[Iesu]

Just wondering if any of the resident folks with good knowledge can help me (apologies for the long-winded-ness of this post and I HAVE tried the search, honest  ):

I've been suffering from lower back pain ranging from mildly irritating to almost debilitating for about the past 2 months. Symptoms include stabbing type pain during motion in lower right lumbar area (particularly when getting out of chair/car seat) and shooting sensations down the back of right leg occasionally as far as foot. Loss of flexibility to the point where i'm almost having to sit down to put on shoes and socks, especially first thing AM.

I've stopped bike riding because i didn't think that was helping. After 2 days on moderate bouldering before christmas I was in pain sitting at my desk on the monday. While surfing in cornwall end Nov/early December there was some pain when wading out through the white water as the waves tend to wash your feet away from under you backwards.

I spent a LOT of time driving over the festive period (about 1300 miles at a guess), and was getting the shooting sensations into my calf/foot quite frequently despite what I consider to be a reasonable driving posture. I also did a fair bit of driving in November soon after symptoms started.

I went to see a physio this AM whom I have visited a long time ago for a whiplash injury and trust. She did a bit of manipulation and managed to cause a loud 'pop' noise during a twisting motion (which isn't that unusual in my experience). She thinks that there is a problem with (one of) my SI joints, but that there is also a problem with range of motion in my upper back as well. She didn't have my notes from my previous treatment for whiplash (obviously upper back and neck issues - I have long term problems there); I told her about my knee cartilage surgery 16 months ago and how it had started to deteriorate again. She thinks there may be a correlation between my knee causing me to alter my gait and the SI joint.

I will probably see her again once she has my old notes to hand, but I don't fancy being a long term patient at her rates. I've done a quick web search and found some info about SI joint pain and pain down the legs etc. Can anyone out there give any further advice or assistance about rehab? I'll try to lay off the driving a bit (diesel is a bit dear these days) but unfortunately my job occasionally demands it.

cheers

[Dirty Lion]

Have you tried an osteopath? Back pain I've experienced which sounds similar to yourself ie a lot of driving and time sat at a desk also pain whilst getting up out of a chair and almost unbearable pain at times whilst sitting or driving etc has been improved with about four+ visits to a good osteopath. I also had sciatica going down one leg which resulted in numb toes (think this the the S1 nerve being pinched), the osteopath fixed the tightness in my lower back and i was able to operate normally again just taking it easy as first, walking a lot and then easy sessions at the wall.

I found that pilates exercises helped and if I have to do any long distance driving with my job I try and take a lumbar support and really try to remember to work on my posture.

I would try to get the opinion of an osteopath as I found it helped a lot. Hope this helps

[rich d]

More back pain woes. The wife was diagnosed by the gp as having a minor prolapsed disc. Google search will be my friend, but just wondered if the "we've had every injury" UKB massive could recommend any exercises? Also as usual with our gp the advice was take it easy bla bla bla - not worth referring at your age bla bla - so is it worth seeing a physio/chiro.
Cheers Rich

[Oldmanmatt]

Take it easy, might be the worst advice possible!
Best treatment I've found for mine is strength training the lower back and Abs.
Dorsal raises, dog cocking (fna fna), crunches etc etc.
I find full sit ups irritate it like buggery!

There is a good exercise for stretching it, that gives me relief every time I get a flare up. I can't remember the name, I'll look it up.
Lie on your back, arms out 90* to body (starfish), bring feet up towards rear end until soles flat on floor and knees bent ~90*. Keeping ankles together, rotate knees down to the floor, a few times on each side.
Also, laid on back "hug" knees to chest (actually, I usually do that to limber up prior to the rotating exercise).

I've tried epidurals, ostio's, quacks and physio's. The physio's being the best by far.
Mine was pretty bad, lost the use of my left leg entirely.
Not had any trouble since building up the strength around the core.
Also worked on the wife...

[rich d]

Cheers Mat - great advice. The shorty is thinking about starting pilates to help strengthen it too.

[duncan]

Generic back pain advice, aimed at GPs but of some use to most people here

Some exercises to try here and in video form here.

[fiveknuckle21]

Generic, nonsense advice alert. With no medical knowledge to boot.

