What is SI or Sacroiliac Joint Dysfunction?

 SI pain is definitely the most common complaint that I have from pregnant women. Hormones (primarily relaxin) are the all too familiar culprit!  Often SI pain begins during pregnancy and becomes a recurrent problem with subsequent pregnancies. However, chiropractic care during pregnancy can reduce the likelihood of SI joint dysfunction occurring and most certainly can help alleviate the pain associated with it.

First off, let’s look at the sacroiliac joint.

At the lower end of the spine, just below the lumbar spine lies the sacrum. The sacrum is a triangular shaped bone that is actually formed by the fusion of several vertebrae during development. The sacroiliac (SI) joint sits between the sacrum and the iliac bone (thus the name “sacroiliac” joint). You can see these joints from the outside as two small dimples on each side of the lower back at the belt line.
The SI joint is held together by several large, very strong ligaments. Because the pelvis is a ring, these ligaments work somewhat like the hoops that hold a barrel together
The SI joint hardly moves in adults. During the end of pregnancy as delivery nears, the hormones that are produced cause the joint to relax. This allows the pelvis to be more flexible so that birth can occur more easily. Multiple pregnancies seem to increase the amount of arthritis that forms in the joint later in life

Taken from this great site http://www.orthogate.org/patient-education/lumbar-spine/sacroiliac-joint-dysfunction.html

What are the symptoms of SI pain or dysfunction?

Symptoms include:

• Localized pain on the left or right side of your lower back. The pain is an intermittent to constant ache but sometimes occasional to frequent sharp pain. (Really specific, I know)
• The sharp pain occurs especially with certain movements (even as minimal as shifting your weight). It can be so acute that many patients are not able to perform basic daily activities like turning over in bed, bending over to put on shoes or brush teeth, or getting in and out of the car.
• The sharp pain usually stays local or travels into the buttock but can travel as far as the back of the thigh or around to the front.   It does not travel into or past the back of the knee.
• The pain may be worse upon rising from sitting or lying down and decrease after walking for a few minutes.
• There is often tenderness when palpating the SI joint itself and spasm of the gluteal (buttock) musculature.

How does SI dysfunction differ from sciatic pain?

They are very similar.  In fact they are so similar that many medical doctors mistake SI dysfunction for sciatica.  However there are two important distinctions:

1. SI pain will not go into or past the knee, while sciatica often does.
2. The ache of SI pain is primarily in the SI joint itself and the sharp pain always shoots from the SI joint while sciatic pain can begin higher up in the low back (lumbar spine) or in the muscles of the buttock with no tenderness of the SI joint.

 The treatment for each is quite different, so it is important to get an accurate diagnosis so that you get the proper treatment.

How is SI different from PSD?

SI pain is localized in the back of the pelvis while PSD is in the front of the pelvis. All three joints (two SI joints and one pubic symphysis joint) make up the pelvic ring and need to be able to separate during the birth process to allow the baby to pass through the birth canal (assuming a vaginal delivery). Therefore, all three joints will be affected by the hormone relaxin and can become hypermobile (too much movement) during pregnancy that results in pain.

Tips to reduce SI or pubic symphysis pain

There are two things to consider to reduce SI or pubic symphysis pain:

1. Reduce stress on the joints.
   
   • This is done by avoiding certain activities and postures.  For example, don’t do anything that causes the knee to cross the midline or puts more pressure on one side of the body than the other.  Here are some examples:
   • Don’t cross your leg when sitting (keep both feet on the floor)
   • Don’t stand with one hip sticking out to the side (keep equal weight on each leg)
   • Don’t vacuum in the fencer’s (or lunge) stance (keep both feet next to each other, or better yet, have your husband vacuum instead!)
   • Sleep with a pillow between your legs
   • Don’t slump when sitting nor sit in a semi-reclined position (sit straight up or lie completely down)
   • When rolling over in bed keep your knees locked together
   • When getting in and out of your car keep your knees together (get in by backing in and then swinging your legs into the car)
   • Avoid bending forward, especially for sustained periods, without supporting yourself with your arm (for example, after brushing your teeth support your weight on the counter as your lean forward to rinse)
   • Avoid walking up and down hills
     
2. Reduce the mobility of the joints.
   
   • This is most easily accomplished by wearing a sacroiliac belt.  I personally like the Serola brand the best, but there are many good ones out there that work well with some being more comfortable than others.  The key is to make sure the belt goes around the SI joints (rather than a belly support band that is worn higher up).

