Sacroiliac Joint Pain: Not limited to Back and Buttock

The sacroiliac joint (SI) is the joint between the sacrum, the base of the spine, and the ilium of the pelvis. 

Frequently it is a cause of pain in patients who have undergone lumbar fusions and traumatic injuries.

ST is 47 y/o active patient with 4 year history of left buttock pain which was constant in duration, progressive in nature with radiations into the left lateral thigh extending down calf and into the fourth and fifth digits of left foot.  Buttock pain was aching and throbbing whereas  the leg pain is ‘nerve’ like with intermittent sharp electrical sensations. Patient is active in volleyball and cycling.  Physical examination was significant for positive  Fortin test and patrick test.

ST was surprised of by the diagnosis of SI joint dysfunction.  Surely this was irritation of the nerve root caused by a protruding lumbar disc.

Can SI joint be responsible for lower extremity pain?

Yes !

Slipman demonstrated that SI joint pain is not limited to the lumbar region and buttock.  50 patients were evaluated who had confirmed Si joint dysfunction. 94 % of patient described buttock pain whereas 50% of patients had lower extremity pain, 28% had leg pain distal to the knee and 14% reported foot pain.

Not all lower back, buttock and leg pain arises from disc disease.

At the Centeno-Schultz Clinic we are committed to making the correct diagnosis.  Treatment options for sacroiliac joint dysfunction includes prolotherapy, PRP and bone marrrow derived stem cells.

Stem Cell Therapy for Sacroiliac Joint Pain

The sacroiliac joint is common source of pain.  It is a cartilaginous joint between the base of the spine (sacrum) and the waist bone (ilium).   

SI joint pain can occur in patients who have undergone lumbar fusion due to the increased biomechanical forces or following trauma. Conservative therapy includes physical therapy, core stabilization, prolotherapy and intra-articular joint injections with low dose cortisone .

BM is a talented athlete who hit a tree after going over a cliff on his snowboard.  He struck his left back and buttock injuring his SI joint.  He underwent extensive therapy directed at both his lumbar spine and SI joint which included PT, chiropractic care, lumbar facet injections, lumbar facet radiofrequency ablation, steroid injection in the SI joint and  40 sessions of prolotherapy without significant relief.

 Surgery was the next option which BM declined.  Instead he opted to undergo the Regenexx procedure which allowed him to use his own mesenchyml stem  cells. The SI joint and associated ligaments were injected with stem cells.  Yesterday, patient returned to clinic, 4 months post stem cell therapy reporting 90% improvement in pain.  He is very excited about the results and is in training for the upcoming session.

Mesenchymal stem cells can differentiate into ligaments, bone, cartilage and tendons.  Stem cell therapy allowed BM to avoid surgery, significantly reduced his pain and to return to his passion.

MISLEADING MRI: The picture does not tell the whole story

In a previous blog, I have discussed the limitations of MRI’s in identifying the source of a given patient’s pain.  A clinical evaluation today illustrates this point.

35y/o athletic patient presented with a 4 year history of lower back pain, constant in duration, 6/10 in severity, progressive in nature, localized in left lower back and buttock area without any radiations into his leg.  Pain which was aching in character was aggravated by prolonged sitting, standing and twisting.

Treatment to date had included massage, chiropractic care, physical therapy, trial of anti-inflammatory agents, narcotics and a surgical evaluation.

Physical examination was significant for tenderness in the left lower spine and buttocks with no neurologic abnormalities.  Direct pressure applied to the mid-buttock was painful.

MRI of the lumbar spine was significant for advanced degeneration of the L5/S1 disc and bone swelling.

The patient was convinced that his pain was arising from the degenerative lumbar disc.  Family members, his primary care physician and surgeon endorsed this view.  The surgeon had recommended lumbar fusion to relieve his pain.

