Sacro-iliac pain ... or not?
(May 2004)
by Mr. Marc Jones DO (UK), BSc(Hons)Ost, Osteopath (UK)
The picture to the right is taken from the University of Maryland Spine Center at www.umm.edu and shows the bony pelvis from the front. Take note of the sacro-iliac joint and the intervertebral disc below the 5th lumbar vertebra, which is called the lumbo-sacral area.
The sacro-iliac (or S/I) joint is a region of the pelvis linking the spine and the lower extremity (we don't tend to use the word 'leg' as it is the anatomical description of the area below the knee and not the whole lower extremity).
To locate the joints on yourself, feel for the bony lumps on each side of your lower back and pelvic areas and then drop in towards the spine. As you 'drop-in', these are the sacro-iliac joints.
All healthcare professionals (myself included) have their own ideas as to what each group of symptoms means to themselves. Sacro-iliac joint pain can divide opinion as much as any other area of the body and I find myself on the side which believes that not all sacro-iliac pain is due to the sacro-iliac joint alone. This does not mean that I do not believe that sacro-iliac pain exists, as I know that it does. The most common examples that I have seen are at opposite ends of the spectrum as they relate to pregnant women in the final trimester or football players (soccer as you North Americans call it!) that have missed when kicking a ball. Other examples can come from ankylosing spondylitis, colitis or obvious joint degeneration/destruction, which can usually be verified with x-rays or rheumatological tests.
After nearly a decade in practise, each time I hear someone mention 'S/I' pain I always think to myself, "is this another lumbo-sacral or ilio-lumbar problem manifesting symptoms at the sacro-iliac joint?" This is especially so if there is no history of direct trauma and the onset is of an insidious nature.
The lumbo-sacral and ilio-lumbar areas are the spinal connections to the sacro-iliac joint and my experience has lead me to believe that many unresolving sacro-iliac joint problems are actually secondary to these two other spinal areas. As a simple test, I find that putting a springing motion through the sacro-iliac joint in various angles will confirm or deny if there is any local inflammation or oedema in the joint itself and then I perform similar techniques on the lower spinal joints. Presuming all other examinations show nothing to the contrary, whichever hurts more is usually the primary cause of the lesion and I treat accordingly. More often than not, the patient with a chronic 'S/I' problem feels more pain in the spinal joint.
Sacro-iliac joint disorders do occur, but, if you have been diagnosed with sacro-iliac pain that is not resolving, there is a good possibility that it is originating from the spine.
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Copyright © Marc Jones - Osteopath (UK), Osteopathy Vancouver 2003 onwards
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