Dr. Jeffrey I. Kennis,  D.C.
205 Commercial St.
Boston, MA 02109
NORTH END

( 617)720-2329


 

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Dysfunction in the sacroiliac joint, also called the SI joint, can sometimes cause lower back and/or leg pain. Leg pain from sacroiliac joint dysfunction can be particularly difficult to differentiate from radiating leg pain caused by a lumbar disc herniation (sciatica) as they can feel quite similar.

Sacroiliac joints

Sacroiliac joint dysfunction refers to pain in the sacroiliac joint when they move either too much or too little. Sacroiliac Joint Dysfunction Video

For decades, the sacroiliac joint was suspected as a common cause of low back and/or leg pain, although difficulty in accurate diagnostic testing left many in the medical profession skeptical. Today it is estimated that the sacroiliac joint is responsible for 15% to 30% of lower back pain cases.1

 

Anatomy of the Sacroiliac Joint

The sacroiliac joint connects the hip bones (iliac crests) to the sacrum, the triangular bone between the lumbar spine and the tailbone (coccyx). The primary function of the sacroiliac joints is to absorb shock between the upper body and the pelvis and legs.

See Sacroiliac Joint Anatomy

The sacroiliac joint typically has little motion. Small movements at the joint help with shock absorption and forward/backward bending. The joint is reinforced by strong ligaments surrounding it, some of which extend across the joint in the back of the pelvis. This network of soft tissues provides support, limits movement at the joint, and assists with absorbing pressure.

Other muscles that support sacroiliac joint function include the gluteus maximus and the piriformis muscle.

Sources of Sacroiliac Joint Dysfunction

The primary mechanisms of SI joint dysfunction include:

  • Too much movement (hypermobility or instability) in the sacroiliac joint can cause the pelvis to feel unstable and lead to pain. Pain from too much motion is typically felt in the lower back and/or hip, and may radiate into the groin area.
  • Too little movement (hypomobility or fixation) can cause muscle tension, pain, and may inhibit mobility. Pain is typically felt on one side of the low back or buttocks, and can radiate down the back of leg (similar to sciatica pain).
 

Inflammation of the sacroiliac joint (sacroiliitis) can also produce pelvic pain and stiffness. Sacroiliac joint dysfunction may cause inflammation, or inflammation may occur with normal function of the joint from an infection, rheumatoid condition, or other cause.

Sacroiliac joint dysfunction is more common in young and middle-aged women. Women who are pregnant or have recently given birth may be more susceptible to sacroiliac joint pain.2

Airplane travel can expose you to uncomfortable positions and prolonged periods of stationary sitting, causing neck pain. Try these 7 tips to avoid neck pain next time you fly.


Long airplane trips can be daunting for people with back or neck pain. Luckily there are several tips that can help reduce or avoid pain and discomfort while traveling. Read Pain-Free Travel Tips

1. Pack over-the-counter medication
Over-the-counter pain medication, such as ibuprofen (e.g., Advil, Motrin) and naproxen (e.g., Aleve), can help reduce inflammation and lessen pain from a stiff, sore neck. Pack this medication in your carry-on luggage, making it easy to access if your neck starts to hurt during the flight. Or if you’re already dealing with chronic neck pain, consider taking the medication an hour before your flight so it gets in your system prior to takeoff.
See NSAIDs: Non-Steroidal Anti-Inflammatory Drugs

These medications carry risks and possible side effects, so check with a doctor or pharmacist before use.

2. Use a travel neck pillow
The cramped space of an airplane can leave you susceptible to incorrect posture. Laying your head on the tray table or leaning against the window, for example, can lead to neck strain and muscle stiffness.

A travel-sized neck pillow can help keep your neck straight and upright during the flight, minimizing the painful effects of incorrect posture. One popular option is a scarf-like wrap that features a supportive brace inside the fabric. Wearing this pillow allows you to comfortably lean to one side without bending your neck too far.
See Pillow Types to Consider

3. Relax
Plan ahead for some enjoyable, relaxing activities that can help take your mind off the pain. Listen to soothing music or an interesting podcast on your smartphone. Bring a novel or magazine to read and stimulate your mind. Think about your vacation destination and all the fun activities you look forward to doing there.

4. Get up and walk around
Holding a sedentary position for several hours can lead to neck pain—and lower back pain, too. You may find some relief by walking up and down the aisle when the pilot turns off the seatbelt sign. Changing positions and keeping your body loose can help reduce the muscle tightness caused by sitting in an uncomfortable position.

5. Stretch it out
Stretching can help ease neck stiffness, loosening tight muscles and restoring the neck to a more natural range of motion. You can perform many simple, effective neck stretches while you sit in your seat. It is recommended you practice stretches you learned from a qualified health professional, such as a physical therapist.
See 4 Easy Stretches for Neck and Shoulder Pain Video

6. Try a self-massage tool
You may find neck pain relief by using a handheld self-massage device while on the airplane (if the device is battery operated, check with the airline ahead of time to see if it is allowed onto the flight). A tennis ball can also be used as a self-massage tool and fits easily in a purse or laptop bag.
See Trigger Point Exercises for Neck Pain

Some airports have a massage therapy business on site, where you can hire a massage therapist to help relax your neck before or after a long flight.

