The Sacroiliac Joint Rarely Gets the Credit for the Back Pain It Causes

Posted on July 11, 2012 by Sarah Todd, PT, DPT

Back pain is one of the most common complaints of patient’s coming in for physical therapy. The sacroiliac joint (SIJ) can be a contributor to back pain. Interestingly enough, I was fairly oblivious of this sneaky cause of back pain until a senior clinician and women’s health practitioner opened my eyes and started my fascination with this joint.

The sacroiliac joint consists of 3 bones — the 2 ilium and the sacrum. The sacrum wedges snugly between the 2, serving as a keystone. Even though this is a “snug” joint, there is still a fair amount of movement that occurs here.

Common mechanisms of injury are:

a sudden jar to the body
falling on your buttocks
a possible lift and twist maneuver

Common symptoms of SIJ pain are pain at the belt level and pain that radiates into the buttocks, hip, and/or thigh. Your physical therapist can diagnose SIJ dysfunction through observation, palpation, and special tests.

Treatment of SIJ dysfunction may entail:

soft tissue mobilization of muscles, which may be in spasm or are short/tight
muscle energy techniques to correct the malposition of the joint
joint mobilization to decrease pain and/or improve the mobility of the joint
strengthening of the muscles surrounding the joint, including the pelvic floor muscles
stretching to decrease abnormal stress on the bones of the pelvis
taping or the use of a brace to help stabilize the SIJ

The SIJ is a “snug” joint that experiences small amounts of movements, but has the ability to cause a large amount of back pain. If you suspect you are experiencing SIJ dysfunction, consult with your physician or physical therapist for a full evaluation.

Gardening Tips to Prevent Injury

Written by: Lisa Martin, PT, DPT

Posted on July 5, 2012 by Lisa Martin, PT, DPT

Now that we find ourselves in the middle of gardening season, we want to make sure that you are thinking about proper body mechanics to take your garden from seeds/seedlings to blooms and veggies without injury. Below are a few easy tips to follow to help prevent injury during gardening:

1. Never bend straight over – this puts tremendous stress on your low back.

Squat Down: Keep your back straight, feet a little more than shoulder width apart, push your hips back and squat down. Do NOT push your knees forward over your toes.
Half-Kneel: If your knees will tolerate this position, place one leg in front and one leg behind you to kneel on the ground. Push your hips backward, letting your knees bend and keep your back straight as you lean down toward your garden.
Tall-Kneel: Again, if your knees can tolerate this position, kneel on both knees, keep your back straight and push your hips back toward your heels as you move closer to the soil.
Sit on a Stool: Sitting will decrease the stress to your legs and back. Keep your back straight, knees a little more than shoulder width apart and hinge at your hips to get movement toward the soil.
Hands and Knees: Get on your hands and knees with the plants off to one side. Keep your hands under your shoulders and your knees under your hips. This is a great position to move around mulch or pull weeds.
All of these positions are a safe way to plant, weed, and move soil or mulch.
You always want to make sure that you are not being a “lazy” gardener. Take a few extra minutes to figure out what position is most comfortable for you. Then make sure you are keeping your stomach and gluteal muscles contracted. Don’t forget about keeping a gentle squeeze of your shoulder blade muscles as well, you can do this by squeezing your shoulder blades together and down toward your back pockets. Activating these muscles will help you keep your spine in a good position.

2. When raking, never stand still.

Take steps and walk to what you are trying to rake. Keep your strokes small and never lean to the items you are raking.
Keep the rake or yard tool close to you – you should never be farther than an arms length away from what you are raking.
Do not twist – this can be avoided by always moving toward the object you are raking and keeping your body squared off to the object.

3. Lifting plants.

Keep the plants close to you when lifting. Remember to keep your stomach and gluteal muscles contracted.
Make sure to always move your feet when turning, never twist.
You can use a squat or half-kneel technique when lifting to avoid injury. Squat: Keep the plants close to your body. Have your feet a little more than shoulder width apart, hinge through your hips to push your butt back and keep your back straight. Place the plants on the ground. Half-Kneel: Keep the plants close to your body. Start with your feet shoulder width apart. Take a step forward with one leg, begin to bend both knees, and let the knee behind you touch the ground. Then you can push your hips back, keeping your back straight and place the plants on the ground.

