Hey everyone. Julian Corwin here, Pain and Performance Solutions. Today I want to talk to you guys about low back pain.
Now we’re often told stories of other people who’ve had back pain or they’ve had, let’s say, a disc injury. Disc injuries can cause a lot of different types of pain, but so can another thing that’s a lot… but so can another problem that is a lot more innocuous and a lot easier to resolve than a lumbar disc injury. So, I want to go over some of that with you today and we’re going to use the skeleton here.
So, lumbar vertebrae. We’ve got five lumbar vertebrae here. One, two, three, four, five. Now on the front of the vertebrae we’ve got these little discs. So, this is L5 S1 disc, L4 L5, that’s how they’re denoted by what vertebrae they sit between. Now, sometimes when we get a lot of lumbar compression these discs can push against the nerves which can then cause herniating symptoms down the rest of the body. It can also cause local pain here.
So, this is what we probably think of most of the time. Hey, I think I have a disc problem or something in my lower back. What I actually see more often is a problem here, which is just a simple joint problem, sacroiliac joint is what it’s called. Sacroilio… Sacroiliac joint. This is the sacrum, this is the ilium. Now, what happens there? Well, every step we take involves a full opening and closing of that joint. As we bear weight into the ground, the ground pushes back. If it didn’t, we’d fall through the earth.
So, if we take a look at this little chart, this is an anatomy of motion chart. It involves every movement of the body through all phases of gait. If you look at the SIJ here there’s moments when it’s open in a couple of dimensions and closed in another. One where it’s closed entirely and one where it’s open entirely. Now this joint is very thin, that is the space in there is very small and it’s just simply closing during one phase of the gait, and opening during another. Now, if that opening and closing doesn’t happen, you don’t get enough blood flow, we don’t enough flow of fluids into the joint to heal the joint from daily wear and tear.
If it’s chronically opened, we can also get pain because those ligaments are on stretch, and there’s no way to push fluids out if it doesn’t compress. We often assume that blood flow is just like this thing that happens and it’s perfect, but flow in the body also involves joint movement and muscular movement, movement of the body. It’s not just that heart that’s at work. We have got lots of other mechanisms throughout the body that are pumping fluids to irrigate the body, irrigate the joint, provide nutrients to different cells and bones.
What I find is that tons of back pain and hip pain is really centered around a misalignment of the pelvis. The pelvis is either pushed forward, kind of rotated. The pelvis is either anteriorly tilted, posteriorly tilted or on level. That is a hike on one side or drop on the other, or it could be rotated too. Now, rotation of the pelvis this way, you can see opened left SI joint a little bit more to one side and closed more a different way on the right side. Either one of those can be attributed to, or can be related back to some pain in the lower back.
Let’s just look up sacroiliatic joint pain on Wikipedia and I’ll read to you what it says here. Signs and symptoms of SI joint pain is a dull ache on one side of the lower back that may extend into the thigh. Pain can range from an ache to sharp stabbing pain that extends down one or both legs. Low back pain while climbing stairs. Activities that require the pelvis to twist may produce SI joint pain. We talked about that misalignment. If you further go into that rotation, it can aggravate the pain and stretch the ligaments SI joint more or compress them more.
Often experiences an ache on one side that causes a person to shift weight to one side to relieve the pain on the other. Low back pain, buttocks pain, siatical pain, groin pain, hip pain, basically everything you’ve ever heard when it comes to back pain can be attributed to the sacroiliac joint. Pain can increase or decrease with physical activity. Symptoms can worsen with prolonged sustained positions; sitting, standing or lying. The only main difference I would say, a big differential diagnostic piece here that is we are able to distinguish SI joint pain from maybe a lumbar disc problem is that SI joint pain rarely radiates below the knee.
If it’s radiating below the knee affecting numbness in the foot, pain in the foot as well, then it’s probably going to be a disc thing. If it’s a disc thing the first thing you want to do is get some traction in the lumbar spine. We’ll talk about that more later.
I want to go over real quick what would our approach be for solving a problem in an SI joint? Then we go back to this map essentially. First we’ve got to find out is it open or is it closed and then in these moments in our gait cycle let’s say the person’s SI joint is chronically closed. Then in all likelihood they can do something in this chart to relates to opening that SI joint.
Oftentimes I’ll say someone has a flat foot. That means that they can’t externally rotate their rear foot. So, we go over here and we see that external rotation of the rear foot is related to opening the SI joint in the transverse plane. So, maybe they had an ankle sprain there. Maybe their foot never got stimulated enough because we’re on flat surfaces and in shoes all day long, and that can very much affect the function of the foot.
It’s funny how often I hear people say I know everything is all connected; foot bone connected to the tibia bone, connected to femur bone, connected to the pelvis, connected to the sacrum, but when I tell them that hey your back pain is likely coming from an ankle problem, this is the ankle problem, they’re a little bit skeptical. They’re skeptical that is until we actually tie those pieces together and they sure enough don’t have as much back pain.
I’m going to switch the camera here and I’m going to show you in my body from the bottom up how this happens. Just look down at your feet. Let’s say you’ve got one foot that’s a little bit flatter than the other. That causes a slight internal rotation of this tibia, internal rotation of the femur, which then whereby the pelvis to be in a slightly different position, and you can see we’re already all the way up to the pelvis. Biasing the pelvis in a certain direction will change its contact with the (8.31 unclear). And low and behold there you have it, sacroiliac joint pain and dysfunction.
Anyways, that’s my approach on back pain. It’s usually SIJ related. Most commonly it is at least. Hope you guys find this video helpful and if you’ve got any problems, you should be able to find the link to my website down below and call me up for a consultation or a first appointment. Cheers. Have a good one.