May 5, 2018

Low Back Pain That May Not Be Coming From Your Back

By Spencer Wells

Not all “back pain” originates from the lumbar spine. A common pain generator is the joint between the tailbone (sacrum) and the hip bones (iliac bones) on either side of the tailbone. This joint is called the sacroiliac joint and, if thrown off kilter or irritated, is often the culprit for what some may refer to as back pain. The sacroiliac joint plays a major role in the transfer of upper-body weight to the lower extremities.   Think of the lumbar spine as the weight-bearing beam of the upper body. Its base is the sacrum which is wedged in between the two iliac bones and joined by a complex of ligaments. If this weight is not evenly distributed or transferred smoothly onto the hips and legs, inflammation and arthritis can occur.

One may then ask, “Why wouldn’t the weight be transferred evenly to the lower extremities?” There are many reasons but one of the most common causes would be a leg-length discrepancy. In other words, one leg is longer than the other. It is actually common to have a slight leg-length discrepancy simply due to genetics. Most of the time it is insignificant and isn’t a pain generator, but if it is greater than a ½ inch, it is more likely to be a source of dysfunction and possibly pain. Another possible cause of SI dysfunction is due to the slight leg-length discrepancy or altered gait (the way one walks) which may occur after hip or knee replacements.

The most common symptom of SI joint dysfunction is pain over the buttock which may radiate down the groin or lateral aspect of the thigh but not below the knee. Pain from the sacroiliac joint is typically not nerve type pain (electrical, burning, tingling, or numbness) but rather an achy deep pain.

When forming a treatment plan for sacroiliac dysfunction, it is important to consider a heal lift if leg length discrepancy is suspected as the cause. Other options include trials of NSAIDS, TENS (transcutaneous electrical nerve stimulation), physical therapy, and chiropractic manipulation therapy. When the less invasive measures fail to relieve the pain, an SI joint injection under x-ray guidance can be performed to reduce inflammation and more rapidly help the patient return to full physical activity.

If you are experiencing back or SI joint pain and have questions regarding treatment options, you are welcome to call Desert Pain Specialists for an appointment at 216-7000.

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