Make sure that you get to enjoy the ENTIRE gardening season this year by following some of the guidelines listed above. If you are unsure about your gardening mechanics and proper positions, you should come visit us. We would be happy to review these with you and help you achieve an injury-free gardening season. Please let us know how these gardening positions worked for you!

Patient Walks Daughter Down the Aisle Despite Setbacks

Written by: Sports PT Blog Team

Posted on May 22, 2012 by Sports PT Blog Team

When physical therapist Meredith McHale introduced herself to her new patient James, neither one could have ever imagined the clinical roller coaster ride they would soon be taking.

James came to physical therapy (PT) like so many others, with severe pain in his back. After a thorough evaluation, Meredith created a specific treatment plan for him, and with his positive attitude, he was looking forward to getting started. When James returned for treatment 2 days later, Meredith realized that he had lost movement in his leg and immediately referred him to a spine specialist. James was rushed into emergency surgery on Easter Sunday to undergo a laminectomy, a procedure in which a portion of the patient’s vertebrae is removed to relieve pressure on the nerve.

Unfortunately, James’ emergencies did not end there. One week after surgery he suffered a pulmonary embolism, a blood clot in his leg that had traveled to his lung. He was transferred back to the hospital for surgery to receive a femoral stent. Post surgery James went back to the in-patient rehab facility only to find out an infection had developed at his incision site. Most of us would have found it difficult to bounce back from just one of these setbacks, but James is a survivor.

After endless nights in the hospital, James was finally able to come home. He began in-home PT as well as wound care, three times a week. Meredith was kept informed of the traumatic journey her friend James had been on.

Eventually, James became strong enough to start outpatient physical therapy and he returned to Meredith for treatment. He was unable to lift his left foot but he set an important goal for himself – James’ daughter was getting married and he wanted to walk her down the aisle. Meredith was by his side every step of the way to help him achieve that goal.

James began his sessions in a back brace, using a cane, and unable to drive himself to therapy. Through months of hard work, a positive attitude and lots of good old fashioned laughter, James was able to trade the brace and cane for his daughter’s arm on their special day. Meredith credits James’ determination and incredible outlook for achieving his goal, and all the while motivating every other patient in our office to do the same. Congratulations James, you did it!!

Can Physical Therapy Help to Alleviate Low Back Pain During Pregnancy?

Written by: Lisa Martin, PT, DPT

Posted on May 14, 2012 by Lisa Martin, PT, DPT

Are you pregnant and suffering from low back pain? Well you are not alone; over 50% of pregnant women experience low back pain during their pregnancy.¹ This pain can be debilitating, preventing you from working, taking care of your home and taking care of your other children. Pregnancy-related lower back pain can be due to postural changes, ligament laxity due to the release of the hormone relaxin, and weight gain, resulting in decreased stability of the back and hips.^{1, 2}

The good news is that you don’t need to suffer with pain during pregnancy. It has been shown that physical therapy can help to decrease or even eliminate pregnancy-related low back pain and improve your function through manual therapy, spinal stabilization exercises, and education on sitting, standing, lifting, use of support pillows, and turning in bed.^{1, 2, 3}Exercises will emphasize the abdominals (stomach), pelvic floor (muscles you use to stop urination), and gluteal/hip (buttock) muscles to help stabilize the pelvis. For example, some exercises your physical therapist might show you include: lying on your back with a wedge doing a bridge, getting on your hands and knees lifting opposite arm and leg, side-lying lifting your leg, and sitting on a physioball marching and standing doing small range squats.^{1, 2}

