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The Sacroiliac Joint and ‘Sciatica’

Sacroiliac Joint locationUnfortunately ‘sciatica’ is an often misused diagnosis for pain radiating into one or both legs, above as well as below the knee. For some reason patients often appear happy that a doctor has slapped a diagnosis on their pain and given them some drugs to make them feel better. That is, of course, until the sufferers realise that the drugs either do not offer the relief hoped for - or that the benefit only lasts for as long as they keep taking the medication.

To my mind sciatica is a term that should be reserved for those cases where the sciatic nerve is involved in the leg pain experience, and often it is completely innocent. A reasonable physical examination, often not performed by your local GP, should be able to help determine whether or not the sciatic nerve is responsible. As with all treatment it is important to find the source of the pain to have the greatest chance of alleviating it. It is also worth noting that the advertised ‘targeted pain relief’ often offered by pain killers is complete nonsense. No painkiller can target a particular pain site.

A potential leg pain generator is the sacroiliac joint (SIJ) but it is frequently overlooked as a possible source of pain radiating below the knee. The aim of a recent study was to determine the short-term effects of physiotherapy, manual therapy, and cortisone injection into the joint in patients with SIJ-related leg pain.

51 patients were randomised into one of three treatment groups. SIJ-related leg pain was diagnosed using a physical and a neurological examination, SIJ pain provocation tests, along with investigations of the lumbar spine, pelvis, and SIJ. Patients in the physiotherapy group underwent a 6-week protocol of exercises aiming to improve SIJ mobility and strength for the lumbar spine and pelvic floor. The manual therapy group received high-velocity thrust SIJ manipulations over a 2-week period. The last group had a cortisone injection. The primary outcomes of interest were pain scores – determined by the VAS (Visual Analog Score) and RAND-36 (quality of life questionnaire) – conducted immediately, at 6-weeks, and 12-weeks post-intervention.

51% of the patients were had a successful outcome. Analysis of the individual treatment groups revealed that physiotherapy was successful in 20% (1 in 5) of cases, cortisone injections were successful half of time and manual therapy took the honours with a 72% (nearly 3 out of 4) success rate - so 3.5 times better than physio and 1.5 times better than injuections.

This study had a relatively small number of patients and short-term ( 3 month) follow-up. However, these results suggest that manual therapy may be the choice of treatment in patients with SIJ-related leg pain. I hope that future studies investigating more comprehensive outcomes, coupled with longer-term follow-ups would shed further light into the efficacy of the above interventions.

It is also important to appreciate that the chiropractors here at the Park View Acupuncture and Chiropractic Clinic use more than just manipulation in treating sacroiliac joint and other back pains. In our goal to eliminate the pain our approach may any use combination of manipulation, muscle and ligament work, mobilisation, exercises, advice and help to identify the things, which may have triggered the problem. We can also advise on the appropriate use of painkillers and anti inflammatories.

To get a proper diagnosis, help and advice call us now on 01903 230066

# Sacroiliac Joint - Front Sacroiliac Joint - Back

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Reference: Visser et al., Eur Spine J (2013) (Epub ahead of print). All rights reserved to Springer-Verlag Berlin Heidelberg.

All images are public domain from Wikipedia (July 2013)

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