Chiropractic for SI Joint Pain

Chiropractic for SI Joint Pain Blog  SI Joint Pain Chiropractic Care

The sacroiliac joint, or SI joint for short, links the spine to the pelvis. This linkage enables the body to transfer weight and forces between the legs and the upper body. Because it is attached to the spine, SI joint pain is often experienced as low back pain, and can be caused by normal wear and tear on the joint as well as injury or sciatica. This pain is often rather severe due to the high number of nerve endings present in the SI joint, and many times the pain proves difficult to treat. This has prompted numerous studies into treatment of pain in the SI joint. While conclusions vary from study to study, the hypothesis that SI joint pain is best treated with therapeutic manipulation of the spine is well supported.

One small, random process, blind trial that was published by one medical journal investigated treatments for this kind of pain. This research, spearheaded by Dutch doctors utilizing 51 patients as a sample, established the efficacy of chiropractic in treating the SI joint.

Patients volunteering for the research had previously been diagnosed with leg pain originating from the SI joint, and doctors assigned treatment in three groups utilizing a random assignment method. One treatment group was provided treatment via chiropractic, another via exercise therapy and the third via injections with steroids.

The doctors determined success and failure based on simple criteria. A therapy was deemed to have succeeded if there was complete pain relief, or if the patient’s VAS score (a method of determining pain) improved. Conversely, a given therapy was deemed to have failed if therapy was ended by the patient either because pain worsened or because the patient experienced no improvement. The results among the three groups were as follows.

  • The exercise therapy research section contained twelve patients who suffered failure and three 
    patients who enjoyed success.
  • The chiropractic research section had five patients suffer failure and thirteen patients enjoy success.
  • The steroid injection research section contained nine patients who suffered failure and nine patients
    who enjoyed success.

Manual therapy proved to be the big winner from among the methods tested, and injections came in second at approximately even odds of success. This is based on number of successes and failures alone. However, this study also showed that the degree of improvement among successful treatments was more pronounced among manual therapy patients, as well. Successful physical therapy caused scores to improve, on average, 0.4 points; successful manual therapy caused scores to improve, on average, 1.9 points; successful injection caused scores to improve, on average, 0.7 points. In other words, manipulation of the joint for the treatment of pain in the SI joint is, at least among the three treatments compared, the clear best option.

Though the test’s sample size is small and the researchers recommend the commencement of a larger investigation in order to establish the efficacy of this treatment as a method of treating SI joint pain in a variety of different people, the results show strong promise for this therapy in the treatment of such joint pain.

It is also worth note that those investigated via this research were suffering specifically from leg pain originating in the sacroiliac joint, and screening occurred to establish and remove from consideration those with a history of radiculopathy prompted by hernia of the lumbar disc. As such, those who have received such a radiculopathy may not see identical outcomes as those studied.

Interestingly, this research contradicts some studies. One earlier study indicated that manipulation of the lumbar region was more effective than manipulation of the SI joint in easing pain, while others’ results have demonstrated more efficacy for the other treatments researched. Because of the number of different research conclusions there are on the subject, a good chance exists that there are differing solutions depending on the specific nature of the patient or that of the SI joint pain. However, chiropractic can often be a good first line of defense in such cases because it does not rely on the use of a pharmaceutical. If the body can heal on its own with the assistance of a chiropractor, that is great news indeed.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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