By Dr. Scott E. Rosenthal
Are you like so many of my new patients - suffering from severe, one-sided lower back pain that came on abruptly? Are you anxious because it’s not getting better and pills hardly touch the pain? Are the muscles in your lower back and buttocks gripping with an aching persistence that is only interrupted by periodic jolts of sharp pain? Does your pain surge when you change positions, such as going from lying to sitting or sitting to standing? Is your tail bone tender or hot to the touch or feel swollen on the edges? If so, chances are you may have a significant problem that makes you think stretching will give relief. BEWARE- most types of stretching can prolong and worsen the condition!
Ladies and gentlemen, I would like to introduce you to the sacroiliac joint (SI joint). Made famous for contributing to the “cute” dimples of Venus seen in the upper derriere, this large L-shaped joint is formed by the connection of your hip bone or ilium and your tail bone or sacrum. Strong connective tissue bands called ligaments hold the bony structures together and allow for slight movement. The sacrum is a triangular shaped bone that is made up of five smaller bones that normally fuse in adulthood. The point or tip of the triangular-shaped tail bone points downward while the wide base forms a platform for the spinal column. The ilium is the large hip bone on each side. The main function of the SI joint is that of shock absorption and distribution of the forces of the body to the hips and legs. When all is well, this joint is a hard-worker that shows up on time, does what you ask and never complains. At other times, you are literally aching for relief.
I remember the facial expression and unbearable movement of the first person who came to see me with severe pain caused by sacroiliac joint misalignment and instability. Seeing him suffer with such pain and dysfunction made me feel very eager to help! Since then, hundreds of similar cases have walked or crawled through my office door. This is one of the most common problems helped by chiropractic. The cause often eludes the sufferer. He or she would often state, “But I didn’t do anything?” Many would tell me that they tried heat, ice, over-the-counter and/or prescription drugs and STRETCHING. But the problem was unrelenting! I would then ask them, “Did the stretching help?” The response was almost always the same. Most of the sufferers told me that they believed the problem was a “tight butt muscle,” but the stretching only felt good while they were doing it. I have found that tight muscles are rarely the cause. When they are, the pain usually resolves by itself within days.
Being a large joint held by thick rubber-band-like ligaments, in most cases, the joint was over-stressed. Common causes include traumatic injury, poor posture, improper lifting techniques, weakened muscles, being out of shape, sedentary life styles and/or pregnancy. The connective tissue becomes stretched and no longer holds the joint together, thus allowing for too much movement and misalignment. Pain and inflammation result. Like a boxer contracting his abdominal muscles in order to protect the vulnerable organs beneath, the body responds by engaging the back and pelvic muscles in order to protect from aggravating movement.
A tight muscle is your friend. Unfortunately, like a good friend, when asked to do too much, it starts to complain. The extra workload required of the muscles to stabilize the injured SI joint causes fatigue, and dull pain is the result. Despite the secondary pain that the muscle guarding produces, it is important to remember that the tightness is a directed and intelligent response of the body to immobilize and allow for healing to take place. This is why treating the muscle tightness and pain by stretching can be counter-productive. It can be aggravating and may deepen the injury.
I have found that the fastest and most comfortable way to resolve sacroiliac dysfunction and pain is to start by gently adjusting the tail bone and hip into proper alignment. I next analyze to determine if there is connective tissue twisting or pulling. Think of the times when you get up from sitting and have to readjust your clothing into position. When your shirt or pants become crooked, it’s harder to walk or move your arms. As with bony misalignment, imbalanced connective tissue prohibits correct function and can disrupt the healing process. Abnormal pelvic, hip and lower back muscle function is assessed to determine irregularity. Various techniques are employed to bring back normal muscle support and movement. Cold laser therapy is useful to decrease inflammation and pain. In this way, the laser accelerates the healing process. Herbal anti-inflammatory supplements offer a non-invasive aid. When the problem is very severe, I have found it helpful to fit the patient with a specific SI belt for short-term use that provides a protective compression and immobilization. Homework may involve ice and/or strengthening poses from yoga (not stretches). Office visits are repeated through the week to allow the healing process to take place. Although most patients feel relief on the first day, it can take several weeks to fully resolve.
As a certified yoga teacher and doctor of chiropractic, I find stretching to be a valuable tool for many conditions, as well as for prevention of injury. However, when there is a problem, recognizing that your muscle tightness and pain may be related to your body’s response to a severe underlying sacroiliac condition can avoid causing further harm. With proper treatment and care, you can soon return to a pain-free and active life. In other words, seek other solutions because stretching sacroiliac conditions can be a real pain in the… don’t ask!