What is Sacroiliac pain?
Two large joints connect the pelvic bones to a big, triangular bone at the lower end of the vertebral spine called the sacrum – one on either side. These are referred to as sacroiliac (si-) joints. Si-joints are tight and strong, with a limited range of motion, and their role is to provide structural support and stability. Si-joints also function as shock absorbers of the pelvis and the lower back, dispersing the forces of the upper body and the impact from walking, running and jumping. Whenever an si-joint “gets stuck”, this may cause pain in the lower back and legs. This condition is also referred to as si-joint dysfunction.
How can it occur?
A wide range of factors or events may cause si-joint dysfunction, including activities that involve twisting, bending or heavy lifting. Direct trauma from a fall or a blow to the area can also be possible triggers. Muscle dysfunction can seriously affect core stabilization and muscle tension in the back and is an important contributing factor to si-joint dysfunction. Muscle overuse often occurs when the body fails to compensate for existing muscle dysbalance. Muscle dysbalances are very common and naturally occur as the body adapts to specific training demands over time. As long as compensation is effective – or, in other words, as long as the dysbalance is well managed by the body – this need not cause any problems. However, with high training loads, insufficient rest or after a minor injury, the body may struggle to compensate, leading to muscle dysfunction in the various muscle groups involved in the compensation. This is why symptoms may simultaneously occur in different parts of the body in an overuse situation.
The psoas muscle is probably the most important muscle involved with low back issues in dancers. It can affect the lumbar spine in many ways as it connects to four of the lumbar vertebrae in two different planes. Psoas dysfunction will pull the lumbar vertebrae forward, creating hyper lordosis (over arching of the spine) and will exert high pressure on the intervertebral disks and joints. Usually, only one of the two psoas muscles is tight and this will twist and torque both the lumbar spine and the pelvis. As a result, muscle dysfunction will extend toward the trunk (erector spinae muscle, quadratus lumborum muscle) and the lower extremity (rectus femoris muscle, hamstrings), causing severe muscle dysbalance. It is often mutually dependent on a weakness of the abdominal muscles and the glutes. This pattern of imbalance creates joint dysfunction, particularly at the last two lumbar segments, the si-joints and the hip joint.
How can sacroiliac pain be diagnosed?
Your doctor will examine your spine and review your symptoms as well as your current training activities. This will include a functional examination of the si-joints to find out if a joint dysfunction is present. He will also check for muscle dysfunction of the back and the extremities (legs and arms). Some basic neurological tests will be performed to find out if typical reflexes are normal and if any muscle weakness or palsy is present. Your doctor may order X-rays to get an overview of the anatomy of your spine, especially if you have a scoliosis. Howevever, X-rays cannot show si-joint dysfunction.
This CT scan shows a three-dimensional reconstruction of the pelvis and lumbar spine as well as of the hips. Using a CT scan is surely not an adequate means to diagnose sacroiliac pain. However, this scan perfectly shows the anatomy of the si-joints. If you look closely, you can even detect a rotation of the iliac bones (marked ilium) and a twist in the symphysis.
What are the treatment options?
If you have severe or constant si-joint pain, you should take a break from your ballet training immediately. Ignoring the pain can have serious consequences, as the situation will become increasingly complicated the longer you train with the dysfunction. First aid of acute back pain includes taking a painkiller and resting in a comfortable position. A pillow under your knees may help when lying down. It is also recommended to apply warmth to the affected area, as it will help to alleviate muscle cramps. There are few things that you can do to influence the pain from an si-joint dysfunction unless you are familiar with self-mobilizing techniques. Manual therapy will be necessary in most cases to treat present dysfunction of the si-joints.
In order to handle a given overuse situation successfully, its underlying causes – namely muscle dysfunction and muscle dysbalance – have to be addressed specifically in the rehabilitation process.
Muscle dysfunction can appear as muscle tightness (contraction) or weakness (inhibition) and the muscles affected have to be treated accordingly in the rehabilitation process. Some muscles will have to be stretched whereas others will rather have to be strengthened. A well-suited training program including corrective exercises as well as a general strengthening and endurance routine is the most effective way to deal with most overuse situations. Ensure that you follow your specific training routine after the rehabilitation is finished. Myofascial rollers (Blackroll, Triggerpoint Roll, etc.) as well as Lacrosse balls and resistance bands are easy to use in the studio and will help you remain balanced in the long run.
You think you might have a blocked pelvis and want to have it sorted out? These are the next steps:
- See a doctor
Dancers seek help from various different kinds of therapists, many of whom may employ treatments that are outside of mainstream medicine. Before considering the use of such alternative medicine, you should see a doctor for an evaluation and diagnosis.
Finding a doctor who is familiar with the specific medical issues faced by dancers is often challenging and you may need to see several different specialists in order to get a full picture of your diagnosis. A good place to start is to ask your friends and fellow dancers for the names of their favorite doctors.
- Find a specialist in manual medicine
Doctors who specialize in manual medicine practice a whole-body approach. They will try to identify and specifically treat the underlying causes of your problem, rather than just the localized symptoms. This approach is important in addressing all aspects of the often very complex overuse problems that dancers experience. A specialist in manual medicine will perform a functional examination on every part of your body and will treat you according to these thorough findings.
To find a physician who specializes in this field, search for “Manual Medicine”, “Osteopathic Manipulative Medicine” or “Osteopathic Physician” on the internet.
- Start working on your problem
There is a lot that you can do to work on your problem after a proper diagnosis has been set. Ultimately, it often comes down to addressing the same fundamental issues. Here are some useful exercises that I recommend to my patients:
Please refer to your doctor to confirm that the exercises you choose to do are suited to your individual problem, and obtain supervision from a professional trainer to ensure that you are performing them correctly.
- Talk to your ballet master or dance teacher
Technical issues and faulty dance technique are important predisposing factors of overuse and injury in dancers. Amending dance techniques often plays a crucial role in the treatment and prevention of overuse and injury and you should not hesitate to address any issues, if necessary.