As we excitedly watched the 2018 Olympic games and were amazed by the progression of many of the winter sports like snowboarding, skiing, hockey and many others, I continue to be amazed at the ability of the human body to adapt and recover. The impact that these athletes can withstand and their body’s ability to absorb impact is mind-blowing.
As they are pushing their sports and bodies to the next level, I think of the physics of it all and how amazing the human body really is. Let’s go back to our grade school song “the hip bones connected to the leg bone” and take a look at our natural shock absorbers: the SI joint, alongside the tricky issue of sacroiliitis.
The SI Joint: Connection Between the Sacrum and the Iliac
The sacroiliac joint, also known as the SI joint, connects the pelvis with the lower spine. It carries the weight of the upper body and bridges it to the lower body. The sacrum or lower section of your spine is made of five non-moveable vertebrae alongside the two large hip bones called the ilium or iliac crests. (1)
The SI joint is an essential shock absorber during weight-bearing activities and also relieves some strain on the lower lumbar. According to a sports medicine study by Jack Harvey and Suzanne Tanner, “Lumbar spine pain accounts for 5 to 8% of athletic injuries. Although back pain is not the most common injury, it is one of the most challenging for sports physicians to clearly diagnose. Athletes who participate in sports involving repeated and forceful hyper-extension of the spine may suffer from lumbar facet syndrome, spondylolysis, or spondylolisthesis.” (2)
The sacroiliac joint is surrounded by strong ligaments and muscles such as the erector spinae, psoas, quadratus lumborum, piriformis, abdominal obliques, gluteal muscles and hamstrings, all of which strengthen the SI joint. These surround and encapsulate the sacroiliac joint and all can be affected in sacroiliitis.
What Is Sacroiliitis?
Medically speaking, the suffix “itis” refers to inflammation, while sacroiliitis refers to inflammation of the sacroiliac joint. Sacroiliitis is pain that could be dull or sharp and starts in your hip joint but can move to your buttocks, thighs, groin or upper back.
The pain may worsen when sitting for prolonged times and stiffness can be felt in the hips and lower spine. Sacroiliitis is a term that is sometimes used interchangeably with the term sacroiliac joint dysfunction. This can also lead to lower back pain and/or leg pain and can be caused by lumbar disc herniation or sciatica pain.
Why does sacroiliitis happen?
Pain usually starts when your sacroiliac joint is inflamed or irritated. This inflammation is then classified as either acute or chronic. Acute inflammation is typically intense, short-lived and can be caused by an injury that heals in times as the pain gradually subsides. This can last anywhere from 10 days to six months. Chronic inflammatory pain is ongoing and may be mild or intense.
Sources of sacroiliac joint dysfunction usually include hypermobility/instability or opposite hypomobility/fixation. This pain can spread throughout your lower back, hips and legs. This pain becomes chronic after a patient experiences a prolonged level of pain that surpasses the acute phase.
There are several diagnostic tools that can be used such as x-rays, CT scans or MRI’s that can show the narrowing of the joint space or erosion of the bone area.
What causes sacroiliac joint pain?
- Impact sports, weightlifting or falling down
- Repeated impact from activities like jogging or repetitive impact sports
- Pregnancy (when the body releases hormones that cause your joints to loosen up and move more, causing hypermobility)
- Illnesses like infection, arthritis and gout could cause inflammation
Conventional Treatment of Sacroiliitis
- Physical therapy: PT improves strength and makes the joint more flexible to decrease the inflammation in the SI joint. This could also help correct any overcompensation habits created due to the pain. In conjunction, a therapist may use ultrasound, heat/cold treatments, massage and stretching.
- Injection: Shots of cortisone can be used to cut the inflammation to the joint. Some physicians will use a numbing solution such as lidocane or bupivacaine to relieve some of the pain.
- Rest: Utilizing a short period of rest along with heat and/or ice.
- Nerve treatment: Using a needle to permanently damage the nerves that send the pain signal to the SI joint and then to your brain.
- Surgical fusion of the SI joint: This is a very invasive procedure in which the sacroiliac joint gets surgically fused together. Both the nerve treatment and surgical intervention are considered last resort treatments.
