SIJD - the reason for low back pain,
scoliosis, lordosis, lumbar/thorax hypermobility, forward head position, bad posture, headaches,
leg length inequality, knee problems, achilles
problems and so many others... Very common problem and yet so poorly understod!
(SIJD = sacroiliac joint dysfunction/dislocation/syndrome, rotated pelvis, rotated iliac, pelvis misalignment,... A lot of different names to this!)
Content:
Read and cry!
Toni Rintala, MA,
ex-SIJD patient,
Finland
Email: parantunut[at]blondit.net
I was about 12 years old when one doctor diagnosed my left leg shorter (LLI), bad posture, mild lordosis and scoliosis. The doctor promised me that I will probably have back troubles when I grow up. He was so right!!!
My pains started when I was about 15. First I had heel pain. Doctors said it was only “growing pain”. Then around at age 17 I started to have low back pain and shoulder and neck muscle stiffness. Doctors said it is normal with bad posture as mine. At age 20 I started to have leg weakness. It was weird. I thought I was over exercising. But I was not doing that much sports... At age 24 I started to have shoulder pain, headaches, heart problems. Few years later I got high blood pressure and ischias. Then severe low back pain, foot cramps, neck pain, migrens,... and those weird leg weaknesses continued.
At that time I started to see doctors (MDs), doctors of physical therapy and chiropractors. They ordered all kind of blood tests, X-rays, MRIs and a lot of others. Everything was normal. Doctors told me to get a heel lift for my LLI and told me to accept my pain and learn to live with it!
After years of search I finally found one professional who knew how to cure my back pain: to correct my SIJD. His exact diagnose was:
M53.8
Dysfunctio/dislocation articuli
sacroiliacale l. sin.
M41.9 Rotatio scoliosis
G54.0 Syndroma TOS l.a.
M35.7 Syndroma hypermobilitas levis
R29.8 Symptomata musculi quadriceps l.a.
And
the best part was: He pushed my SIJ “down” to its place! After that all my
symptoms were gone! Amazing! My legs got power. My spine was no longer hypermobile. My posture got better! No headackhes,
no high blood pressure,...
What
is that dysfunction/dislocation of sacroiliacale???
It is SIJD?
Before that expert I met tens of others “medical experts” who diagnosed me wrong or didn't know anything at all, including chiropractors, PTs, MDs and others!
I spent thousands of dollars during many years for doctors, physical therapists, pictures, exams, test,...
My
problem was hypermobile and anteriorly
rotated left iliac bone (SIJD), but all the doctors
were totally lost, or few of them diagnosed something wrong on right side of my
back where the pain was... That is wrong side!! The pain is often on the other side than the problem!
After I got rid of my back pains (and many other problems too connected to SIJD) I started to search information about SIJ dysfunction and to interview patients who have the same problems I did. I have found hundreds of them! And I see thousands of them...
According to many researches and medical studies almost all people have leg length inequality that causes bad posture, scoliosis and other problems. That is because of misalignments in pelvis -> SIJD.
When iliac bone is rotated anteriorly it causes leg shortening and sacrum to lead forward -> lordosis. That leg length inequality causes pelvis misalignment and pelvic torsion.
Those all cause problems to spine all the way from lumbar to cervical spine! And from there to shoulders, arms and even fingers. And that functional leg length inequality is responsible for ankle, achilles, knee and other problems too, like PFS just to mention one.
Here some references:
Richard DonTigny,
PT:
"Eight
of ten people in the world will have low back pain at one time or another and I
firmly believe that most of it is SIJD.”
http://www.kalindra.com/faq.htm
Wolf Schamberger, M.D.
"Patients presenting for cardiac
rehabilitation are no different from the general
population in that 80 to 85% are out of alignment."
http://www.cacr.ca/news/1998/9812Schamberger.htm
Maciej Dluski :
“The
theory of the YUMEIHO method is grounded on the fact, that over 95% of people have had incorrectly positioned pelvis since their
birth. Most often it means, that one ilium is placed
higher than the other. The limb on the higher ilium
side is comparatively shorter.”
http://www.yumeiho.pl/o_terapii_en.html
Lisa Mancuso, M.D., Hugh S Thompson, M.D, George A. Bitting, M.D.
"The sacroiliac joint is a commonly overlooked cause of lower back pain.
