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Back Problems Message Board

Back Problems Board Index

[QUOTE=teteri66;5030028]Welcome to the board. An issue with the sacroiliac joint can often bring on piriforamis problems. Usually there are just a couple things that become problematic. The SI joints connect the sacrum, the lowest level of the spine that is immovable, with the iliac which a part of the pelvic girdle. There are no muscles involved in the SI joints. They are held in place with ligaments. Problems with the ligaments being either too tight or too loose account for one type of issue...and this will allow the joint to move or "slip." (SI joint disorder or syndrome)

The other issue is an inflammation of the joint and is called sacroilliitis.

It is a fairly common incident to carry one hip slightly higher than the other, or to have a slight rotation of the pelvis. These can be caused by a SIJ disorder, which often results in the piriformis muscle becoming irritated or inflamed. This can result in hip pain or if the piriformis is taut or inflamed, it can put pressure on the sciatic nerve, which runs directly underneath the piriformis.

The only way to tell if there is a problem with the SI joint is to have a diagnostic SI joint injection. This is done with fluoroscopy and a long needle and included a numbing agent in addition to some steroid. The joint will immediately become numb and you will be asked to go about your normal activities, especially those that normally cause you pain. If you can do them without the pain, it is an indication that they have located the pain generator. As the numbing agent wears off, the pain will gradually return. This is repeated a second time at a later date to confirm the results. Then sometimes a rhizotomy is performed to desensitize the nerves.

If the issue is sacroilliitis, then anti-inflammatory medication, rest and PT are tried to bring down the inflammation.

Piriformis issues often go hand in hand with sacroiliac joint problems.

I would suggest you keep doing all the exercises you were shown in PT, work at keeping your core and back muscles as strong as you can and give it some time. I would also suggest you be sure your feet do not pronate or have any other issues that might be throwing off your structural alignment. Be sure one leg is not longer than the other and that your pelvis is not rotated. A good ortho pt or someone in bodywork should be able to assess you.

Both these issues can be very difficult to get rid of...and it can take a long time. I wish you good luck.[/QUOTE]

That is about the best description of sacroiliac joint issues I've ever read.

I must add that not every injection is the same. My last injection was CT guided and that injection was placed deep inside the joint ( kinda space age stuff ) and I was pain free almost immediately. With my other fluoroscopic injections I was still left in confusion. Another thing is that I had no leg numbness with the CT injection or the standard steriod hot flashes.

Piriformis Syndrome is a real pain for sure. I find that stretching only makes it worse. Just use a tennis ball and roll the trigger points out.

For the OP:

Avoid bending at the waist. Sitting with butt lower than knees. Twisting. Stair climbing.

If you must do any of the above - learn how to activate your transverse abdominus.

I also must say that you may just have muscle imbalances caused by prolonged sitting. Sitting causes your hip flexors to shorten, iliopsoas problems, etc. When this takes place the Piriformis and other muscle groups ( glute medius, etc ) will fire trying to correct the imbalance.

Swimming ( and lots of it ) is something that I've implemented lately. I'm trying to get my muscle to work together again. This I believe is the cause of many issues with people. It's not like we're in school anymore - where we would go run and play after each class. We just sit or stand for hours. And when we do exercise it is usually controlled isolation exercises. We'll see if all my swimming does any good

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