Sunday, November 14, 2010

Sacroiliac Joint Dysfunction

I've mentioned before that I've had intermittent hip pain since my last pregnancy. I had a spell for about a year where it didn't bother me (from August of 2009 to around May of 2010) so I thought it was something that I could just let work itself out. At some point, I realized that its become too much of a fixture in my life so I needed to do something about finding the root cause. On my birthday this year, it got really bad again so I became serious about addressing it.

I recently visited my naturopathic doctor/midwife who listened and poked around my hip and lower back to try to isolate where the pain was coming from. She mentioned the sacroiliac joint (a joint connecting the sacrum in the low back to the pelvic girdle. Its connected with ligaments and covered with cartilage). She then referred me to a physical therapist who specializes in lumbar-pelvic PT. While I'm waiting for an appointment with the PT, I've been doing some internet homework to try to figure out what is going on. With sacroiliac as a clue, I started my searches.

And this is what I found:

Another common cause of SI joint dysfunction is pregnancy. During pregnancy, hormones are released in the woman's body that allows ligaments to relax. This prepares the body for childbirth. Relaxation of the ligaments holding the SI joints together allows for increased motion in the joints and can lead to increased stresses and abnormal wear. The additional weight and walking pattern (altered gait) associated with pregnancy also places additional stress on the SI joints.
Any condition that alters the normal walking pattern places increased stress on the SI joints. This could include a leg length discrepancy (one leg longer than the other), or pain in the hip, knee, ankle, or foot. Patients with severe pain in the lower extremity often develop problems with either the lower back (lumbar spine) or SI joints. In most cases if the underlying problem is treated, the associated lumbar spine or SI joint dysfunction will also improve.
The most common symptom of SI joint dysfunction is pain. Patients often experience pain in the lower back or the back of the hips. Pain may also be present in the groin and thighs. In many cases, it can be difficult to determine the exact source of the pain. Inflammation and arthritis in the SI joint can also cause stiffness and a burning sensation in the pelvis. 1
Several things can aggravate the SI Joint too. Continual sitting or lying on the affected side will impinge nerves and skew the pelvis. Remember, the body will adopt a bad posture and accept it as normal after a period of time. The pain often worsens when riding in a car, sitting in a movie theater or putting weight on the hips while walking (for example, carrying a child). 2
As I read these findings, I was nodding along.

Pregnancy? Yes

Short leg? Yes (caused by scoliosis)

Pain in the low back, hip, thigh, and thigh, stiffness, burning, and difficulty determining the source of pain? yes, yes and yes.

Sitting or laying on the affected side aggravates? Yes

Worsened pain when carrying a child and walking? Yes (that's exactly what brought it on today, actually)

I'm still using chiropractic, yoga, massage and hip circles to address it. Hip circles, actually, make the most difference when my SI is tight and hurting. I'll have to remember to eat eggs for breakfast tomorrow and its probably time to make my grandma's famous baked custard because that's a mega dose of eggs and so good.

In addition to suggesting physical therapy, my naturopath suggested looking into craniosacral work. She also gave me a medical referral for massage. And she reminded me, which is embarrassing that I completely forgot, about homeopathic arnica for muscle soreness. I've also been seeing an Upper-Cervical chiropractor which is new and different for me than the typical pop and crack chiropractors I've been seeing.

At this point, my husband and I swearing off conceiving another baby. In my lower moments, I come close to despairing and giving up getting pregnant again ever. We even put the option of surgical sterilization on the table, which is a momentous and terrifying thought to me. In having those conversations, I realize in a new way how much I love and appreciate the children I have. I knew then that I can be happy being mother to my two and not regret having another. Still, if it is possible, I hope to recover enough that I can physically handle another one or two or three pregnancies and births. My hopes aren't so high so I can content myself with whatever that is coming my way.

Based on what Vanessa said on my blog page, I'm glad that I'm planning to put off more births. She told the story:
"That is what derailed my planned homebirth with Tess. It was excruciating and worse than any labor pain -at one point, I almost blacked out, threw up and peed myself from the pain. Thought I was in transition -except I was 1cm and 50% effac...ed. Saw an osteopath at 40+3 who tried her best to fix it, but couldn't really do anything. It took a long time to get better. I mainly saw the osteopath, but have also considered a chiropractor (and acupuncture) in case it comes up again in a future pregnancy."
I definitely hope I can avoid that. I have heard acupuncture being helpful for hip joint problems but I haven't pursued it yet either.

I'll update as I meet with and learn more from the physical therapist. I do hope that we can welcome additional biological children into our family and that it will not be at the expense of my physical well-being.

