Dr. Howard Liss treats disorders that cause pain and disability by providing consultative services and soft tissue and joint injections when needed. When medically appropriate, he makes specific referrals for diagnostic testing (lab work, imaging, electrodiagnosis), physical and occupational therapy, interventional procedures (epidurals and facet joint injections), and surgery.
As an integral system linking the lower spine to the pelvis, the sacrum (tailbone) connects on each side to the ilia (pelvic bones). This connection forms the sacroiliac (SI) joints. Given their location, it may seem as though the SI joints would be somewhat rigid in nature, allowing for careful and controlled movements. Yet, due to a sports injury, trauma or general instability, some SI joints have too much motion (hypermobility). With excess movement, the sacroiliac joints settle into an abnormal position, and this causes pain. On the other hand, when the SI joints experience impaired function, or stiffness (hypomobility), there is pain and discomfort. In either case, the sacroiliac joints are not moving normally. Medically speaking, this condition is referred to as sacroiliac (SI) dysfunction.
While hypomobility, or stiffness, does result in SI joint pain, it is often due to other conditions or pathologies such as ankylosing spondylitis. Though not as common, this type of condition is marked by inflammation, the fusing of bone and perhaps even permanent stiffening of the spine. Even so, there are many more cases of hypermobility in relation to sacroiliac dysfunction.
Normal movement involving the sacroiliac joints are no more than a few degrees. Muscle systems, particularly the abdominal core muscles and the deep gluteal muscles, surround the SI joint. These critical muscles establish the position of the joint, as well as provide stability, control and protection. Thus, when these surrounding muscle groups are weakened, the sacroiliac joint is susceptible to too much movement, resulting in hypermobility and ultimately SI joint pain.
Symptoms of Sacroiliac Joint Dysfunction
Because symptoms associated with SI joint dysfunction closely mirror those of other conditions (facet joint syndrome and herniated disc), classifying SI joint dysfunction may be difficult. Even so, specific symptoms of SI joint dysfunction may include:
- Pain in the low back, hip, groin, buttock and sciatic nerve
- Pain that worsens when standing and walking
- Pain that worsens when sitting with legs crossed
- Pain when bending forward, walking upstairs or getting up from a chair
- Pain that increases with sexual intercourse
Treatment and Rehabilitation for Sacroiliac Dysfunction
Physiatrists are well positioned to classify sacroiliac joint dysfunction and determine the most appropriate treatment and rehabilitation to manage its effects. While initial treatment will center on pain relief and reducing inflammation, therapy will likely involve exercises and rehabilitation to de-load the inflamed joint or structures.
Ice therapy, non-steroidal anti-inflammatory medication, electrotherapy, acupuncture, taping techniques, a sacroiliac joint belt, massage and assistive aids (temporary cane or crutch) may be used in the early stages of treatment to prepare the patient for more concentrated rehabilitation.
As patients enter the second phase of therapy, lower abdominal and hip core stability training will take place. This is along with techniques to restore proper pelvic alignment and SI joint range of motion. In regard to hip muscles, physiatrists understand that the order in which muscles are activated matters. For instance, normal hip muscles follow a “recruitment pattern,” beginning with deep muscles, followed by intermediate and superficial. When this pattern is faulty, it may result in altered muscle activity. In a clinical sense, this becomes important as physiatrists take a comprehensive approach, considering multiple body systems.
When pain and inflammation are settled and the sacroiliac joint control improves, patients are led through carefully selected positions and postures that advance muscle power, balance and gait (walking pattern). For athletes, conditioning is proposed here to help equip the SI joint to safely meet the demands of their particular sport. Patient education focuses on preventing a recurrence of sacroiliac joint dysfunction.
At the Howard Liss, M.D. Rehabilitation Institute in Tenafly, patients can rely on Dr. Liss to put together the right treatment, therapy and rehabilitation plan to ensure the most optimal outcome. Dr. Liss works closely with other specialists required to rehabilitate patients suffering from chronic pain or serious injuries, and Dr. Liss will refer patients as needed to ensure appropriate treatment. With extensive education and exposure to a variety of conditions that affect the cervical and lumbar spine, bones, nerves, joints, ligaments, tendons, muscles, brain, and spinal cord, Dr. Liss is uniquely positioned to help patients manage their pain and maximize their functioning.
To schedule your appointment, contact the Howard Liss, M.D. Rehabilitation Institute in Tenafly today.