As mentioned above, the hormone relaxin is increased during pregnancy to ten times the normal levels.³ The purpose of relaxin is to help the pelvis adapt and prepare for childbirth by softening connective tissues and ligaments around the pelvis, pubic symphysis, and sacrum. These changes will allow the baby to pass through the birth canal.³ Unfortunately, due to the increased release of relaxin, your sacroiliac joint and lumbar joints can become unstable and move out of alignment contributing to your pain. Research has shown that it is safe and effective for your physical therapist to perform gentle muscle energy techniques (manual therapy) to correct the alignment and allow you to train your muscles in proper position.³

Bottom line, you are not alone and you do not need to suffer with low back pain during pregnancy. It has been shown that exercise, education, and manual therapy during pregnancy is a safe and effective way to treat low back pain, reduce sick leave from work, reduce need for bed rest, and prepare you for labor. ^{1, 2, 3}

Reference:

3. The Effects of Manual Physical Therapy and Therapeutic Exercise on Peripartum Posterior Pelvic Pain: Two Case Reports. The Journal of Manual & Manipulative Therapy. 2005; (2): 94-102.

One Leg Longer than the Other?

Written by: Julie Wolfley, PT, DPT

Posted on May 2, 2012 by Julie Wolfley, PT, DPT

Have you noticed that your pants always fit a little weird or that you are always leaning to one leg when standing for awhile? If so, one of your legs may be longer than the other. This is known as a leg length discrepancy.

There are two main reasons for a leg length discrepancy. One reason is that one of your leg bones (tibia or femur) is longer on one side. This is referred to as a true leg length discrepancy because the actual length of your bones is different. A second reason is that your pelvic bone may be rotated on one side making it appear that one leg is longer than the other. This is referred to as an apparent leg length discrepancy because the actual length of your leg bones is not different. In order to figure out if you have a true or apparent leg length discrepancy, your doctor may take an x-ray to measure the length of your leg bones or a simple measurement from your belly button to your ankle can help determine the reason.

Over time, the leg length difference can cause stress on your low back, hips and knees, which may cause pain or discomfort.

How to fix the issue:

You may be prescribed a heel lift, which will equal out your leg length and decrease stress on your low back and legs. If it’s your pelvis causing the leg length discrepancy, then your physical therapist could use your muscles to realign your pelvis and then strengthen your core/abdominal region to minimize the risk of such malalignment happening again.

If you think that one leg may be longer than the other and it is causing you to have pain or you are just curious, then call your local Sports PT facility and make an appointment with a physical therapist.

Sitting for Prolonged Periods

Written by: Teresa Hall, PT, DPT, OCS

Posted on February 15, 2012 by Teresa Hall, PT, DPT, OCS

We now live in a time where many of us are sitting for most of the day at work. What do we then do after we commute home in our car, bus, or train? The answer is probably sit for dinner, then sit and watch TV. With the workforce becoming increasingly more computerized and less manual labor, a new breed of couch potato-related problems have emerged.

The Facts:

Prolonged sitting (more than half the day) leads to increased risk of:

Heart disease
Metabolic disorders
Obesity
Some types of cancer

Click here to find out more about these risks.

Sitting takes a toll on our musculoskeletal system:

Sitting shifts a person’s center of gravity to the middle of their chest rather than the hips, increasing stress on the neck and shoulder muscles. This can lead to nagging neck pain at the end of the day.
Another common complaint from prolonged sitters is low back and/or sciatic pain, a burning pain that travels down the back of the leg. A flexed sitting posture increases pressure on the discs in the lower back and also decreases blood supply to the nerves making them more irritable.

What can be done?

I get it…you need to sit at work. However, there are a few things you can do to decrease the bad effects of prolonged sitting. One thing I commonly suggest is to set a timer for 30 minutes on your Outlook calendar or use a kitchen timer. When it dings, get up and walk a little bit. It’s easy to get caught up in work and lose track of time, so the timer is a great method to remind your body to move and get some blood flowing. Another recommendation is to make your workstation inconvenient. Put that printer across the room. Move your calendar to the bookshelf. Get your phone off your desk. This will force you to get out of the chair. You could also do some stretching or exercise while watching TV instead of sitting on the couch. This will not only feel good, but can help to counteract some of the risks of prolonged sitting.