There are two small sacroiliac joints located at the base of the back.  They are located between the sacrum (the large triangular bone at the base of the back) and the pelvis.  The sacroiliac joints do not move very much but they are critical to transferring forces between the upper and lower body. Sacroiliac joint pain is usually due to mechanical overload of the joint.  This may be due to a sudden excessive traumatic force or long term repetitive strain.  Long term repetitive strain can be caused by misalignments such as a twisted pelvis or  a leg length difference.

During pregnancy hormones are released that relax the ligaments of the body to allow the pelvis to change shape to permit childbirth.  This increased flexibility and the change of shape during pregnancy can cause sacroiliac joint pain.  Less commonly inflammatory joint diseases such as ankylosing spondylitis may cause sacroiliac joint pain.

Symptoms

• Pain at the base of the spine on one side only.
• Pain may be both dull and sharp in character.
• Pain usually worse in the morning for up to 30 minutes
• Pain may radiate (spread) into the buttock, groin or leg
• Spasm in muscles of the lower back and buttock on affected side.
• Pain is aggravated by
  • Turning in bed
  • Abducting the hip (swinging the leg out to the side) for example when getting in or out of a car.
  • Walking as the heel hits the floor on the affected side

What you can do

• Cold therapy
• Rest  -  avoidance and reduction of aggravating activities
• Employ correct posture and body use to avoid overloading area
• Anti inflammatory medication – speak to your doctor or pharmacist about a suitable product

What we can do

• Diagnostic tests to incriminate sacroiliac joint
• Questioning to eliminate inflammatory joint disease as a cause of pain
• Manipulation of affected joint to open up the sacroiliac joint and break down scar tissue formation that may restrict joint movement
• Massage to relieve spasm in overlying muscles and therefore decrease pain
• Pumping techniques to remove inflammation from around the joint (foraminal gapping, reinforced flexion and traction)
• Reduce mechanical load on affected area by
  • Improving alignment of spine and pelvis including assesement of leg length difference
  • Mobilising and stretching joints to increase movement in adjacent areas of the spine to reduce loading on affected joint

Further treatment options

• Corticosteroid injection into the facet joint to reduce inflammation.
• Radiofrequency denervation’. A technique that destroys the nerve supply to the joint using ionizing radiation

Intervertebral discs are located between adjacent vertebrae of the spine.   They consist of an outer layer called the annulus fibrosus, that surrounds the nucleus pulposus.  The annulus fibrosus consists of many concentric rings of fibrous material that contains the gel like nucleus pulposus. The nucleus acts as a shock absorber and allows movement between adjacent vertebrae. The disc can be thought of as a doughnut: the annulus fibrosis is analogous to the dough and the nucleus pulposus the jelly filling.

There are three grades of disc injury

• Grade 1: Annular strain – this is the lowest grade of disc injury and involves a tearing some of the outer fibres of the annulus fibrosus.
• Grade 2: Disc bulge – due to ageing and injury cracks form in the annulus fibrosus that allows the jelly like nucleus pulposus to move through the annulus towards the edge of the disc.  This causes the disc to bulge, impinging onto adjacent structures causing pain.  If the bulge presses onto a nerve root it can cause pain, weakness and altered sensation along the path of the nerve.
• Grade 3 Disc Prolapse (Slipped Disc).  A disc bulge may develop into a prolapsed disc (slipped disc) in which the jelly like nucleus pulposus breaches the annulus fibrosus.  The contents of the nucleus cause a strong inflammatory reaction in the surrounding tissues and therefore may be very painful.  Almost all slipped discs in the lower back occur between L4 and L5 or L5 and S1 i.e. in the lowest two most discs.

Causes of disc injury

• Disc injuries are most common in the 25-45 age group.  As we grow older the jelly like nucleus pulposus dries out making it less likely to bulge or herniate.
• Injuries are more common with a history of heavy manual work – especially if incorrect lifting techniques are employed.
• Trauma – discs may be damaged in an accident are especially vulnerable when lifting with a bent and rotated back.

Symptoms of Slipped Disc

Disc bulges and herniation may press against adjacent structures causing pain.  Overlying muscles may go into spasm.  Nerves branch off the spinal cord and body exit the spine just above each disc. A spinal disc herniation can press against the adjacent nerve causing symptoms along the course of that nerve. A slipped disc can produce varying degrees of pain in the back along with numbness or weakness.