If you are interested in reading other posts that chronicle what I now know is SI joint dysfunction see the following posts (starting from earliest to most recent):
Belle's Birth Story: I describe the moment I felt my SI stretch abruptly.
Not a very interesting update: I describe the hip pain for the first time
Been Away: Started yoga at 3 months postpartum to be gentle on my hip (instead of returning to Irish dance)
Preparing to conceive again: I started wanting another baby but was feeling ambivalent because of my hip problems.
A remedy that might help my hip pain: I learned about lecithin to relieve joint pain
Check that Off the Bucket List: My husband and I took a massage class where he learned some strategies to help massage my hip when its hurting


cc said...

I had just about the worst hip pain I could imagine when I was pregnant with my third and it turned out to be the same thing, but it must have started with my second pregnancy. After my second I saw a chiropractor and eventually an osteopath. The osteopath really helped identify that the excruciating nerve pain in my knee (the reason I went there) was related to my hip and was all connected to an old ankle injury that never healed properly. One thing out of place in the leg can throw everything else off. SO...addressing the initial cause helped me a great deal until I got pregnant again. And then I couldn't sleep on either side for most of the pregnancy. I slept in a recliner much of the time and even took pain relievers and sleep aids it got so bad (I never take drugs)

I've learned a lot of techniques to help it over the years from the chiropractor and osteopath, but the strange part? This last pregnancy actually made it better! I'm not sure if that's common, and obviously not something to count on, but really quite amazing. My chiropractor was surprised as well. I still have to keep it flexible or it stiffens up on me, but the pain is no longer ruling my life. If it was, I would probably be doing acupuncture to deal with it as well.

I hope you find something that gives you a more long term solution. Since you haven't yet, I would give an osteopath a try. The fascial manipulation really helped me.

And I hope you find peace with your number of children. I can understand the feeling of simultaneously not wanting to stop that beautiful process and being afraid of becoming pregnant and continuing on. I know I'm done, but I'm still sad and fearful.

cc said...

I forgot to add, I do really think the cold oils and omegas that I ate with my last pregnancy may have had something to do with it.

Cher said...

Jenne, I saw you in the Sunstone panel on Saturday. Thanks for participating! I had this after my last pregnancy (my 3rd). I ran too soon on loose ligaments, didn't take the time to strengthen my core before I did jarring exercise. I was in terrible pain and went to one PT after another until I found a great one here in Seattle. I did PT for 6-8 months and was fine for a while. Then I lapsed in my strengthening exercises and put out my back again. Started at square one. Now I know to keep up on the exercises for life! Once those ligaments are stretched you have to rely on your muscles to hold everything together and stabilize.

Good luck with everything and be patient! It takes a while but I am virtually pain free now, and while I won't ever be able to run marathons again, I do exercise pretty hard for 90 minutes 6 days a week and I'm doing fine!

Jenne said...

I'm really surprised how many stories I've heard of this now that I said something. The two of you here and then three more of my friends on facebook experience(d) it too.

Cher, that's really disappointing to hear that its something you feel will affect you for the rest of your life. I didn't want to hear that, no matter how helpful it is (and don't feel bad for saying it because reality and directness is better). And I just checked out your blog and think I fell in love a bit. If you want a thrift store buddy sometime...

I'll try not to sound too pessimistic but I'm beginning to accept the realization that I'm done with pregnancy. That's not what I expected at all with my life!

I also think I remembered the cause of the injury. The idea that it happened in pregnancy with Belle just hasn't sat right with me until I remembered a time when I fell hard on my SI. I was walking down the stairs carrying Willem when he was 10 months old and slipped on the newly cleaned carpet and hit my SI right on the edge of the stair. Because I was holding a baby, I couldn't try to catch myself with my hands so I hit it really hard. I was in bed and unable to walk for 3 days. Its no wonder that pregnancy aggravated it.

I talked with a PT today that my naturopath recommend. I need to get in sooner than later, but for some reason I'm feeling really daunted. Cher, can you send me the name of the PT you saw?

Kimberly said...

Thanks for this post. So far I've been spared this pain of being pregnant. I forget how blessed I am. Pregnancy is harder than I thought it would be but there are no complications with mine (so far) and no sacroiliac joint pain. Thanks for the reminder of how lucky I am.

DePuy said...

Thank you for sharing this blog about your experience with your intermittent hip pains and how you deal with it, its very educational and i am going to send this information to a friend who seem to be experiencing same degree of pain.

Kelly said...

Thank you for sharing this story. I have the same thing and didn't realize it. Everyone kept insisting, including doctors that it was sciatica. When I read this a few months ago I realized that that was my issue exactly. I've had the problem for the past 10 years that wasn't so bad but then my 3rd pregnancy and now with my current 4th it is way worse. PT, massage and chiropractic don't help so I am toughing it out for my last month. Wintergreen helps a little. I have a question... I am due for a csection, and trying to work in a regiment with doterra oils including the GX assist, PB assist and zendocrine oil but not quite sure how to do it. When should I start them, how many should I take, etc. to clean out the heavy meds from the surgery. Do you have any suggestions? Thanks, Kelly

Jenne said...