Is it Pubic Symphysis Disorder or round ligament pain?

Pubic Symphysis Disorder (PSD or SPD) is a painful condition felt in the pubic area and is often mistaken for round ligament pain.  Unfortunately not a lot of OBs will give much heed to PSD (or even round ligament pain) because they cannot do much about it.  However, being able to distinguish the two will allow you to choose a more effective remedy in reducing your pain.

1. Where is the pain?

PSD: Almost always the pain is felt at the pubic symphysis joint—the bony part at the top of the pubic area—and will be very sore to the touch.  The pain usually radiates down into the groin and will often also radiate out into the hip joints.

Round Ligament: The pain is usually felt in the lower abdomen and slightly off to one (or both) sides.  It often radiates into the groin and/or around the sides to the flanks or hips.

2. What is the quality of the pain?

PSD:  Sharp and intense.  For some the pain feels like they are breaking open from the inside or their hip bones are grinding together.  Oftentimes a clicking sound is heard when walking or moving.

Round Ligament:  Also sharp and can be intense.  Many times the pain happens suddenly.

3. When is the pain felt?

PSD:  When standing, walking, shifting while sitting, and intensely when rolling over in bed.  The pain continues even after stopping the movement.

Round Ligament:  When performing sudden movements and usually diminishes if not goes away after a few seconds.

If you still aren't sure which it is here is a simple test: stand on one leg (please use your arms to support yourself when doing this).

PSD: You will experience increased pain or even an inability to stand on one leg (the other leg may give out).  You will find it difficult with activities like walking up stairs, raising one leg to put on pants, or getting in/out of a car.

Round Ligament: You will experience minimal, if any, change in pain and should find it easy to stand on one leg.

Here is a side note: Sciatica and sacroiliac joint dysfunction (SIJD) are sometimes co-conditions of PSD.  The presence of sciatica or SIJD does not rule out PSD, but it doesn’t guarantee it either.

Pelvic Pain in Pregnancy

Pelvic pain during pregnancy is something that is often misunderstood by the medical community at large. The degree of pain is something that is often not addressed at all.
I became aware of the severity of pelvic pain when my wife was pregnant with our second child.

During the 2nd month of my wife’s pregnancy she began to complain about pain in her hips and pelvis when she rolled over in bed at night. She said it felt as if her bones were grinding together. I was a young, inexperienced student at that time and I told her I didn’t know how to help her.

She went to her OB multiple times over the next 3 months as the pain became debilitating. She walked as if she were an old woman, and used a wheelchair for situations that required a lot of movement. Her OB could only recommend Tylenol and told her she might want to try massage. Other than those suggestions she would just have to wait it out.

Now, my wife is not one to sit around and wait for anything, so she began her own research. She found a small blurb about something called  Symphysis Pubic Disorder or SPD in a medical journal online; she then was able to find a support group for SPD in Great Britain. She emailed them and found out that this disorder is something that is just recently gaining attention in Great Britain and they sent her some literature. She was relieved when one of the first treatments mentioned was chiropractic care. (Did I mention I was a student and was somewhat MIA?)

My wife began chiropractic care and within a week was making great progress. Her pain levels went from a 10 to a 3 and she was able to tolerate the remainder of her pregnancy without too much discomfort. She moved like a different woman in a matter of weeks.

So now, thanks to my wife, I look like the hero when I tell pregnant women I know what is wrong with them and how to help them. She is the real hero.

Check back next week for details about SPD and its treatment, or email me directly at drrichards@abetterbrain.com.