7. Apply heat and/or cold therapy
Heat therapy encourages blood flow, reducing stiffness and allowing the neck to heal. You can use a disposable heat wrap, for example, which you can put on the back of your neck before your flight. Some people prefer cold therapy for neck pain relief. Consider packing plastic bags, which you can ask a flight attendant to fill with ice so you can make an ice pack.
See How to Apply Heat Therapy

Try some or all of these tips the next time you travel on an airplane. Hopefully these ideas help prevent neck pain, so you can have a more enjoyable flight.

Learn more:

If you have issues with your back, you may have been surprised at how hard it can be to arrive at a correct diagnosis and treatment plan.
See Getting an Accurate Back Pain Diagnosis


Your doctor will typically take your symptoms and medical history into account when making a diagnosis. Read: Lower Back Pain Symptoms and Diagnosis

If you have ever wondered why this is, look no further. Here are 4 big reasons why back pain is hard to both treat and diagnose:
See Back Pain Overview: A Guide for Understanding Back Pain

1. Diagnostic challenges
There are numerous potential issues when it comes to diagnostic tests. But the preeminent problem is that there is no single diagnostic test that can provide an accurate back pain diagnosis.
See Back Pain Diagnosis: Diagnostic Tests for Indicators of Back Pain

So then, many diagnostic tests have limited value, and some may even be controversial. Of course, this does not mean that your medical professional cannot accurately diagnosis your back condition. For example, certain common conditions, like a lumbar herniated disc that leads to sciatica symptoms, can often be diagnosed quickly and accurately through a variety of tests, questions, and image scans.
See Diagnosing a Lumbar Herniated Disc

But the inadequacy of any single diagnostic test helps to explain why you may receive different diagnoses from different doctors.
See Introduction to Diagnostic Studies for Back and Neck Pain

2. Trial and error
It is important to note that even if you correctly identify the underlying problem with your back, this does not necessarily dictate the proper treatment plan. There is typically more than one way to treat a back condition, and finding the treatment that works best for you can often times be a process of trial and error.
See Back Pain Treatment: Non-Surgical Options for Pain Relief

For example, some people with leg pain caused by a disc problem find that an epidural steroid injection provides great pain relief. Others find that it has no effect at all. So it is important you work closely with your doctor, and are clear and honest about your symptoms and the effectiveness of various treatments.
See Injections for Neck and Back Pain Relief

3. Subjective experience
Pain is a very personal experience. What may be mild back pain to one person can feel severe and overwhelming to another. This means that the same condition can require completely different kinds and levels of treatment for different people. For example, over-the-counter medication may be sufficient to treat the pain from a common back condition for most people. But your subjective experience may dictate that you need a more robust treatment plan to handle your intense pain.
See Medications for Back Pain and Neck Pain

4. Back pain can lead to a lack of sleep
The majority of people with chronic pain suffer from some sort of sleep problem. This can create a painful cycle, as a lack of sleep can make your pain worse; and more intense pain can make it more difficult to fall asleep.
See Chronic Pain and Insomnia: Breaking the Cycle

All this means that it may be difficult to treat your chronic back pain because you need to treat both your pain and your sleep problem. This can be tricky, as you have to try to juggle and combine two treatment plans into one cohesive whole.
See Pain Management for Chronic Back Pain

With all the above factors, along with the advances in imaging and treatments, no one doctor can be an expert in regards to all spinal problems. This makes it all the more important for you to educate yourself on your symptoms, conditions, and treatment options. The more you know, the better chance you have of finding meaningful and lasting pain relief.
See Causes of Lower Back Pain

Learn more:

A neck spasm occurs when your neck muscles suddenly, involuntarily tighten. Your neck becomes painful and stiff, likely affecting the ability to turn your head. An awkward neck movement or stress-related muscle tension is often what triggers a neck spasm. Here’s a quick guide to relieving the pain.