Low back pain can arise from many structures including muscle, ligament, facet, disc and sacro-illac joint (SI). Evaluation to determine the source of the pain had not been performed.  At the Centeno-Schultz Clinic this is achieved by injecting a small volume of local anesthetic under x-ray into a specific targeted tissue.  If the pain is significantly relieved from the injection, the pain generator has been identified and an appropriate treatment plan can be created.  Often without such diagnostic evaluations, the source of a given patient’s pain cannot be established and therefore the patient is at risk for incorrect diagnosis and therapy.

Patrick’s Test: Evaluation of Sacroillac Joint Dysfunction

The Patrick’s Test is a physcial examination test  to determine the presence of sacroiliac joint dysfunction in patients with lower back pain. It is important to evaluate all sources of lower back pain.  Common sources of lower back pain include lumbar facet dysfunction, lumbar ligamental instability, lumbar degenerative disc disease and sacroillac joint dyfunction.

The sacroillac joint is a synovial joint formed by the articular surfaces of the sacrum and ilium.  The stability of the joint is maintained by a series of ligaments which include the anterior and posterior sacroillac ligament.  The joint functions as a shock absober for the pelvis and lumbar spine.

Trauma is the most common cause of SI dyfunction.  Patient often times report falling directly onto their buttucks or being involved in a rear end motor vehicle injury.

Symptoms of SI joint dsyfunction include mild to moderate pain, unilateral in nature, aggrevated by prolonged sitting often times referred into the buttuck and posterior thigh.

The patrick’s TTest is performed by flexing the patients leg and putting the foot of the tested leg on the opposite knee.  Pressue is applied on the superior aspcect of the tested knee joint lowering the leg into further abduction.

Patrick's Test

The test is positive if there is pain at the hip or sacral joint, or if the leg can not lower to the point of being parallel to the opposite leg.

At the Centeno-Schultz Clinic, sacroillac joint dyfunction is treated with core stabilization, restoration of muscle imbalances and prolotherapy.

Back Pain Relief

Back pain relief starts with making an accurate diagnosis.  At the Centeno-Schultz Clinic we are committed to identifying the source or “generator”  of one’s back pain so that the appropriate treatments can be applied.

There are many sources of back pain but the major 4 are muscular, facet, sacroillac joint and lumbar disc.

The facet is an  cartilaginous joint in the spine and according to Dreyfuss is  responsible for 15-40% of chronic lower back pain.

If you have fact joint problems, back pain relief is obtained by injecting the joint with local anesthetic and very low dose steroids.  If back pain relief is only temporary long term back pain relief can be obtained from facet joint radiofrequency (cauterizing  the nerves that provide sensation to the facet joint) or injection of stem cells into the joint.  Regenexx affords the patient the ability to inject their own stem cells into the joint to regenerate the damaged cartilage and provide long lasting relief.

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Lumbar Degenerative Disc Disease and Discectomy

Lumbar degenerative  disc disease is very common.  Virtually everyone at some point in their life has lower back pain.  Fortunately for many the pain resolves never to return.  For others their back pain becomes chronic and erodes the  quality of their life.  These individuals seek the advise of professionals which  include surgeons.

Yesterday I had the opportunity to evaluate a patient who was seeking a second opinion for her severe left sided back pain.  A surgeon had recommended a discectomy.  Her MRI showed moderate degeneration of the L5/S1 disc with a slight protrusion. 

 

 

 

 Her examination was significant for  exquisite tenderness in her left buttock with only mild tenderness in her back.  At the Centeno Schultz Clinic we are committed to identifying the source of a given patients pain.  We accomplish this through diagnostic injections performed under intermittent x-ray.  Back pain can arise from many sources which include muscles, ligaments, facets, the sacroiliac joint as well as the disc.  Due to this patients severe tenderness over her left buttock I injectioned  her  left sacroilliac joint which to her surprise provided her with 100% pain relief.  

 

 

The sacroillac  joint is a source of lower back and buttuck pain in approximately 15% of the population.   

 

 

 

 

 

 

 

 

This patient  did not need a discectomy but rather a thorough assessment of her back pain. 

 

 

 

 

 

 

 

 

 

 

 

 

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