I had exactly the same problem and it sounded bang on when you say the terrible word s.c.i.a.t.i.c.a. Mine was a result of muscle inflammation but the pain, I fully sympathise with, can be unbearable. Far worse than any break I have ever had.

It sounds like the worst thing ever but just keep moving as much as possible. Even if its just up and down the stairs a few times. My cure was a week in font, climbing all but one day, sleeping on a very, very uneven camping surface and some super strength anti inflammatory medication. In regards to your specialist, well, what do they know? Mine told me it was a result of bad posture. Ih or.

Good luck with your recovery buddy. I wish you the best.

[fatkid2000]

SI joint pain can be really painful and a bugger to treat.

Really the only thing that helps is a decent anti-inflammatory - something like diclofenac or naproxen. I would hope most people on here can take these.

The next thing is physio - and for this depends on where you live. Sometimes where I work people get seen in a couple of weeks - sometimes not - it's a bit random. The people I've sent for physio have had good results - but it can often re-occur.

Be careful of  chiropractor -  ( speak to any back or neuro-surgeon)

SI joint pain if often mis-diagnosed as sciatica. I probably see between 2 and 5 people a day with back pain & 95%+ get better on there own with pain relief / simple exercise - hence the reason most people don't get referrrals / scan. Remember the NHS has finite resources and a bit of mechanical back pain is pretty low down on the priorities list at the moment - unlike PIP breast implants.

[duncan]

Generic, nonsense advice alert. With no medical knowledge to boot.

I'm not entirely sure what this means.  If it means it is nonsense to give anything other than generic advice for a medical problem on an internet forum then I agree with you.   As it is generic it wont be the best advice for everybody, the OP should listen to their physio./doctor/whoever they see.   

The article linked was commissioned by the leading arthritis and pain charity in the UK, it is evidence-based, and material from it has been recycled by the British Medical Journal  in a training package for GPs.  I'm one of the authors and I have sufficient medical knowledge.

[Iesu]

Generic, nonsense advice alert. With no medical knowledge to boot.

I'm not entirely sure what this means.  If it means it is nonsense to give anything other than generic advice for a medical problem on an internet forum then I agree with you.   As it is generic it wont be the best advice for everybody, the OP should listen to their physio./doctor/whoever they see.   

The article linked was commissioned by the leading arthritis and pain charity in the UK, it is evidence-based, and material from it has been recycled by the British Medical Journal  in a training package for GPs.  I'm one of the authors and I have sufficient medical knowledge.

To be fair to fiveknuckle, I personally read that as a qualification of his "advice"/experience no anyone elses.

I saw a GP this morning who more or less fobbed me off and said "come back in 2 weeks if it doesn't improve"; pretty much what I expected based on previous experience of going to GP with musculo-skeletal problems. GP reckons it IS Sciatica (after looking at me on the treatment bed for 5 minutes) and gave me a couple of sheets of ARTHRITIS exercises. What really DID gall me was that she refused to even DISCUSS my recurrent knee problem "you'll have to ask about that NEXT time". oh well.

anyone got experience of SI joint dysfunction diagnosis? I may well stump up another £35 to see the private physio.

Good luck to everyone else, it is a debilitating (and depressing) thing to deal with.

[climbon]

Iesu

I am a PT in the US. I will do my best to help you out, but it is extremely difficult without being able to see you and do a full assessment.

The pain you are describing does not sound like an SI joint (SIJ) issue. Pain down the leg is normally related to sciatica, especially if it is going into the calf. The positions that you are describing that cause the pain or worsen it also suggest sciatica. SIJ issues do create some leg pain. Usually the pain starts at the SIJ (where ilium and sacrum meet), goes down into glute/hip area, and then wraps around the front of the thigh to the knee. People will often complain of one leg being shorter or feeling like they are stepping in a hole while walking. The reason for this is that the ilium will rotate either anteriorly or posteriorly. This creates a functional leg length discrepancy because it changes the position of the acetabulum.