Kelly, if you can, find a Webster certified chiropractor near you. Typical chiropractic techniques made my joint slip more easily than before, leading to more pain, but a gentle Webster adjustment with a provider also trained in Craniosacral therapy has really helped me a great deal.

Unfortunately, I do not have any experience with using those oils and supplements for that purpose. Do you have a copy of Modern Essentials? That will help you find the information you are looking for, especially dosage recommendations. I can also refer you to a consultant with more experience in that area than me. If you would me to get you in touch with her please email me at jennedoula AT gmail DOT com.

Amanda said...

I had this exact pain. It really is that debiliitating. I was under the care of a regular chiropractor for my first pregnancy (when the problem first popped up) and the last month was still excruciating. It felt good to get adjusted, but the pain always came back quickly.

This second pregnancy, the pain returned at the beginning of the second trimester. After enduring it for two months, I was referred to a chiropractor who specializes in prenatal care. His techniques were MUCH different than the regular chiropractor. He also gave me a set of exercises to do each day to strengthen specific muscles to help hold the adjustment in place.

It made a world of a difference and I actually enjoyed being pregnant. Sure, there was still the discomfort of being HUGE at the end, but the pain was gone. The week before I had the baby, we were walking around the zoo, no problem!

The delivery went well also. Once the baby had actually dropped, labor progressed quickly. I pushed twice and there he was.

So I agree that if you are going to see a chiropractor, make sure that they SPECIALIZE in working with pregnant women.

Steph Black said...
This comment has been removed by the author.
Laura Lake said...

I am 5 months post partum and I am going through this bad. My hip on the right side is killing me and it radiates down my leg and both my feet are killing me! I hope this does not last forever!

John Dudley said...

Melissa said...

I have this same pain that left me in crutches the last 5 weeks of my pregnancy and 10 days after the birth. My whole pelvis feels weak and feels loose sometimes still 9 months postpartum. I also suffered a prolapsed bladder from pushing. (I pushed very hard and held my breath. I don't think that was necessary in hindsight...that baby was coming no matter what I did). I wonder if anyone else with the SI joint dysfunction suffered a prolapse organ after birth. Wondering if the looseness made me prone to the prolapse. I find the prolapse far scarier for future pregnancies and births. It can be really uncomfortable as is.

Anonymous said...

I am also 5 months post partum. With the same situation as Laura just wondering if anyone has found any relief since posting?

Amanda said...

Anonymous, I did find a solution. After going to 2 doctors, a physical therapist, and getting an MRI (no one able to find a legitimate cause or solution other than medication or surgery) I found a chiropractor who could show me the root of the problem. My sacroiliac joint was incredibly misaligned and my muscles were not strong enough to keep it in line.

I did a 5 week rehabilitation with the chiropractor, who worked with a rehab specialist in his office. I went in 3 days a week to be adjusted, then spend 30 minutes with the specialist working on specific exercises to target muscles that pulled my pelvis back together. They gave me different exercises depending on where I was feeling the pain.

Before I got help, I had been really scared that the debilitating pain would permanently cripple me. Using a walker looked like a really appealing idea (I am 27...not gonna happen). Even my husband said we shouldn't have more kids because I was in such pain for months afterwards.

BUT after the rehabilitation, the pain is GONE. Gone. I still can't believe it. I still have to continue doing a few exercises every day on my own to maintain the strength we built up. If I stop, I notice things starting to ache and sharp pains shoot through my leg. But a couple of simple exercises a day is worth the relief!

There is hope. I would recommend a chiropractor who also focuses on rehabilitation. 5 weeks is a realistic goal. I know you are reading this and being skeptical, but the recovery I experienced is completely miraculous to me. I hope all of you wonderful moms find relief.

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Center1 said...

You guys need a radiofrequency ablation done. I have severe SI joint pain after a twin pregnancy and they take away 100% of the pain. Call a few pain management docs to ask if they do them. Most docs do. You need to get them done once a year but who cares? It removes the pain. Email me with any questions:

theshatteredimage said...

Those of you who found a good chiropractor, PLEASE post the name of her office! I really need to go, and maybe tour chiro knows a chiro in my area! I can't even hold my baby theses days...,

Center1 said...

I would stay away from chiropractors. The last thing you need is someone moving that joint around. They can only do more damage. Just my advice.

Center1 said...

You need to have a radio-frequency ablation done. It removes 100% of the pain. Unfortunately it only lasts for 4-6 months so you have to keep getting them done but while it lasts the pain is gone.

theshatteredimage said...

