic bone (os coxa) connects with the right side of the sacrum and the left pelvic bone connects with the left side of the sacrum.

The traditional surgical model for correction of this joint when it is irreversibly sprained, loose, and unstable, aims at surgically "fixing" the joint through some type of bony fusion. This seemed logical in the middle of the 1900s. But surgical outcomes were notoriously bad and tragic, so the practice was all but abandoned as the century progressed. These outcomes were bad because the joint is SUPPOSED TO MOVE, albeit in a specific way. Fixing it predisposes the patient to harmful and unnatural stresses on adjacent joints including the lowest lumbar disc and joints.

The movement that is normal for the SI joint is subtle and rhythmic. It is so unique to the sacroiliac joint that it has its' own name, NUTATION. This has been referred to as "joint breathing".

Let's try to simplify our understanding of this complicated joint and its' unique movement. Stand a hard-cover book up on a table. This will act as our "sacrum". Now lightly squeeze the book between your two palms and fingers, which will represent the two pelvic bones, right and left. In this straight book position your palms should be symmetrical to one another with the book in between. Keep your elbows on the table. Now bend the book a little to the right at the top part while bending your wrists as little as possible. Keep those palms against each side of the book and allow your hands to move but not much movement at the wrists or elbows. Bend the book the other way and twist it a little too. This acts like a person bending over to one side to pick something up. Watch your hands. They move the same amount but each in a different and COMPLEMENTARY direction. This is the essence of sacroiliac nutation. The two pelvic bones rotate in complementary directions around the two sacroiliac joints in order to achieve the fluid pelvic movements we require throughout the day and night. No wonder the patient is discouraged when this joint is chronically mal-functioning. Try the same movement with the book but, this time, do not allow one of your hands to rotate much. The fluid movement of the book stops and is blocked. Maybe it hurts the wrist a bit too. This is something like what happens during chronic pelvic asymmetry, or hip rotation as Chiropractors call it. One sacroiliac joint moves too much, or sprains, while the other moves too little, or fixes. For both sides the function suffers. Remember, it takes two poorly functioning SI joints to make an SI sprain.

The therapies that make sense for this condition are those that aim to repair the torn and over-stretched connective tissue on the painful sprained side, and those that aim to introduce forgotten and normal movement to the fixated side. The repair treatment for the chronically sprained SI joint is the practice known as Prolotherapy. The mobilization treatments for the fixed side are the business of Chiropractic, Naprapathy, and exercise rehabilitation. If this problem is very chronic and persistent all these treatments should be employed.

Click here for more from Dr. Young on SI Sprains

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