SIJ dysfunction does tend to cause pain with sit to stand transfers. Here is a way to assess for SIJ dysfuntion. Lay supine on a firm bed or floor. Bend your legs so that your feet are flat on the floor. Now raise your hips up, i.e. do a bridge. Lower back down and extend your legs so that you are now lying completely supine. You can have some body place a thumb or finger underneath the medial malleolus (inside of your ankle) to assess the position of each leg. Then they can hook a thumb underneath your ASIS to assess position of your pelvis. This allows you to see if the pelvis has rotated and created a leg length discrepancy. There is a muscle energy techinque called scissor-shotgun that may be used to correct the pelvic obliquity. Let me know if the previous test is positive for a rotation and will do my best to describe that technique to you.

I want to add a disclaimer that I am not attempting to diagnose you via the internet. I am only providing some information that I have seen working with several patients with low back and SIJ dysfunction. My advice, given your description of the pain, is to continue seeing someone in person and make sure they rule out any disc bulging/herniation and nerve issues. I would seek out a PT who has a lot of Manual PT skills and has experience with Neurodynamics. There are two Aussie PTs who are leaders in those areas and teach courses worldwide. Their names are Maitland and Butler. I would not hesitate to ask your therapist if they have taken any courses or experience with those two names. There are other PTs around the world who have different Manual Therapy systems that are good as well. These are the two that I have the most experience with and trust the most. If you do have a disc issue, then Mackenzie has some good treatment techniques to help. In my experience, combining some of the Mackenzie extension protocols with joint mobilizations can make a big difference.

Hope that helps and sorry for the long post.

[rc]

Apologies if this is too much info - but y'know, maybe it'll help someone. I'm a sufferer not a physio.

Somewhere about 2-3 years ago I started getting sciatic pain, especially when driving, and discomfort when sitting at my desk for a long time. This was definitely exacerbated by jumping off when bouldering. Got to the point I could not jump off at all and was downclimbing everything at the bouldering wall etc. Then I could only drive for about an hour before the sciatic pain stopped me. I was also getting terrible IT band pain while running and had to quit this too.

To cut a long and bloody frustrating story short I finally got a correct diagnosis: my SI joint was out of whack. The physio I now see (one of the few good ones) identified it immediately, and did a very simple "gentle crunch" on my sacrum to push it back into place - the symptoms eased within the day.

This "joint" can get slightly misaligned (it might be out by 1cm or less) and this pulls all the small structures,  muscles etc out of alignment. One typical consequence of this is your piriformis muscle clamps down - mine was in spasm a lot of the time. The sciatic nerve runs in a small gap next to (or in many people right through) the piriformis muscle, so the spasmed piriformis clamps on the sciatic nerve and causes sciatic pain. Jumping off aggravates all these ass-muscles, pisses off the piriformis even more, making it all worse.
SI joint being "out" can also often cause:
- lower back pain (due to ligaments connecting lower spine to pelvis being pulled out of normal alignment and getting strained)
- IT band and knee pain (due to everything being out of whack in hip/pelvis)
- Psoas muscle (in abdomen) spasming

For me the answer was (1) find a physio that is not shit [very difficult] (2) get them to crunch my SI joint back into place (3) have a lot of extremely painful super hard-core massage on the piriformis to de-spazzify it (4) do specific stretches and strengthening exercises (5) repeat

My SI joint was probably "out" for about 2 years. So now it keeps popping out again. I do not even notice this happening. I only notice I start getting a bit of sciatic pain again, then I get someone to crunch it back in (it is very easy to do, but you need someone else to do it).

Also note that some stretches will tend to pop it out, hence good to get advice on how to stretch. I also have some theraband exercises to strengthen all the small muscles that will eventually hold it all in place.

Maybe this is all irrelevant to your problem, but thought it was worth explaining on the off chance it is helpful. I wish someone had given me this insight as it took me a long time to get it diagnosed. Obviously give me a nudge if you need any more info or whatever.
Cheers,
Richard


An anecdotal aside (disclaimer: this is from a.n.other, a qualified physio):
Until quite recently (~15 years ago) people thought the SI joint was totally fused solid and did not move at all. This is because all their understanding came from chopping up cadavers, and within a few hours after death the SI joint does fuse totally solid. So in dead bodies it is not mobile at all, and this is what doctors understood. In fact with modern scan technology they can now see that this joint can flex up to 5 degrees and that this mobility is important.
This misunderstanding has lead (since the 1930s) to osteopaths and medics in general to not even have SI joint on their radar. So with back pain they look for other causes. One favourite became to look for and find bulging discs and identify this as the cause of back pain even though often it is not. If we scanned a lot of people with no back problems - a lot of them would show bulging discs, so this unfortunately compounded the wrong belief that back pain was a lot about discs.
Even now when you talk to older (hence "expert") docs/osteopaths etc and tell them the SI joint moves many will tell you you're an idiot. We are effectively waiting for this old mentality to retire out of service before the new understanding can take over.
This may explain a bit why many NHS docs (and others) simply dont even imagine to look at SI joint stuff - their whole back-pain paradigm has this "joint" as totally fixed and hence they diagnose based on the wrong assumptions.

