Sacroiliac joint

Every once and a while my back gets all screwed up from some minuscule movement that should not cause harm. Yesterday was one such day and this "injury" forced me to go see a chiropractor here in Denver.

From my knowledge of back pain, I knew my sacrum was stuck in flexion and not gliding between the ilium bones. How did my sacrum get stuck in flexion? One reason is I sit ALOT! For the past few years, I have been in school sitting for most of the hours I am awake. When you have poor posture with sitting, this leads to a decrease in lordosis and a flexed sacrum (sort of like a dog with it's tail between it's legs). If there are other forces involved in this scenario, such as, tight piriformis muscles, which I have, then the sacrum is pulled strongly anteriorly from the attachment of the piriformis. If the piriformis is taut and poor posture is the norm with hyperflexion, a severely restricted SI joint is very likely. Hence, my reason for seeking care today.

The minuscule movement that set all this off was as simple as picking up a trash bag while holding a heavy door open with my foot. A slight twinge of pain occurred and immediately I noticed a difference in my gait. It was almost as if I was waddling around. The pain didn't really get that bad until later that day and the next morning. This heightened pain left my back quite spasmed. Extension hurt like hell and flexion at end range was a little sore. The forces that accumulate from a stuck joint like the SI joint, absorb into the surrounding tissues. Muscles become hypertonic and as wastes accumulate in the overactive tissues, pain increases and circulation reduces. Why did this happen?

My thoughts are that the day before, I did a relatively long run. I am a bit dehydrated from being at altitude and swilling coffee and a little bit of Denver's finest micro brews (less tissue pliability). Coming off a long quarter of sitting and running and skiing with poor posture, this lead to very tight piriformis muscles. Being that I do not stretch nearly enough, my SI joint was prone to injury yesterday from the relatively minor movement.

I searched out the chiropractors in town and found a handful that seemed good. One I found appealing was Primary Care and Chiropractic. Yes, that is the name of the practice. The couple that owns the clinic went to Texas Chiropractic College and seemed quite successful. I checked them out pretty thoroughly online and searched for any negative comments left by prior patients. Nothing looked bad and their clinic was pretty sweet. I filled out the medical forms and was questioned by a CA for my chief complaint history. I did my active ranges of motion for her and reported pain in my SI joint with extension and left rotation. It was weird being a patient. I caught myself answering questions similar to many patients I have worked with, where they give a long winded answer to something as simple as saying, "yes, I did take ibuprofen for the pain" or "no it doesn't hurt when I do this". Realizing these folks are very busy and not students made me answer more concisely. It was like looking in a mirror.

The doctor came in, asked me some questions about radiculopathy and past history of this issue and he did four orthopedic tests; Nachlas, Hibb's, Ely's and Yeoman's. All confirming SI joint involvement. He did not do, SI compression or distraction, sacral thrust or thigh thrust. He also did not do active straight leg raise. Regardless, he figured it out pretty quick.

He sent me to this motorized machine first. It rolled on my back muscles rhythmically and reduced a lot of my muscle splinting. This lasted about 10 minutes. Then the CA took me to a treatment room and hooked me up to the inferential current machine. She hooked up my upper back and my SI region and pumped it up to contraction then below. I believe the doctor wanted to reduce nerve accommodation and confuse my brain as to what it felt peripherally. They also put four ice packs on me. I thought that was counterproductive being that they were trying to induce movement versus control inflammation. It was a little off from what we do in the clinic. For a patient like me, I would use IFC and moist heat, then adjust them.

I got off the table feeling worse then I came in. I was much more sore and my back was stiff as hell. My muscles were guarding every movement. I kept thinking, once he adjusts me the pain and stiffness will reduce and my joints will begin moving correctly, therefore reduce spasm. The doctor came in and told me to lay on my back. I figured he was going to adjust my thoracics into extension because I told him this was an area of ongoing pain (thank you school posture). He planted his hand behind my back, placed his abdomen on my crossed arms and pulled me into flexion and did not drop over his contact. My back EXPLODED! He did this down to the thoracolumbar junction. I then went to side posture and he adjusted a few lumbars into right rotation. Flipped over to the other side and he adjusted my pelvis. INSTANT RELIEF!

I stood up, moved into extension and flexion and rotation and no movement reproduced my pain. As my wife as my witness, I have improved 98% since the treatment. I have some sore muscles around the SI joint and my piriformis muscles are still tight, but my joints are moving normally and I do not have any muscle spasm.

This whole incident got me thinking about our role as chiropractors and how incredibly powerful our treatments are. There are so many people out there that suffer from all sorts of musculoskeletal pain and avoid chiropractors. This is a big issue. Faulty biomechanics can have a significant effect on all aspects of life. For instance, we had some friends in from Portland last night and first thing this morning we were planning on going downtown for breakfast. I was in so much pain from spasm that I was quite withdrawn from the conversations. It was depressing and debilitating. Imagine having such pain from a similar problem chronically and you avoid things you love to do to avoid pain. These issues are quite common.

I now have homework to do to prevent this problem from happening again. Largely this homework is to stretch more. Secondly, I need to regain strength in my gluteus medius muscles and medial arch stabilizers of the foot. I think I can do that.

All for now