Neck muscle spasms are a relatively common occurrence, typically occuring when one or more muscles becomes painfully tight and/or fatigued. Read Understanding Neck Spasms

Stretch
Try to relax your spasming neck muscles. Stretching may be an effective method to loosen and soften your muscles, which tighten and seize up during a spasm.
See Neck Stretches

Perform a stretch that lengthens your lateral neck muscles. One way to do this is to keep your shoulders in place and tilt your ear toward your shoulder until you feel a stretch in the side of your neck. If a certain movement causes more pain, stop it and gently try a different movement.
See Easy Levator Scapulae Stretch for Neck Pain


Try these 4 stretches to relax the neck muscles, which tighten and seize up during a spasm. Watch: 4 Easy Stretches for Neck and Shoulder Pain Video

Get a massage
Massage therapy can help you relax, which may calm your tight muscles and ease the pain from your neck spasm. Gentle pressure placed on the stiff, tender points in your neck may release tension from the constricted muscles, providing relief and restoring range of motion to your neck.
See Massage Therapy for Chronic Stiff Neck

Consider NSAIDs
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAID), such as ibuprofen (Advil, Motrin) and naproxen (Aleve), may help reduce inflammation and relieve pain brought on by a neck spasm. These medications won’t treat the underlying problems that may have triggered your neck spasm, but they can provide quick-acting first aid to reduce pain.

Before using any medication, carefully read the warning label. If you’re already taking a medication, check with your doctor or pharmacist before using another medication.
See Medications for Back Pain and Neck Pain

Apply cold/heat therapy
Cold therapy can reduce local inflammation, which may help relieve pain from your neck spasm. Fill a plastic bag with ice and some water and wrap it in a thin towel, then press it against the painful area on your neck.
See Ice Packs for Back Pain Relief

You may also find relief through heat therapy. Apply a heating pad, switched on a low setting, to the tender area of your neck. If you prefer, stand in the shower with a gentle stream of warm water hitting your neck. The warmth can increase blood flow to the affected area, relax muscles, and soothe your pain.
See How to Apply Heat Therapy

When applying ice or heat, limit applications to about 15 minutes every 2 hours to reduce the risk for skin damage.

Relax
Your neck spasm may indicate that your neck has moved in ways it shouldn’t, and your tense muscles probably need a rest. One way to relax is to lie on your back with a cervical pillow or neck roll under your head and a pillow under your knees. Play calming music or a podcast to help pass the time as you relax.
See What Causes Neck Spasms?

When to See Your Doctor
Most neck spasms occur because of a sudden muscle strain and should clear up within a week. Pain that persists or gets worse may indicate an underlying spinal problem, such as osteoarthritis or herniated disc. For any unexplained neck pain that does not start to feel better within a week or so, visit your doctor. If your neck pain is accompanied by a severe headache, dizziness, nausea, arm numbness/weakness, or other troubling symptoms, seek immediate medical attention.
See Specialists Who Treat Back Pain

Learn more:

While no single treatment works for everyone, any of the following 3 techniques for coping with chronic sciatica may help you better manage your symptoms:

1. Disassociation
As you likely know by now, the location of your sciatica symptoms can vary based on which of your sciatic nerve roots is pinched or irritated. This means it’s possible to experience symptoms in a variety of places, such as your calf, foot, or hamstring (and symptoms may be experienced in multiple locations at once).

Regardless of the location of your symptoms, you may find relief by imagining that a painful part of your body is separated from the rest of your body (a mental practice known as disassociation). For example, picture your numb foot on the dresser located on the other side of your room. You can then tell your foot (or whichever body part is experiencing symptoms) to stay where it is (as you continue to hold this mental picture in your mind).

When your first start out, you can hold a particular image in your mind for as little, or as long, as you like. If possible, it is also a good idea to locate a dark, secluded room in order to practice the dissociation technique.

2. Biofeedback
Biofeedback refers to the process of using a monitoring machine (often a computer) to retrain physical states in your body that are not normally under voluntary control. Put another way, biofeedback measures a physical process, and then immediately reports the information to the person being monitored so that he or she can learn to consciously influence that physical state.

Biofeedback is used to train people to do such things as lower their heart rate, decrease muscle tension, and lower their blood pressure.

If your sciatica is provoked by muscle tension in your lower back, biofeedback treatment may help bring you relief by training you to reduce the tension and allowing your mind to focus away from your symptoms.

Biofeedback training for muscle tension involves placing electrodes on the skin over the area of the muscle that needs to be retrained. The computer can then measure the amount of muscle electrical activity that is present (this electrical activity is related to the tension in the muscle). On the computer screen, you will be able to see the amount of tension present in the muscle, and then you can slowly learn to decrease it.

3. Enjoy your favorite activity
It might seem too simple, but regularly engaging in your favorite hobby or activity can reduce your perception of your chronic sciatica pain. This is possible because your attention is drawn away from your chronic pain, and instead is placed on the pleasurable task at hand.

You may no longer be able to run a marathon or go mountain biking, but you can likely still engage in simple tasks like writing poetry or reading a good book. Another option is to call a good friend on the phone at least once a week.

As a final word on this technique, I often tell patients that when their pain is at its worst, the last thing you should do is give up on your hobbies. This is not only because engaging in hobbies can reduce your perception of your chronic pain, but it also places you at greater risk for developing depression.

Make sure to have the underlying cause of your sciatica diagnosed. This is important because your chronic sciatic pain may be more than a nuisance—it might be a warning signal alerting you to a serious medical problem.





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