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The SacroIliac Joint. What can help?

The SacroIliac Joint. What can help?

The SacroIliac joint is the joint that attaches the spine via the Sacrum to the pelvis. It is a joint with cartilage much in the same way as the hip or knee.

The Sacroiliac joint also demonstrates movement in all directions, and the Sacroiliac joint and its surrounding areas has a lot of nerves, which help transmit pain.

Function of the Sacroiliac Joint

Its main function is to provide stability, motion and to also provide protection of internal organs and structures.

It is a rather immovable joint. In women its mobility increases during pregnancy to allow the passage of a baby, which helps open up the pelvis during childbirth.

Prevalence

There is a 13-30% incidence of SacroIliac pain in patients with low back pain. The SacroIliac joint can also become diseased in a inflammatory condition called sacroiliitis. This can be the start of an inflammatory disease called Ankylosing Spondylitis where the ligaments around the spine calcify and eventually fuse.

The other interesting thing to note is that 43% of pain in the SacroIliac joint comes about after spinal fusion. So the Sacroiliac joint is a significant source of pain after lumbar fusion.

This is thought to come about because sometimes the diagnosis of Sacroiliac joint is missed! Furthermore after a fusion more strain is put opon the Sacroiliac Joint which then becomes symptomatic.

In terms of health burden SacroIliac pain is roughly equivalent to hip Osteoarthritis, Spinal Stenosis, Knee Osteoarthrits and Chronic depression 

Referral Patterns

SacroIliac pain can frequently refer into the groin, but also to the side of the leg, and occasionally down the back of the leg. 

This sometimes makes diagnosing Sacroiliac patterns difficult as low back pain and leg pain often overlap.

However with a good Osteopathic examination it is relatively straightforward to diagnose whether pain is coming from this joint. 

Treatment

Once a diagnosis of Sacroiliac dysfunction is made, then treatment can be initiated.

Osteopathy is the number one choice where stretches are made to the joint, which helps return it to normal function which in turns helps reduce any inflammatory changes.

The joint is large and is usually quite stiff and sometimes difficult on which to use manipulative treatment.

In such a case Acupuncture is used as this has the advantage of not having to use any form of manipulative treatment, helps stimulate blood flow and is effective at reducing pain in the area.

Case of Knee Pain caused by Hip problem.

Case of Knee Pain caused by Hip problem.

In this blog I am highlighting an interesting case history of knee pain, caused by a hip problem.

I have written on cartilage tears for knee pain before. I want to write about some interesting cases whose outcome may come as some surprise.

Knee Pain

I want to write about an interesting case of knee pain caused by a hip problem. What you initially suspect is not always what it seems.

This case of knee pain concerns a 56 years old man who complained of right sided knee pain, over an eighteen month period. He had previously seen his GP, Physiotherapists, and another Osteopath.

Eventually he saw an Orthopaedic surgeon who found a tear in his cartilage.

No arthritis was found and the tear was deemed to be the cause of his pain. He was advised to undergo arthroscopic surgery. The outcome was that he still had exactly the same amount of knee pain after this surgery.

Treatment had not relieved any of his symptoms of pain and restriction, and he had difficulty walking any distance, and he walked with a walking stick.

Knee Examination

On recommendation he consulted me and the remarkable things was that his knee had a normal amount of movement and could flex and extend his knee normally.

I then examined his hip joint which was painful and restricted on rotation. This immediately suggested the possible start of hip Osteoarthritis.

I then proceeded to treat his hip with Osteopathic manipulative treatment to try and increase the movement, and lessen the pain in this area suspecting that this area might indeed be the cause of his pain.

within a few weeks all his symptoms had gone, and was able to walk without pain.

Case of knee pain caused by hip problem

This was a more unusual case in which his hip joint was actually referring pain into his hip.

This can happen as inflammation around the hip can be a cause of knee pain. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336883/

This is a good example of why it is important for an Osteopath o look around the body for tissue that may refer pain to other parts of the body.

It is always wise to have your body checked to make sure there are no patterns emerging that may lead to your body not working as it should.

If you have any niggles that just aren’t going away give a call on

020 76921818 to get your body working efficiently again!

Paracetamol for Back Pain?

Does Paracetamol Help Back Pain 1
Does Paracetamol Help Back Pain

Does Paracetamol Help Back Pain?

As recently as 2014 with regard to paracetamol for back pain there was a paper in the lancet which suggested paracetamol for back pain was of almost no effect in the treatment of back pain. (The Lancet 2014; 384(9954): 1586-1596). https://www.sciencedirect.com/journal/the-lancet/vol/384/issue/9954

Sifting through the evidence though it seems paracetamol may still have a place, which helps answer the quandy of paracetamol and back pain?”.

Paracetamol for low back pain

Has been an over the counter medication that has been used over years to help reduce low back pain.  Studies have suggested that paracetamol for back pain is of little or no benefit to low back. These studies have not had many subjects in them to reach any definitive conclusion.

Recently studies have been done which was much larger where low back pain subjects were given ad hoc paracetamol for acute flare ups and some were given regular paracetamol.

The results showed that neither regular nor as required paracetamol improved recovery time as compared to a placebo.  There was additionally no effect on function, disability or pain and as a result there was no symptom change in sleeping or quality of life. There was also no increase in recovery time.

However, looking more carefully at the results although paracetamol does not alter the recovery from back pain it is still “mildly useful” in helping pain on a short term basis including on an “as needed basis”.

I advise patients in pain to try and see if it helps as the great thing with paracetamol is that unlike anti-inflammatories, it does not cause heartburn or aggravate the stomach.

The more noteworthy aspect is that manipulation and or Acupuncture are both superior to just paracetamol and in many cases not only reduces pain quicker but also curtails a low back event enabling a patient to get back to normal activities quicker, and as a result not having to take any medication!

If you do suffer back pain give a call and help will be there to get you off your Paracetamol.

Paracetamol and back pain
paracetamol