Sacroiliac Pain Treatment

Sacroiliac pain refers to pain caused by dysfunction in the sacroiliac joints, located near the bottom of the spine below the tailbone. The sacroiliac joints connect the pelvis to the sacrum, the triangular bone at the bottom of the spine, effectively joining the spine and pelvis. Sacroiliac pain may radiate through the buttocks and lower back, sometimes even reaching the anterior pelvis. Because these symptoms can so easily be mistaken for sciatica, accurate diagnosis is essential to sacroiliac joint pain treatment.

The sacroiliac bones are formed by the connection of the iliac bones, the largest bones in the pelvis, with the sacrum. The sacrum is composed of five fused vertebrae. There’s relatively little motion in the sacroiliac joints, with most of the pelvic motion occurring at the hips or lumbar spine, but they do support the weight of most of the upper body when a person is standing. Because so much stress is placed on these joints, they are especially susceptible to sacroiliac joint pain caused by cartilage degeneration and arthritis.

Loss of cartilage is the most common cause of sacroiliac joint dysfunction. As the cartilage degenerates, it can no longer function as a protective shock absorber alleviating friction between bones rubbing against one another. As a result, osteoarthritis may ensue. Patients may also develop joint dysfunction as a result of abnormal gait patterns and joint disorders such as gout and rheumatoid arthritis. Pregnant women are also susceptible. Hormones released during pregnancy relax the ligaments holding the sacroiliac joints. This has the positive effect of increasing joint flexibility, but may have the negative effect of leading to increased wear and stress on the joints.

This form of joint pain affects between 15 to 25 percent of patients suffering from axial lower back pain. Sacroiliac joint pain physical therapy is designed to restore postural and dynamic muscle imbalances that may have contributed to excessive pressures. A physician will assist the patient in correcting gait abnormalities and creating an individual program of exercises to strengthen the weak muscles and stabilize the pelvis.

At New York Dynamic Rehabilitation clinic (NYDNRehab), located on Manhattan’s Upper East Side, we provide several advanced methods for sacroiliac joint pain treatment. Technological gait and running analysis diagnoses abnormalities in a patient’s running and walking cycles. Markers are placed on strategic locations of the runner’s body. Then, as he or she moves along a treadmill in our gait lab, computers record, measure, and analyze information from all marked parts of the body to create a fully comprehensive picture of the runner’s movement in real time. Computer-Assisted Rehabilitation Environment is also a new but demonstrably effective treatment that assesses and rehabilitates postural stability and balance control. Patients stand upon a computerized platform surrounded by a giant, 180-degree hemispherical screen which creates a fully simulated virtual reality environment to create imaginary scenarios for the performance of exercises that can’t be done in a normal environment. With over fifteen years’ experience treating sports and orthopedic injuries, NYDNRehab is a pioneer in patient care and rehabilitation.

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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)

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Complete tear of rectus femoris
with large hematoma (blood)

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

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