Recent studies have found that Sacroiliac dysfunction was the cause, or a major
component, in a high percentage the cases of mechanical back pain. Dysfunction in the sacroiliac joint not
only causes back pain but also may mimic pain seen in lumbar disc herniation or a facet joint with pain referred into the
buttock and thigh."
http://www.firstchoicehealthcare.com/assets/docs/012405.pdf
Protonics method:
“In a normal person the spine sits on top of a neutrally positioned sacrum (central portion of the pelvis) and has a slight lordosis (arch forward). When the pelvis is anteriorly rotated the sacrum is tipped forward and the rest of the spine has no choice but to follow suit. Rather than fall over forward, the body compensates for this excessive forward tilting of the lower spine by tilting backward at some point higher up the chain. This creates a large increase in the amount of curvature (lordosis and scoliosis) of the lower back. This deep curvature of the back can result in extreme pain and various problems including muscle spasms, pinched nerves, and possibly damage to the intervertebral discs.”
http://www.protonics.com/How%20Pelvic%20Instability%20is%20the%20root%20cause.htm
Greg Spindler:
“One side (usually
the left) is rotated forward and then the other side is rotated back. This
creates the unstable pelvic condition while under weight-bearing
stress. As a result, the sacrum is off-center
and tipped which initiates a direction for the scoliotic compensation (the curvature) to begin. The
bottom line is, not treating the pelvic area puts limits on relieving scoliosis
conditions.”
http://www.gregspindler.com/treatingscoliosis.html
Postural
Restoration Institute
“The left pelvis is anteriorly tipped and forwardly rotated. This directional, rotational influence on the low back and spine to the right, mandates compulsive compensatory movement in one or more areas of the trunk, upper extremities and cervical-cranial-mandibular muscle. The greatest impact is on rib alignment and position, therefore influencing breathing patterns and ability. It is very possible that respiratory dysfunctions, associated for example with asthma or daily, occupational, repetitive, work positions, can also influence pelvic balance and lead to a compensatory pattern of an anteriorly tipped and forwardly rotated pelvis on the left.”
http://www.posturalrestoration.com/about/science.html
Richard DonTigny,
PT:
"Here is the mind blower. In 1982 the American Academy of Orthopaedic Surgeons met in Toronto specifically to address LBP. They established criteria for testing and for the interpretation of those tests. They assumed that the SIJ was so strong as to be immune to injury through minor trauma and paid scant attention to it. They also reported that 'in spite of thorough examination they could establish a firm diagnosis less than 15% of the time.
What
they did not seem to realize is that when you use their recommended tests and
interpret those test in the recommended manner that you will be compelled to miss the diagnosis over 85% of the time!
It's not that they are not an intelligent group, but they just have not
considered all of the evidence.“
http://www.kalindra.com/critical.pdf
The most common mistake the expert do with this: They follow the pain!! That is wrong!
But most of the experts can’t even read the signs! They find nothing
wrong at pelvis or some might find that on standing position that other PSIS is
higher or other ASIS is higher or more “in front”. But they just blame it on leg length
inequality (LLI) and tell to get a heel lift. But that LLI is only functional and comes from
slightly anteriorly rotated iliac bone...
Physical Therapy volume 79 · number 12 · December 1999
http://www.Ptjournal.Org/ptjournal/december1999/v79n12p1134.Cfm
Research report: Measurement of sacroiliac joint dysfunction: A Multicenter Intertester Reliability Study
Janet K Freburger and Daniel L Riddle
“for example, a patient with symptoms in the region of the right sij, with a right asis lower than the left asis and a right psis higher than the left psis, would have an anteriorly rotated innomimate on the right. Conversely, a patient with symptoms in the region of the left sij, with a right asis lower than the left asis and a right psis higher than the left psis, would be described as having a posteriorly rotated innominate on the left.“
That last sentence is wrong! If right PSIS is higher it is dislocated ie. in dysfunction regardless where the pain is! But it must not be measured when patient is standing. I have seen patients who have right PSIS higher when standing and left PSIS higher when lying. Because iliac rotation effects to the functional length of a leg, PSISs must be palpated while lying.
Here
is other similar:
Physical Therapy . Volume 82 . Number 8 . August 2002
Evaluation of the Presence of Sacroiliac Joint Region Dysfunction
Using a Combination of Tests: A Multicenter Intertester
http://www.Udel.Edu/pt/manal/spinecourse/sijlab/riddled.Pdf
Reliability study
Daniel L Riddle, Janet K Freburger, North American Orthopaedic Rehabilitation Research Network
According to table 3:
1. Standing flexion test: my left SIJ lifted, so it was hypermobile!
This test alone should give enough evidence that it was left SIJ dysfunction!
