Tuesday, February 19, 2008

Case of the week - Sacroiliac Tension

Patient: 30 year old female office worker complains of right sacroiliac pain of several years duration. Pain has increased recently with increased time spent sitting at work and increased stress level. Pain is worst in the morning, feeling as though pressure needs to be released. Patient has tried massage and exercise, but the pressure remains. These treatments helped alleviate pain, but did not affect the “pressure”.

Examination: Significant bilateral sacroiliac joint dysfunction and lumbar joint dysfunction at L4 and L5 levels. Fortin Finger Sign. Tight and tender muscles in the right piriformis, right lumbar paraspinal muscles. Tight and tender right upper thoracic spine with right rib joint dysfunction. Range of motion, muscle testing and nerve testing were within normal.

Discussion: This patient displayed a classic finding in sacroiliac joint cases: the Fortin Finger Sign. Elegant in its simplicity, the Fortin Finger Sign indicates that the patient points directly to the sacroiliac joint when describing their pain. This sign is highly specific for the diagnosis of a sacroiliac joint problem. Lest you think Fortin to be moronic, it is actually very common for a patient to complain of pain in one location, while the source of that pain is located elsewhere. In this case, the patient’s pain and feeling of pressure were due to a chronic joint dysfunction of the sacroiliac joints. This dysfunction was so longstanding, it began to affect other areas of the spine, including the lumbar and thoracic spines. The patient’s long hours using a mouse at a computer were contributory to the thoracic pain.

Outcome: The patient underwent a series of treatments involving adjusting of the sacroiliac joints, the lumbar spine and the thoracic spine and ribs. Treatment also involved significant ergonomic corrections to the patient’s workstation and included postural re-training exercises to help the patient maintain the effects of her care.

Exercise: Knees to Chest – A great way to reduce tension on your sacroiliac joint is to stretch it in a flexed position. To achieve this, lay on your back on a comfortable surface. Slowly bring both knees to your chest and hug them with your arms. Take a deep breath, and, as you exhale, sue your arms to pull your knees closer to your chest. Repeat until you feel a stretch in your low back, just above your buttocks. Hold the stretch for 10 seconds, and then release very slowly, returning your legs to the ground. Do this once in the morning and once at night to help maintain your sacroiliac joint flexibility.

Remember never to engage in an exercise without first consulting your chiropractic physician to see if it is safe for you and your unique conditions.

Suggestion: Ergonomic Support – For all the hours we spend seated, we need to make sure our spines are supported. Evaluate your chair to make sure it allows your spine to be supported, with a lumbar curve and arm rests at the proper height. Ask your chiropractor to help you fix your chair for your specific needs, and watch your productivity soar!

Remember never to engage in an exercise without first consulting your chiropractic physician to see if it is safe for you and your unique conditions.

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