Thanks. I will look that up. But I want to actually fix the problem, not just remove the pain.

Center1 said...

Sure, understood. Then please don't let a chiro touch you. They only make it worse. You want to keep that joint stable and build muscle around it. If a chiro does adjustments and moves the joint, he/she can further damage it. Unfortunately it's a bear to fix and you may have to consider surgery. But don't fret if it comes down to that. Look up the iFuse and watch the patient testimonials.

Amanda said...

Center1, when you have found a chiropractor who knows what they are doing, it will actually correct the problem and stabilize the joint. You have to do a lot of research to find someone who does physical therapy and rehabilitation hand-in-hand with the adjustments. If you found something that works for you, that's fine. But don't dismiss something that works for me.

Amanda said...

Dr. Wilson is a great chiropractor. He brought me TOTAL relief at 38 weeks pregnant. He specializes in treating pregnant women and strengthening your body after childbirth. I know a lady who drove 3 hours to get to her appointments because he was the only one who could help her.

He focuses on the way your muscles and your spine work together. After an adjustment, he send you down the hall to work with a personal trainer for 30 minutes to strengthen the muscles to hold the adjustment in place. He also emphasizes continuing to do the exercises everyday to keep up your strength and avoid a relapse of SI joint dysfunction.

Those of you not in the Dallas area might be able to call the office and ask what to look for in a chiropractor who can fix this specific problem. It is not something that can be fixed by the common chiropractor.

If anyone wants to know more about my experience or the exercises I now do every day, feel free to contact me (click on my name at the top of this comment). I would love to tell you more about it.

Center1 said...

As a physician I can tell you with absolute certainty that this will NOT correct the problem. Moving the joint is the absolute worst thing you can do and will lead to long term, permanent and disabling pain. Do what you want. You were warned.

Center1 said...

Give it a year. Your pain will return and by then the joint will be so damaged that you'll never get it back. Good luck.

Amanda said...

It has been two years. I feel stronger than ever. You can't argue with that.

I know physicians and chiropractors have a long-standing rivalry. Both have their place in treating different maladies and illnesses. I am not here to start an argument. Anyone who is genuinely interested in learning more, please contact me.

theshatteredimage said...


How can I contact you? I want to know what to look for in a chiro.

Amanda said...

email me at songbird116 @ aol dot com. After I get your msg, I will erase my email. You can also click on my name and contact me through one of my blogs but that is more complicated. Thanks!

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ACL injuries or athletes who we feel are at a high risk for any knee injury, we try to incorporate specific plyometric exercises and sports specific agility drills into their therapy. I feel maintaining a good quadriceps to hamstring ratio is the best way to ensure a safe return to sports as well as preventing further injury. anterior cruciate ligament

Amanda said...

Anjlena, I have heard several people mention the quad and hamstrings ratio as being key in helping to stabilize the SI joint. What would you recommend?

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costlules said...

This might embody a leg size discrepancy (one leg longer than the other), or pain within the hip, knee, ankle, or foot. Patients with extreme ache within the lower extremity often develop issues with either the lower back (lumbar backbone)

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Amanda said...

I had an overwhelming number of requests for the pregnancy exercises I was prescribed to do daily.They are also great even if you aren't pregnant. They are most effective for pain relief when accompanied by regular chiropractic adjustments. If you are pregnant and seeking a chiropractor, please make sure you find one that specializes in the Webster technique and/or uses specialized equipment (such as pregnancy cushions) during an adjustment.Most chiropractors have had a little experience with pregnant women, but unless they specialized in prenata l chiropractic care, they can do a lot of harm. Here is the link to the website with the exercises:

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My right si joint hurt terribly during my first pregnancy. Walking was excrucisting, sleeping uncomfortable. I went to a Webster certified chiropractor who want able to give any relief. She finally said she was spey but didn't think she could fix anything for me. I dealt. After having the baby the pain immediately switched to the left side. Word, right? 2 years later silo dealing with it. Now, I suspect in pregnant again (too early to test) as I have some pregnancy symptoms. And oddly enough, I woke up this morning with the pain back on my right side! Weird.

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I'm Mark Raudales from United State...I was in trouble when the doctor told me that I have been diagnosed with Herpes simplex… I though about my Family, I know my Family will face a serious problem when I’m gone, I lost hope and I wept all day, but one day I was surfing the internet I found Dr. Suku contact number. I called him and he guided me. I asked him for solutions and he started the remedies for my health. Thank God, i was cure from herpes by the herbal medication I receiver from Dr Suku I never thought that herpes can be cure until I met Dr Suku who use is special medication to heal me,I will want us to share tip and forum on his or call +234874839242,I will drop Dr Suku contact for any kinds of diseases for cure,him website;