Lower Back Injury, SI Joint Pain

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto, Insync Physio. He's the head boss, the boss man, the clinical director of the Vancouver office. And we're going to talk about lower back injury of the SI joint. How are you doing Wil? 

Wil: I'm doing good. Thanks Mark. 

Mark: So what kind of symptoms would somebody have when they've got that, that kind of pain right along that big bone along the bottom part of your back? 

Wil: We just had a couple of people that came in with SI joint injuries earlier this week. And it's interesting specifically, the kind of pain almost mimics, like you know, very similar other types of lower back pain. It could just appear like a lower back issue. 

So when I say lower back, it's basically, you have five vertebrae that make up your lumbar spine, basically and so in that area. When we get more specific about the SI joint or the sacred iliac joint, you know, it's basically where the, so the tailbone or the sacrum, which is a triangular shaped bone, which is basically the base that connects from the fifth vertebrae of the lumbar back to basically the sacrum and that's the L5 S1. And then that sacrum connects on to what's called the innominate or the iliac bones. And you have one on the left and one on the right. And so essentially your sacro iliac joint is combination their sacrum and your iliac bone, which makes up your pelvis, which makes it part of your lower back.

And so the symptoms are very, very similar. Like I was saying to the lower back where sometimes people point like to a specific pain, kind of just like on that sort of one side. You know be very pinpoint specific and it'll hurt, depending on how it's strained it can be painful, whether, you know, extending backwards or forwards. 

And also your typical functional movements, like just trying to put on your sock or shoe. And quite often people would complain, like it just feels like it's off or stuck kind of feeling. So the other thing too, you want to look out for, sometimes it can also cause some referring pain into like your groin and then even down a little bit into the thigh area. But it shouldn't go all the way down the leg or down to the toes or anything like that. So there's that referral pain. And that's also very common. And it's usually very mechanical. 

Mark: So what are the possible causes of this? 

Wil: Yeah, so there's different ways really looking at like how this can actually come about. But I'll give you an example of one that's very stereotypical, like an ex athlete. She used to play field hockey, competitive field player for a national team. And she basically didn't have any real major back injuries, but tweaked her lower back, you know what she thought was her lower back a few times when she used to play field hockey.

And this is like now, like a decade later after her field hockey days. And she still rides the bike a lot and developed all these imbalances now because with her cycling and then she likes to do a lot of running and a little bit of gym stuff weight lifting, but she does no recovery stuff.

And so essentially she's developed a lot of imbalance and you add that was a previous, maybe she might have you know, all that bending forward playing field hockey, you know, there could have been some kind of strain and maybe some trauma. So my guess is that she had some kind of pain and then she healed from that. And now she presents with this like sacral iliac joint issue where it's just not moving properly. 

And so just to kind of go back, her symptoms were basically, you know, she just felt like it was stuck and it was painful to bend all the way forward. And so what it presented as it was just rotated forward a little bit more and because it was rotated a little bit more forward, she didn't have that full range.

Her hips are really tight and she had a lot of imbalances, a lot of weakness in her core. Her one legged squat was really poor on that side versus the other side. And she didn't realize how weak she was on that left side. So those are the really common things that were going on with her in terms of symptoms and how it was presented.

Other ways that it can really happen, like in terms of getting this injury is that you can also like pregnancy, postpartum. Anything that stretches at the ligaments. So like I said, trauma. And then even just like sitting, if you have a job where you're sitting all day long and then you commute or you bike or whatever, you get really tight. 

So that's still trauma, but a different kind of trauma. It's a repetitive strain where things slowly start to creep. So yeah, trauma's pretty much the number one thing with that. 

Mark: So when you're diagnosing it, what's the process that you go through?

Wil: Yeah. So there really is a series of and really what helps us confirm it, gives us the validity and reliability for being able to say, yeah, this is sacral iliac joint related. These are sort of like gold standard things. So when you look at these different tests and if you have, you know, at least three out of five of them, and then you kind of look at the whole clinical presentation, You know, then you can say that this is what it is. But ultimately when you look at it that the joint isn't moving well, and you have certain of these tests are positive, then yeah that's what usually indicates it. 

And you take into consideration, you know, what they can and cannot do because sometimes it can also mask as you know, you got to rule out, okay, is this like a lower back issue? Is this a disc issue? Or is this you know, something else going on in the pelvis?

Mark: So what's your typical forms of treatment and what's the kind of recovery time? 

Wil: Well so with this individual, it was probably some trauma from her old field hockey days. And she's developed all this muscle imbalance. So basically we did some manual therapy and adjustment on her left SI joint to get it moving.

And it actually was like night and day. She had full range, no pain. Her one leg balance in her one leg squat was like basically from like a one out of three, falling all over the place, you know. Basically no balance whatsoever. To being able to do good squats and balance was perfect. Almost perfect.

But then the fatigue factor was still there. She had all this muscle compensation. So then we had to work on doing a lot of soft tissue stuff as well. And so that's the first session. And then really then it's process of building that back up in terms of the core stability strength, and really looking at the mobility, making sure that it stays mobile.

So if that's not an acute segment, then it can very well take you know, as long as you know, she wants to get back into doing more sports again. You know, a full like four to six weeks to really get that motor pattern changed and really help her get those muscles firing around that hip and that SI joint and even the core and lower back.

So initially yeah, it worked really well, and it's working really well. And like I said, after one session, but it's that ongoing process of being able to keep everything moving, reinforcing that mobility and firing those motor patterns, firing those muscles that recruit the stability in that area. And that can take anywhere from a good several weeks to a good several months of, you know, if it keeps going sort of in a fixated position. 

Mark: So, and some of that's determined by how much work they're willing, or the client is willing to put in because you give them a recovery process that they have homework, basically. 

Wil: That and how much they punish their body with just going back to playing sport because she wants to go back and play some more soccer and, you know, she gets trauma on there again, then that resets everything. And so you have all that muscle atrophy, so you need to really work on strengthening and getting that bigger again and that core strong. So that takes several months, honestly. But it doesn't mean that you can't go back to be being able to play sports, but it's a gradual process. So that's the thing. 

Mark: So if you've got an injury of any kind, especially lower back, but anywhere in your body, you want experts looking after you, call Insync Physio. You can book online at insyncphysio.com for both locations. They have a North Burnaby location, that number 604-298-4878. Or in Vancouver, 604-566-9716. Get some help. Get feeling better. Thanks Wil.

Wil: You bet.