The sacroiliac joint or SI joint is the joint where the sacrum or triangle-shaped bone at the base of the spine meets the ilium (hip). Patients may experience pain in this area, often described as “sharp” with movement or achy at rest and pain in the SI joint region makes up 10-27% of cases of low back pain. A diagnosis of SI joint syndrome is often a diagnosis given when patients have pain in this region although it is usually a diagnosis of exclusion, meaning other potential contributors have been ruled out which can create confusion for a patient. Health care providers may use a series of positional tests to help rule in or out the sacroiliac joint as the cause of an individual’s pain or a physician may use a diagnostic injection; both have decent sensitivity for diagnosis this joint as a pain origin but there continues to be a high margin of error with the accuracy of these tests.
The SI joint is incredibly robust and strong and cannot be “mobilized” despite what many practitioners will tell you. In fact, the SI joint only moves 2-8 degrees depending on the axis which is considered below the minimum level of motion needed to be detectable by hand (Goode at al., 2008). How about the classic “diagnostic injection”? While this injection is often used to confirm the joint as the cause of a patient’s pain, i.e. if it helps it must be that right? Only a portion of the injected medication remains in the joint which doesn’t make it very “diagnostic” as all the surrounding structures are also exposed to the medication. Palpation? Many health care providers will palpate the bony prominences of the pelvis to diagnose a “rotated pelvis” which can be a problematic approach. Specifically, most do not realize that we are often not built symmetrically (Stovall & Kumar, 2010); things like leg length differences, different sizes of the ilium (pelvis), and others are normal anatomical findings and further, despite what many clinicians believe about their own skills, the research tells us we are not very good at palpating to begin with (Cooperstein & Hickey, 2016). This approach is problematic because if a patient has been told the cause of their pain is related to one of these, the intervention will be focused on fixing this structural finding which, if it is just the way an individual is built, may ultimately fail.
The vast majority of low back pain is considered “non-specific” which means even with special testing, clinical examination, and MRIs, we are often unable to reliably diagnose the source of pain. Many patients have the belief that you must know WHAT it is to know HOW to treat it but this is rarely accurate; it is far better to know how an injury will do (prognosis) versus the source (diagnosis). Most patients want a diagnosis because it is commonly believed that if you know what something is, you then know what the treatment should be. However in cases like SI Joint Syndrome, lumbar disc herniations, lumbar strains or just mechanical low back pain, the intervention does not change significantly. How can that be?? At Nevada Physical Therapy our job is to treat the individual, not just the parts. We listen to our patients, establish what they can and cannot do, and create a collaborative plan to build back up to doing activities they enjoy. If you have SI joint pain, for example, we may look at hip mobility and strength from a biomechanical lens. If a patient is sensitive to rotation, bending over or extending, we create a plan to desensitize these movements through education and graded exposure over time. SI joint syndrome can be painful and can often limit our patients’ ability to participate in meaningful activity and our approach is focused on helping patients get their identity back, giving them the tools to manage their symptoms independently, and creating a plan to restore confidence and resilience as they get back to doing the things they enjoy. Treating the person, not the parts is what makes the difference in these challenging cases, especially with those who have tried other treatment approaches and failed to make the progress they were hoping for.
Olivia
Patient
Nick was so attentive to my needs and he structured his schedule to fit mine. My therapy was focused on my strengths and weaknesses; therefore, my recovery time was much shorter than expected. I highly recommend Nevada Physical Therapy for any lingering pain you may be experiencing.
Read More ReviewsAleem
Patient
I cannot say enough positive things about this place. Came in with an ACL injury. I spent a few weeks working with jonathan. His evidence-based approach and motivational ability was really really inspiring. He helped me get back to normal and then some!
Read More ReviewsNadine
Patient
DAKOTA EZELL is at the top of MY list as a highly skilled, intuitive, present professional who values and treats me as a whole person, not just someone to fill a time slot
Read More ReviewsShahbaz
Patient
The best Physical Therapy place I have ever visited. Rare to see an emphasis on finding the best method to improve injury instead of giving everyone the same plan. But the best part about this place is it's approach to well being during and after PT.
Read More ReviewsEP
Patient
I was referred to Brian Fearnley by someone with significant credibility. I consider working with Brian a huge stroke of luck. This specific 'PT' is increasing my recovery potential a hundred fold. Brian knows his stuff. He is well versed in PT. He has athletic history at UNR and is active in our local community. He is clearly in this profession to help people recover and get under their own power.
Read More ReviewsJoyce
Patient
After two plus years of hip pain, three other physical therapists, quarterly injections and no relief, Crista made the pain go away! If I could give her and this practice 10 stars I'd do it!
Read More ReviewsPerris
Patient
As a professional athlete, injuries can make or break a career. Luckily, in my case, I had Nevada Physical Therapy on my side. Not only did they physically help me recover from a meniscus surgery, but they provided the best emotional support you could ask for in such a difficult time.
Read More ReviewsRoss
Patient
Phenomenal. I had some brutal injuries that resulted in four surgeries and seriously disrupted my life. There can be no doubt that the quality of life I enjoy today was a direct result of working with Nevada Physical Therapy.
Read More ReviewsBrandon
Patient
I attended Nevada Physical Therapy for my post surgery physical therapy and have nothing but great things to say. For any of you reading this, this place is by far the best physical therapy place I have ever attended with exceptional staff. I had the pleasure to work with Dakota who is extremely knowledgeable, patient and would go above and beyond to make sure you're taken care of.
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