• Numbness, tingling, weakness, or pain in the buttocks, back, legs , or feet
• Pain down the back of each leg from the buttocks to the knee (this is called sciatica)
• Symptoms are worse in the morning for 20-60 minutes and at the end of the day
• Slipped Disc Pain aggravated by
  • Bending forwards
  • Sitting
  • Lifting
  • Coughing or straining on the toilet
• Slipped Disc Pain relieved by
  • Lying down
  • Standing up and moving around
• Less common symptoms – if experienced seek medical attention immediately
  • Numbness and tingling around the anus or genitals
  • Difficulty controlling bowel movements or bladder function

Symptoms typically last 3-6 months.

What you can do

• Ice therapy
• Rest  -  avoidance and reduction of aggravating activities
• Employ correct posture and body use to avoid unnecessary stress on back
• Anti inflammatory medication – speak to your doctor or pharmacist about a suitable product

Slipped Disc Treatment

• Massage to relieve spasm in overlying muscles and therefore decrease pain
• Osteopathic techniques to increase circulation to discs e.g. traction
• Prescribe exercises to alleviate pain and reduce spinal disc herniation
• Reduce mechanical load on affected area by:
  • Improving alignment of spine and pelvis
  • Spinal manipulation and joint stretches to increase movement in adjacent areas of the spine to reduce loading on affected discs
  • Hamstrings stretching to reduce flexion loading on spine
  • Prescription of exercises to improve core stability

Facet joints are small flat joints located at the back (posterior aspect) of the spine between adjacent vertebrae.   Unlike the discs which are large and transmit force and body weight the facet joints act to control movement at different levels of the spine.  The may be thought as “guide rail joints”.   In the lower back (lumbar spine) the facet joints and arranged vertically and therefore allow flexion and extension (bending forwards and backwards) and lateral flexion (bending to the side).  The vertical alignment restricts rotation in the lumbar spine and therefore helps reduce rotational forces on the lumbar discs.  Each joint is surrounded by a small capsule and contains a lubricating nourishing liquid called synovial fluid.

Facet joints are a common source of back pain.  An episode of pain may be due to a sudden traumatic movement which injures the joint or long term repetitive strain resulting from poor posture and inefficient body use.  Injury creates an inflammatory reaction in the joint resulting in facet joint pain and swelling.  Long term pain may be the result of excessive force passing through the joint causing facet joint inflammation or actual roughening of the joint surfaces i.e. arthritic change.

Facet Joint Syndrome Symptoms

Facet Joint Syndrome Symptoms can be caused either by a sudden traumatic movement or occur for no apparent reason due to repetitive strain.

• Pain is typically located on one side of the spine and can be both dull and sharp in character.  The pain level can be high.
• Pain may radiate (spread) into the buttock and leg.  If the adjacent nerve roots are irritated a sharp electric shock type pain may shoot into to the buttock, leg or groin.
• Muscle spasm is common in the adjacent muscles to the joint.
• Facet Joint Back Pain is usually worse in the morning for up to 30 minutes and is aggravated by
  • Side bending toward the affected side
  • Extending the spine (backward bending).
  • Changing position – standing up, sitting down, turning in bed
• Facet Joint Back Pain Relief via
  • Staying still
  • Lying down

What you can do

• Rest
• Take anti inflammatory medication  -  speak to doctor or pharmacist about a suitable product
• Ice therapy to reduce inflammation
• Heat to reduce muscle spasm.  Be careful with heat treatment – in the early stages heat may exacerbate inflammation and increase symptoms so use heat in small doses intitially.

Facet Joint Syndrome Treatment

• Osteopathic pumping techniques to remove facet joint inflammation from around the joint (foraminal gapping, reinforced flexion and traction)
• Spinal manipulation of affected joint to open up the facet joint and break down scar tissue formation that may restrict joint movement
• Massage to reduce muscle spasm
• Spinal manipulation and stretching to reduce mechanical load on affected area
• Postural advice and exercises to reduce mechanical load on affected joints

Further treatment options

• Corticosteroid injection into the facet joint to reduce inflammation.
• Radiofrequency denervation’. A technique that destroys the nerve supply to the joint using ionizing radiation