SI pain - Doroski Chiropractic Neurology, Woodbridge, VA

Hip pain may be your SI joint

in Chiropractor by Doroski January 22, 2016 0 comments

I see sacroiliac injuries in my Woodbridge, Dale City Virginia Chiropractic office almost as frequently as any other spinal injury. People often come in complaining of what they consider hip pain. Once the injury is examined it is more often than not the SI joint. It is also the cause of unilateral low back pain. Patients will complain of lower left or right side low back pain. Same thing, once you examine the area it is the SI joint. Doroski Chiropractic Neurology in the Woodbridge, Dale City Virginia area has some helpful information for you on the SI joint.

When the hip joint is spoken of, it is typically thought of as a vague area that may encompass anywhere from the iliac crest, the sacroiliac joint or the point at which the femur articulates with the acetabulum. The latter is the actual hip joint. Lower back pain that radiates more laterally to the pelvic area over the acetabulum, groin, and upper lateral thigh is not necessarily definitive of an L4/L5 disc syndrome. Pain in this region may also be secondary to a facet syndrome. Sometimes, pain to the lower abdominal and groin region may be a part of the symptomatology presented by a patient. The differentiation between the L/4/L5 disc and facet syndrome is that the disc with the radiculopathy will generally follow a known dermatome, while a facet syndrome follows a dermatomal pain pattern. Doctors of chiropractic usually find and treat articular lesions of the sacrum, ilium or lumbar spine, for a period of time, without cessation of symptoms or improvement of these complaints. One other consideration would be for a tear of the labrum in the hip, which may result in pain in the SI joint, gluteus area and even anterially into the groin.

Complaints in these more lateral areas are often due to a problem in an area that many doctors don’t check—the femoral head. The femoral head may need to be assessed for the need for manipulation or mobilization. This in turn may cause deep pelvic muscle spasms, which may become chronic. I believe that every day activities, from subtle movements like turning in bed to more repetitive activities like bearing more weight on a pronated foot time and time again, may cause misalignment to the femoral head. This area should be checked and adjusted for recovery, in my opinion.

Drawing upon an example from personal experience: I would open the car door and throw my right leg into the car and then sit down. I would experience a subtle “click” in the acetabulum area, followed by pain and irregular walking gait, pulling of the leg when weight bearing, causing deep spasms of the upper thigh and lower abdominal muscles, pulling the leg forward instead of pushing the leg forward, as in a normal walking gait. This caused a transition of weight-bearing muscle function to muscles not usually used in normal walking. (A compensatory walking gait is developed.) This caused me pain and spasm in adjacent muscles.

All too often, I believe that this problem is missed or misdiagnosed, resulting in unnecessary surgery, hip replacement, repetitive chiropractic adjustments, physical therapy and muscle massage, and none of them address the underlying cause of the condition.

Examination for Hip Joint Dysfunction

Place the patient in supine position, with your superior hand holding the ilium to the table with light A-P downward Force (near the ASIS) to ensure the ilium will not rise off the table during motion of the leg. Holding the ilium on the exam table, grasp the ankle and rotate the foot medially. The big toe should touch the table. Full rotation indicates no hip joint dysfunction. If the ilium rises off the table during this action, this indicates improper function of the femoral head/acetabular articulation.

Corrective Procedure

Ascertain (through the examination described above) the side of restriction. Place the patient in lateral Syms position (Syms is performed by having a patient lie on the left side, left leg extended and right leg flexed) as in a side roll. Place your superior hand under the armpit of the patient, holding the humerus and ribs, with your inferior hand reaching over the patient cupping the femoral head. Proceed with the side-roll-type procedure with this exception: The inferior hand (cupping the femoral head) is driven directly forward (anterior).

If correction has been obtained, the leg now should move freely in a medial direction smoothly and completely, with immediate Improvement of pain. Occasionally the patient may experience residual muscle soreness. Over the course of my practice, I have found that these patients have a tendency to walk around for a while with a displaced femoral head and a compensatory walk, the surrounding muscles are sprained and inflamed, and soreness may continue for days until the patient returns to a normal walking gait. Generally, I find the quicker the patient returns to a normal walking gait, the quicker the syndrome is alleviated. I feel it is important to re-address with the patient what is a normal walking gait and this may lengthen the post-correction period.

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Doroski Chiropractic Neurology

3122 Golansky Blvd, Ste 102

Woodbridge VA 22192

703 730 9588

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Sacroiliac Joint Pain

in Chiropractor by Doroski April 24, 2015 0 comments

Sacroiliac pain is a very common type of low back pain. It can also create a referral pattern similar to sciatic nerve entrapment. Patients who come in with low back pain that shoots into their buttocks are usually concerned about a disc injury. More often than not it is the SI joint. Doroski Chiropractic Neurology in the Woodbridge, Dale City Virginia area wants to help you understand how the SI joint works.

Pain in and around the sacroiliac joint is one of the more common causes of low-back pain. With approximately 80 percent of the population suffering from low-back pain at some point in their lives, the sacroiliac joint dysfunction likely represents about 15-25 percent of those cases.

The following points will help you educate your patients about the sacroiliac joint dysfunction.

What Is Sacroiliac Joint Dysfunction?

Sacroiliac joint dysfunction (SJD) is a broad term often applied to pain in the sacroiliac joint region—the largest joints at the base of the spine.

SJD can be painful and debilitating, but it is rarely life-threatening.

SJD rarely requires invasive types of treatment such as surgery.

Symptoms and Causes

SJD symptoms include low-back pain, typically at the belt line, and pain radiating into the buttock or thigh.

These symptoms are hard to distinguish from other causes of low-back pain, such as disc herniations or facet joints disease.

Most often, SJD is caused by trauma. For example, rotation of the joint when lifting or participating in some vigorous activity may cause tears in small ligaments surrounding the joint, resulting in pain and dysfunction.

While more serious conditions such as fracture or dislocation, infection and inflammatory arthritis can cause sacroiliac joint pain, minor trauma is considered a much more common cause.

The risk of SJD may also increase with true and apparent leg-length inequality, abnormalities in gait and prolonged exercise.

Pregnant women may suffer from SJD because of hormone-induced relaxation of the pelvic ligaments during the third trimester, weight gain and increased curvature of the lumbar spine.

Evaluation

Because SJD pain resembles other types of low-back pain, it is often difficult to isolate it as the actual cause of the patient’s discomfort and disability.

Diagnostic imaging procedures, such as X-ray or MRI, aren’t very helpful in evaluating SJD.

The mostcommonly used diagnostic procedures are physical examination and anesthetic blocks of the sacroiliac joint.

Physical examination involves stressing the joint in various body positions and movements.

During anesthetic blocks, a procedure with unproven validity for SJD diagnosis, the anesthetic solution often creeps outside the sacroiliac joint and may relieve pain from other structures.

Treatment

Because it is often difficult to isolate SJD as the source of pain, an appropriate management strategy is hard to implement. Once SJD is determined as the cause of the problem, many therapies are available.

Chiropractic manipulation and mobilization of the sacroiliac joint has been shown to be beneficial.

Exercise focusing on strengthening the core stabilizer muscles of the spine and trunk and on maintaining mobility of the sacroiliac joints can also be helpful.

Patients with a leg-length inequality may benefit from a shoe inserts helping to properly distribute weight borne by your lower back and sacroiliac joints.

For those with abnormal gait biomechanics, gait training may be needed.

To reduce the excess rotation that sometimes occurs with SJD, a pelvic belt can help stabilize the sacroiliac joints.

In cases of fractures and dislocations of the sacroiliac joints, surgery is needed.

Prevention