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Back Problems Message Board


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Thanks again teteri66 for a very helpful/insightful post. Scheduled SI joint injection consult for Tuesday and this info is super helpful. Hoping to solve for the sitting pain that persists. As a significant pronator, leg length inequality (20mm) and 3 level fusion (L3/S1), it sounds like this consult is time well spent.

keith


[QUOTE=teteri66;5343608]My guess is that your SI joint problems are related to the problems in your foot that required reconstructive surgery. The feet form the basis for our structural alignment. In my mind I imagine a series of building blocks arranged one on top of the other. When there is an issue with the feet, it tends to through off the blocks perched on top of the feet.

For example, if someone has a foot pronation, the ankles turn slightly inward, which affects the position of the knees. By the time this inward rotation reaches the pelvis and hips, it frequently causes the pelvis to tip forward which causes issues with the SI joints...which tends to pull on the piriformis muscles. Since the piriformis passes directly over the sciatic nerve and attached over by the hip, if it is slightly inflamed or stretched, it can result in leg and/or hip pain. I will stop here, but the cascading "adjustments" can continue on up the spine.

It is very common to develop SIJOINT issues after a lower lumbar fusion, and it can take a long time to sort it all out. I was about ready to give up when I finally overcame my issues, but it took a good year.

Have you been through a course of physical therapy for your SI joint issues? It is important to find a PT that either specializes in or has lots of experience with orthopedic cases as they vary so much in the ability to help you. Out of 5 I worked with, three were little better than reading exercises online (in other words, very general, one size fits all people with back-related pain....). One was knowledgeable and one was fabulous and the only one who actually helped me quite a bit. I didn't realize how useless the first three were until I finally found one who really understood the mechanics of the spine. I suspect most of us are dealing with therapists like my first three...which is why physical therapy helps so few people with back issues.

Anyway, I recommend PT so you will have your structural alignment assessed and will be given a program to strengthen and balance your core and back.

If it is determined that your issue is coming from SI joint instability, you might want to get a platelet rich plasma injection into the joint if the ESI doesn't resolve your pain.

The ESI can be given as an injection into the joint or caudally, where it kind of bathes the area in steroids. I agree that the thought of someone sticking a needle in the back is unnerv ing...but it doesn't take long and while I pleasant, is not horrendous. If you have enough of them, you even get used to it!

For best results, arrange your schedule so you can stay off your feet for 72 hours post injection. If you return to your normal schedule, on your feet moving around, it will cause the medication to dissipate more quickly. You can ice the area if you have pain from the injection.
Good luck.[/QUOTE]





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