[climbon]

rc

I completely agree about the SIJ often being overlooked. Depending on what is exactly wrong with it will determine what treatment is best. You are correct that it is often not "off" by much but can make a big difference and affect other areas/structures. Given the original posters description of pain, he needs to make sure there is no issue with his lumbar spine (disc, joint, etc) that is not affecting the leg and creating that pain. Could it all be coming from the SIJ? Yes, but to determine that means seeing him in person and doing a full evaluation. You are also correct with your explanation of the piriformis and it's relation with the sciatic nerve. I often teach my pts. exactly what you mentioned.

One thing you can do to help "de-spazzify" your piriformis is sitting on a tennis ball or something harder. Then roll around on it to "massage" your piriformis. To illustrate how easy it is to slip your SIJ out, it can happen by taking an awkward step or stepping off a curb. It is continues to come out, some other treatment options are taping/strapping and use of an SI belt.

[Ally Smith]

To rc and the OP.

I've suffered from a mis-aligned SIJ, and like you suffered at the hands of quack physio's and GPs. In the end it was a sports massage therapist that diagnosed my issue, and like you with a gentle manipulation i was relieved of many symptoms within a few hours (it has also popped back in when i slipped on an icy carpark - no need to fork out for a manipulation that time  ).

The mthod of diagnosis that was used on me was to have the therapist observe the rotation in my hips as i bent forward from standing, though with you this may be complicated by your knee problems.

Good luck with getting it sorted.

[fiveknuckle21]

Generic, nonsense advice alert. With no medical knowledge to boot.

I'm not entirely sure what this means.  If it means it is nonsense to give anything other than generic advice for a medical problem on an internet forum then I agree with you.   As it is generic it wont be the best advice for everybody, the OP should listen to their physio./doctor/whoever they see.   

The article linked was commissioned by the leading arthritis and pain charity in the UK, it is evidence-based, and material from it has been recycled by the British Medical Journal  in a training package for GPs.  I'm one of the authors and I have sufficient medical knowledge.

It was a precursor to what I said. Not you. Not ever. Sorry duncan.

[rc]

One thing you can do to help "de-spazzify" your piriformis is sitting on a tennis ball or something harder. Then roll around on it to "massage" your piriformis. To illustrate how easy it is to slip your SIJ out, it can happen by taking an awkward step or stepping off a curb. It is continues to come out, some other treatment options are taping/strapping and use of an SI belt.

Good advice. I forgot to mention this: my best therapeutic buy of 2011 was a solid rubber ball from Wilkos. 99p from their pet toys section. Not sure I want to admit to spending hours rolling around on it, but it works. Following the MO of my physio, move around to find the most painful spot then lie so as to have the ball pressing right on it. Keep increasing the pressure until the muscle releases.
(I found a tennis ball was way to squashy to do much good.)

[surfchimpster]

I had this for over 2 years! very painfull good to hear people talking sense on here. The best exercise was to lie on back bring  knees up and squeeze fists try this....

It was the only thing that worked and you could and still can here it pop back into place when its popped out

cheers

matt

[duncan]

It was a precursor to what I said. Not you. Not ever. Sorry duncan.

Re-reading ... I jumped to conclusions and should be the one saying sorry.  Sorry!   

[lmarenzi]

Matt

Interesting thread.

I have had problems on and off with SI joint on right side for years, felt it go while sprinting up hill over uneven terrain a few days ago.

During Yoga today we did crow pose (aka bunny hops / forward tip from squat) and to my unexpected delight I heard and felt it scrunch back in. I suppose its like the exercise you recommend from the video but with a bit more torque through the hips.

Good luck.