5 Natural Treatments for Sacroiliitis and SI Joint Pain
1. Chiropractic Treatment
Techniques that move muscles and joints for alignment and pain reduction. This manual manipulation consists of physical chiropractic adjustments applied to the hips and lower back to help reduce join fixation and muscle tension with a goal of restoring range of motion.
Natural treatments that uses traditional Chinese medicine in which inserts needles into meridian points on the body to decrease pain and inflammation.
A solution of natural ingredients such as saline to ease joint pain. Prolotherapy uses your body’s own platelets (PRP, or platelet-rich plasma) and growth factors to heal damaged tissues naturally.
These are naturally occurring, volatile aromatic compounds that are found in the seeds, bark, stems, roots, flowers and other parts of the plant.
Clove Oil: This oil has analgesic, anti-inflammatory, anesthetic, antiviral and antibacterial properties and is considered a ”hot” oil so when using topically, be sure to use a carrier oil.
Turmeric Oil: this ancient herb has healing properties and contains an active ingredient called curcumin. One study published in the Journal of Agricultural and Food Chemistry evaluated the anti-arthritic effects of turmeric essential oil and found that crude turmeric essential oil given orally at a dose that would correspond to 5,000 milligrams per day in humans had a modest anti-inflammatory effect on the joints of animal subjects. (3)
5. Exercises and Stretches
Exercises: To better support and strengthen the sacroiliac joint and pelvis/lower back area, an athlete can focus on gaining core strength both anteriorly and posteriorly. Here are some strengthening exercises:
- Glute Bridge Variation: Lie flat on your back with your hands to your sides. Next, lift your pelvis upward, squeezing all the muscles of the spine, the glutes and posterior legs. From here, lift and squeeze one knee at a time, focusing on stabilizing your hips as you continue to march and switch each leg. Repeat this exercise for 3 sets of 15 reps.
- Plank Front Row Variation (with exercise bands): Attach the exercise band to the wall or a chair with your head facing the wall. Engage your core abdominal muscles and lift the abdomen off of the floor into plank position. Grab the exercise band and pull the elbow towards the knee, then tap back into plank position. (Do 15 reps on each side.)
- Bird Dog: This will work your lower back and core abdominal muscles in addition to helping stabilize the muscles of the spine. Start first on all fours. Keep the spine and neck in the neutral position and slowly extend opposite arm and opposite leg. It’s important to keep your shoulders and hips straight without arching your back. Hold for 5 seconds and repeat opposite arm opposite leg.
Stretches: These stretches help reduce muscle tension and spasms in the lower lumbar, which could be leading to the acute or chronic hip/lower back pain.
- Knee to Chest: Lie on the floor with one leg extended and the other knee pulled into the chest. Hold this position for 10 seconds and then switch to the other leg.
- Pigeon (Folded Forward Variation): Start on all fours with your hands shoulder-distance apart. Bring your left knee forward and place it on the floor just behind your left wrist, with the side of your lower leg on a diagonal and your left heel pointing toward your right hip. Meanwhile, your right quadriceps should squarely face the floor so that your leg is in a “neutral” position. As you breathe out, you can allow the chest to fall forward towards the mat, holding and breathing through the stretch.
- Lying Glute Stretch: Lie on the floor or mat and bend knees with both feet placed on the floor. Cross lower leg over thigh of other leg and pull in with both hands. Pull leg toward the torso and hold the stretch for about 10 seconds. Release and repeat with the other side.
The sacroiliac joint walks a fine line when it comes to stretching and overstretching of the SI joint. By focusing on creating stability and strengthening of the muscles surrounding the SI joint, you will be able to sustain a pain-free sacroiliac joint.
Just like we have to check the shocks in our vehicles each year, we must also take time to check the shock absorbers of the body to ensure everything is in check and working properly. Waiting until the “pain” light goes on sometimes lengthens the recovery time or creates compensatory injuries that only add to the body being out of balance.
Take time before and after workouts to stretch and lengthen the muscles of your lower extremities. We only get ONE body and it’s time to start caring for it!
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