Staying in the Game: Pain in lower back and legs can begin with sacroiliac

“My MRI and X-rays are negative.” This is a common statement from my patients with lower-back pain.

They have had a full diagnostic work-up and the findings are negative. They do not know what is wrong with them. The over-the-counter pain relievers and anti-inflammatory drugs do not work.

Now what? They do not want to take steroids or injections, and surgery is out of the question.

The pain is interfering with their work, family life and sports activity. They want to get better without drugs or surgery.

The sacroiliac joint is what allows your hips to move as you walk. This joint is where the dimples are on each side of your lower back.

They give you the wiggle in your walk, which is more pronounced in a woman. This is because a woman’s hips are wider than a man’s.

One patient told me his health care provider told him he had an iliotibial band issue, which was the reason the right side of his back and buttocks hurt. The pain also traveled down the side of his leg.

He is a friend staying at my house. He lives in Florida and has a summer home up the coast. He and I have played tennis together for years. When he is catching an early morning flight out of Portland to go to work, he stays with me.

I took him to Prout’s Neck Country Club for a tennis match. After playing, we cleaned up and I then evaluated his lower back, looking for the cause of his pain.

He is very fit for his age. He has no neurological deficits that would indicate he has a disk lesion or herniation. The range of motion in his lower back is normal. There is muscle spasm in the buttocks and tenderness over his right sacroiliac.

I found on muscle testing a weak gluteal muscle and hip flexor. There was no movement of his right sacroiliac joint. The joint is stuck.

I told him the sacroiliac joint is the cause of his back, hip and leg pain. I performed an adjustment to the joint to restore its motion. The adjustment works beautifully and his muscle strength returns to normal. The pain reduced immediately. Exercises were prescribed so he can maintain the normal function of the joint.

Another patient recently ran a 3:30 marathon. She is one of the fittest athletes for her age I have seen in my practice. Now she can barely teach her classes as a personal trainer.

She told me the pain was in her lower back and buttocks. It went into the inside of her thigh and down to her calf. She couldn’t do speed work, and teaching kick boxing classes was aggravating the pain.

I found muscle spasm in her buttocks. Her hamstring, buttocks and hip flexor were all weak. When she lifted her right knee her sacroiliac lifted. It should rock down and back, as her other side did perfectly.

I tested her for sciatica, which was negative.

I treated her with an adjustment. I will use ultrasound to reduce muscle spasm and inflammation, if necessary.

The sacroiliac joint has no disk. That is why it is difficult to image the joint and have a positive finding with MRI and X-ray. Often the patient will be frustrated there are no findings on examination to validate the pain they are experiencing.

I find the sacroiliac joint to be cause of many patients’ lower back, hip and leg pain.

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