SacroIliac joint in Back Pain.

As a Physiotherapist I assess and treat people with back pain complaints.
In my career I have met many skeptics who wish to ignore the pelvis and sacrum as areas which may cause pain in the lowback area and into the legs.
I guess if my back was fine I would have ignored the obvious and followed the crowd down the wrong path. However, in my second year at Physio school, I was training Aikido in my spare time. During one of my training sessions I landed outside of the mat on concrete floor and twisted my left lower back. My back was a bit sore at the time but I kept ignoring it. I was asked by one of the teachers to participate in a video assessment of lowback pain, and to my surprice I found out that bending to the left and backwards caused me some back pain. Nothing was done about it at the time.
Over the next 5 years I had on and off problems in the same region, and tried electrotherapy,manual therapy and acupuncture with no lasting effect.
In 1993 I went to London Ontario to work in a private Physio Clinic.
I was fortunate to attended a course in Muscle Energy Technique of the spine in Toronto. This course changed forever the way I practiced Physiotherapy. Muscle Energy MET for short was developed by the Osteopathic profession and I really liked the way the assessments made so much sense. During the course I volunteered and it was then discovered that my left pelvis was twisted out of alignment in a pattern called " Posterior Vertical Torsion" which meant that my left Sacral Base Was too posterior and was blocking LumboSacral Extension and left sidebending.
The technique was applied by two of the teachers, I was on my back and one teacher flexed, rotated and sidebent my trunk to the right to facilitate an anterior movement of my Sacrum, while the other teacher gapped and pushed posterior my left Pelvis (Innominate Bone). My left low back felt better, however I started to experience numbness in my left anterior Thigh(which worried me!). I told the teachers and after lunch they decided to check my lumbar spine as well and found that my L3 was FRSR (flexed rotated sidebent right) which meant that my L3 facet joint was off the L4 facet joint and was causing an impingement of my Femoral Nerve. After correcting this alignment fault the numbness went away by next day.I was impressed how they could detect and analyse my faulty pattern and take some action. Unfortunately there were no one else to continue this type of treatment for me, so my problem did not end there. I had a bad flare up following laying some heavy stone slabs in my back yard in scotland 1996. I could not stand up straight as my left SI joint got blocked ( Sacrum Posterior- LOR sacral torsion) it was Sunday and nobody to help, so I had to take some action on my own! I tried a few things that did not work, until I finally calmed down and decided to think the problem through. I realized that If I used a belt around my thighs while lying down on my stomach, and used a chair to press my heels together against I could mobilize my left sacral base back to a position I wanted. Pushing out into the belt-I was using Gluteus Med. to gap the Innominate bone away from the Sacrum, and by pushing my heels together I activated the Piriformis which in turn facilitated the correction of my left sacral base position. To my delight this resolved the problem and apart from some tenderness I could move freely again!!! I have used this technique extensively ever since in my private practice..
I would be happy to hear stories from fellow Physios on new solutions to old problems. I believe that by sharing some of our experiences we can all continue to grow professionally and make us better therapists.

PT1964