Have you considered chiropractic care for your sacroiliac (SI) joint pain and dysfunction? Robert A. Hayden, DC, PhD, FICC, a chiropractor in private practice at Iris City Chiropractic Center in Griffin, GA, shares how chiropractic’s conservative approach can help you relieve pain and regain function in your low back and SI joints.
SpineUniverse: What is sacroiliac joint pain?
Dr. Hayden: Sacroiliac joint pain is a prevalent disorder affecting your sacroiliac joints, also called your SI joints. If you look at someone from the back, you may see dimples at the base of the spine—those dimples are over your SI joints. The SI joints are where your sacrum and your pelvis meet.
The SI joints are held together by cartilage. When 1 or both of your SI joint(s) misaligns, you’ll experience swelling in the cartilage that holds the joints together. This can stress the cartilage, causing the joints to become painful and misaligned.
If you have inflammation of your SI joint(s), your doctor may call this sacroiliitis. This condition can be the result of a chronic SI joint misalignment.
SpineUniverse: What can cause SI joint pain?
Dr. Hayden: Several things can lead to SI joint pain. Being overweight certainly increases stress on that joint. Another cause is having an anatomically short leg, or one leg that is shorter than the other. When one leg is shorter, that means one side must work harder and bear more weight than the other.
Another cause is from an improper gait that can occur after knee or foot surgeries. Similarly, SI joint pain is sometimes secondary to hip pathology in seniors that will change the gait as well. Anything that affects the gait will affect the dynamics of the SI joint.
Sometimes a traumatic event, such as a fall, will cause the joints to misalign.
SpineUniverse: How does a chiropractic physician evaluate and diagnose a SI joint problem?
Dr. Hayden: I primarily rely on the patient’s medical history, the history of the current complaint, and physical exam. If the patient has a history of trauma or 1 side of the pelvis is higher than the other (a sign of scoliosis), I may order a plain film x-ray. However, I typically do not use imaging as part of the diagnostic process for SI joint disorders, unless there is a history of radiating pain, infection, cancer, or trauma.
The physical test I use to diagnose a SI joint disorder is called the Patrick’s test, which is performed while the patient is lying on his or her back. I cross a foot to the other knee and depress the knee to stress the SI joint on that side. If the patient experiences pain near the SI joint, that may suggest the diagnosis. (Another name for the Patrick’s test is the FABER [Flexion, Abduction and External Rotation] test.)
Even if the Patrick’s test isn’t positive, localized pain in the SI joint area makes me suspect SI pain if the patient has other factors like leg length inequality, change in gait, and trauma history.
SI joint disorders cause pain in the lumbar spine (low back) and hips that worsens during weight bearing activities, such as walking. If the patient has pain that worsens during weight bearing activity and is relieved by sitting down, that’s another key indicator of SI joint pain.
While I sometimes do not require imaging to diagnosis SI joint dysfunction, chronic sacroiliitis will show on an x-ray, because a chronically inflamed joint deposits extra calcium to reinforce itself. An x-ray will show that extra calcium as increased density on that joint.
SpineUniverse: Some orthopaedists use the term “dysfunction” to describe a SI joint disorder. Do chiropractors use this term?
Dr. Hayden: Yes, we do. That term confuses some patients, so here’s how I explain dysfunction in relation to a joint: I have a door in my treatment room that has 3 hinges. If I took the door off and moved the middle hinge to about a 5-degree angle and then put the door back on with that crooked hinge, nothing would be broken. However, the door would not open and close correctly. That is how important joint alignment is. If it’s slightly misaligned, it has lost its function.
SpineUniverse: What is the first-line treatment protocol?
Dr. Hayden: I often use ultrasound as a first-line SI joint treatment. Ultrasound sends heat to the inside of the joint. When connective tissue is warmer, it stretches better and hurts less.
In addition to ultrasound, I will likely perform a simple chiropractic adjustment on the affected SI joint to realign it and get quick pain relief. But for patients with a leg length inequality, I tend to look deeper.
If there is a leg length inequality or scoliosis, I have a lot of success balancing the pelvis using specially made shoe soles. I work with the shoe shop in my town to build out a sole of a patient’s shoes to balance the pelvis and take pressure off the joints. This is an excellent long-term solution. Custom orthotics are also an excellent choice if the length inequality is not more than 7 millimeters.
Sometimes, I recommend patients use a trochanteric belt if they have an SI joint that won’t stay in the right place. This belt is worn underneath clothes and can help stabilize stubborn SI joints.
SpineUniverse: Are there specific stretches and/or exercises you recommend?
Dr. Hayden: Hamstring stretches are important, as a tight hamstring actually pulls on the lower pelvis and can misalign the SI joints. Lunges like a hurdler’s lunge or fencing stance are great stretches for the iliopsoas, or inner hip, muscle. Stretching is a great habit to adopt if you have SI joint pain—a flexible, limber patient has less trouble with joints.
SpineUniverse: Do chiropractors recommend natural supplements to help reduce inflammation that may be associated with a SI joint problem?
Dr. Hayden: I often recommend glucosamine to patients with joint disorders. Studies suggest glucosamine is good for osteoarthritis, while others say it’s not effective. But the preponderance of studies support its use—plus, it has no negative side effects. I also use turmeric and omega-3 fatty acids. Omega-3s, while most often used to manage cholesterol, also produce an anti-inflammatory effect when taken at higher doses (2-3 grams per day).
SpineUniverse: At what point, if at all, would a chiropractic physician refer a patient to a spine surgeon?
Dr. Hayden: Surgery should only be considered after every conservative measure has failed. SI joint fusion prevents the SI joint from ever moving again—and that has consequences. Joints are designed to move, and the SI joints provide some flexibility and shock absorbency in your pelvis. A fusion means you will lose that function, but it will prevent any future misalignment. That give-and-take is a personal decision that the patient should carefully weigh before committing to surgery.