The Root of All Evil!

By Lewis G. Maharam, MD, FACSM

I’ve had a locked SI Joint that until you manipulated and injected it kept me from running for 2 months! Could you please tell us more about this? John “The Penguin” Bingham, Chicago, IL

Thanks John. The sacroiliac joint was a very popular diagnosis twenty years ago and for some reason forgotten by many physicians nowadays. A friend of mine Sandy Wasko, PT in Virginia Beach has called this joint: “The root of all evil.” Let’s explore what this is so that we all re-remember how important this joint is to pain free living.

The sacroiliac joint is one of two joints in your pelvis that connect the tailbone (the sacrum) and the large pelvic bone (the ilium). The sacroiliac joints connect your spine to the pelvis, and therefore, the entire lower half of the skeleton. Like all true joints, there is articular cartilage on both sides of the sacroiliac joint surfaces. Unlike most other joints, the SI joint is not designed for much motion. In fact, it is common for the sacroiliac joint to actually “lock” when the joint becomes irregular from deteriorating cartiledge.

The sacroiliac joint usually only moves about two to four millimeters during weight bearing and forward flexion. This small amount of motion occurring in the joint is a “gliding” type of motion as opposed to a hinge type of motion of the knee or the ball and socket motion of the shoulder. The SI joint’s main function is to provide shock absorption for the spine through movement.

Doctors find SI problems difficult to diagnose because there is a confusing pattern of back and pelvic pain that mimic each other. You may have no symptoms other than your Runner’s Knee is not responding. Symptoms may include:

• Low back pain
• Thigh pain…particularly lateral thigh
• Butt pain…mimicking Piriformis syndrome (see 3/24/07)
• Sciatic-like pain
• Difficulty sitting in one place for too long due to pain in low back

As with everything else, diagnosis is simple when you know what to look for:

• Facing away from the examiner, with his/her thumbs on the SI joints, you will be asked to raise 1 leg at a time as if you are marching. A trained examiner will be able to see if normal motion is occurring or the joint has locked down.
• Gaenslen’s Test – The examiner will have lay on a table with both legs brought up to your chest. You will then shift to the side of the table so that one butt cheek is over the edge. The unsupported leg drops over the edge and the supported leg is flexed. In this position, SI joint problems will cause pain because of stress to the joint.

• Patrick’s Test – The leg is flexed at the knee and brought up to the opposite knee. Then the flexed knee is pressed on to test. Pain at SI is indicative of the problem.
• Xrays and a CT scan may be needed if the cause of the problem is arthritic changes.

If an SI issue is your problem treatment may range from physical therapy with a therapist that works well with your sports physician to mobilize and or strengthen the joint, orthotics to balance your musculature and a corticosteroid injection into the joint to decrease inflammation (and act like “Rustolium” ) decreasing the irregular particles so that smooth motion can occur again. PRP (Plasma Rich Platelet) injections seems to be a new treatment/injection that works in this joint better than cortisone. Chiropractic manipulation may or may not be appropriate depending on the anatomy of the joint: discuss with your physician before trying this.

But understanding this “root of evil” and addressing it, even if you have Runner’s Knee as well, will get you back on the road faster than ignoring it.

Enjoy the ride.

Dr. Lewis G. Maharam is the world’s premier running physician. He is medical director of Competitor Group’s Rock ‘n’ Roll Marathon series throughout the country and The Leukemia & Lymphoma Society’s Team in Training program. He also serves as Chairman of the Board of Governors, International Marathon Medical Directors Association. Dr. Maharam “s column can be followed in Competitor Magazine and his Facebook page: Running Doc

Any questions you may want answered by Dr. Maharam in future columns should be written in the comments below. Feel free to add your comments about your experience with the above problem as well. A dialog is great and we look forward to expanding that in the comments section of this blog.