Lower Back Pain Defined: Part 2
Last week, I mentioned the 3 most common lower back pain diagnoses and discussed in depth, the first one, Disc Herniation with Sciatica. If you have pain in your back that radiates down one of your legs, then you should take a look back at that post here.
As a quick and dirty review, the 3 main causes of lower back pain are:
1. Disc Herniation, or disc bulge. Referred to by non-medical professionals as “slipped disc”
2. Sacroiliac (SI) Joint Dysfunction, or problems in the pelvis
3. Stenosis, or arthritis of the spine
This week’s topic, is number 2 on the list, low back pain due to SI Joint Dysfunction. I will define this condition, describe its typical symptoms, and then tell you simple ways to assess your low back pain and show you an exercise that may help you find some relief. If the symptoms in this post do not sound like yours, please press this link to explore disc herniation with sciatica.
SI Joint Dysfunction
The second most common cause of back pain is SI joint dysfunction or problems in your pelvis. You have two SI joints, one on each side of the low back, located where the top, flat part of your tail bone, as opposed to the bottom curvy part, meets your pelvic bones. People often have little indentations, or dimples, over the area of the SI joint in the very low part of their back. You can see the SI Joints shown in the picture below, noted with the 2 red squares.
SI joint pain is often located right over the SI joint on one or both sides of the body, but can also radiate into the buttock, groin, and down the thigh, similar to sciatica. The development of SI joint dysfunction is most often associated with pregnancy, but can also develop after a fall onto the buttock, a misstep off of a curb, or any other asymmetrical movement or weakness in the pelvic, abdominal, or leg regions. Functionally, people with SI joint issues may complain of difficulty performing movements that are one-sided, such as climbing stairs or stepping up onto a curb. They may feel a general malaise or dull ache throughout the buttock, hip, and groin region that is hard to define or explain. Often these people feel imbalanced, as though one leg is longer than the other, or they may notice that one leg turns out or in further than the other when standing, walking, or lying down.
SI joint issues resolve readily with conservative management including physical therapy and strengthening. Physical Therapists are experts at regaining alignment in the pelvis, addressing muscle strength imbalance, and improving functional mechanics to restore balance between the two sides of the body. Many people with SI joint pain feel great relief just after one visit to a physical therapist, due to some specific manual techniques that can restore alignment to the pelvis almost immediately.
Exercises for Lower Back Pain
The following images show an exercise progression for rebalancing the pelvis and decreasing pain. By using the gluteal muscle on the right and the hip flexor on the left, as shown in this one leg bridge position, someone with back pain can actually pull the pelvis into alignment with their muscles.
Followed up with a bridge with a ball squeeze between your knees, as seen in the next image, this exercise often results in an audible “pop” in the pubic area as the pelvic bones are pulled together, likely decreasing the pain in the SI region.
Free Low Back Pain Workshop
If you have any of the symptoms I discussed in this post and are looking for more information about your back pain, please call 206-641-7733 to register for our FREE Low Back Pain Workshop on Wednesday, March 29th from 5:30-6:30pm. If you are ready to schedule an evaluation, you can call us or schedule your first appointment online here.
Written by Dr. Ryan Simmons
Director of Physical Therapy
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