2. Prone knee flexion test: I had the pain on right side and right leg was longer, so this test gives the wrong diagnosis to me: posteriorly rotated right iliac. Wrong!
3. Supine long sitting test: again I had the pain on right side and right leg was longer, so this test gives the wrong diagnosis to me: posteriorly rotated right iliac. Wrong!
4. Sitting PSIS test: this is the worst! I had pain on right side and left PSIS was higher. According to this test I had posteriorly rotated right iliac. Totally wrong result!
And this is why I had wrong diagnosises and bad treatments for many years. It took 10 years to find a professional who knew how to do it wright! All the other PTs and chiropractors did it wrong like in that paper. So that is a common mistake!
The pain is usually on the other side than the reason. That is where the mistake is made! Left SIJ dysfunction -> pain on the right side!
This is why the manual treatment is not helping most of the patients... They do it to the wrong side. They try to dislocate the healthy SIJ!
“In ankylosing spondylitis (AS for short), the main
site of inflammation is at the attachments of ligaments and capsules into bone.
This starts most often at the sacroiliac
joints which are located at the base of the spine and spreads upward to
involve the rest of the vertebral column.”
http://www.arthritis.org.sg/101/med/anklosing.html
“These joints can often get
stuck or in some cases one half of the pelvis can glide forwards or backwards,
which is often referred to as a twisted
pelvis. When this occurs it often irritates
the Iliolumbar ligament which results in Inflammation.”
http://www.sportsinjuryclinic.net/cybertherapist/back/buttocks/sacroiliac.htm
“The effects of the core
distortion pattern (one ilium rotated posteriorly and the other rotated anteriorly)
are noted from the iliums down through the feet. This
can be seen in the position of the feet as they relate to the compensation
within the lower leg and ankle to either absorb extra leg length as on the side
of the anteriorly rotated ilium,
or compensate for the short leg as on the side of the posteriorly
rotated ilium. Consequently, the weight bearing
stresses that go through the feet are often the causes of strains and bruises resulting in inflammation
and mineral deposits.”
http://www.kytbinc.com/pages/plantar.htm
“Sacroiliitis
(sacroiliac inflammation) is a word meaning an inflammation (not infection) of
the sacroiliac joints. Bilateral means that both sides are involved. The
inflammation occurs because both joints are subluxated
(slight dislocation). “
http://www.kalindra.com/faq.htm
“A long existing tilted pelvis is 'cushioned' by
the spinal column by allowing the vertebrae to rotate around the longitudinal
axis, alternating left and right dorsally, up to and including C5.”
http://www.orthomanual-medicine.com/tekst5.html
“Inflammation
of the sacroiliac joint is believed to be caused by a disruption in the normal
movement of the joint, despite the fact that the sacroiliac joint (also called
the SI joint) naturally has a very limited range of motion. “
http://www.spine-health.com/Topics/conserv/sciaex/sciaex07.html
“Pelvic
tilt makes the right leg functionally shorter than the left leg. The twisting
of the spine (scoliosis) flattens the lower back and contributes to the
deterioration of the disks.”
http://www.postureflex.com/basics.htm
“These
joints can often get stuck or in some cases one half of the pelvis can glide
forwards or backwards, which is often referred to as a twisted pelvis. When
this occurs it often irritates the Iliolumbar
ligament which results in Inflammation.”
http://www.sportsinjuryclinic.net/cybertherapist/back/buttocks/sacroiliac.htm
And what else?
A lot!
My opinion is that
there is no such thing as posteriorly rotated iliac. It
is (always) a misdiagnose because the pain is very often on the other side
than the cause. Iliac might only seem to be posteriorly
rotated when compared to the other one with no pain. Same thing with legs: One
leg seems to be different length than the other leg with almost all the people.
If SIJ is hypermobile it is so because it is dislocated. If PSIS
is higher on the other side it is so because iliac has rotated (dislocated) anteriorly on that side, no matter where the pain is! But
it must be checked while patient is lying, not standing!
That is why they
say right SIJ is usually the problem. That is not true! The pain is usually on
the right side! But the reason for pain is on the other side. When
left SIJ comes out - the left leg gets shorter - and all the body weight
is carried on right side of the pelvis. That’s why it hurts there!
I believe it
is so. I have seen and interviewed about 100 back pain patients who have got
help same way I did. First some of them got diagnose to wrong side from chiropractors.
So those chiropractors tried to dislocate their healthy SI!!
Questions or
feedback!
Toni Rintala, MA,
ex-SIJD patient, Finland
parantunut[at]blondit.net