Low Back, Pelvic & Sacroiliac joint
Luckily, the majority of people will get better quickly with the right treatment and muscle retraining. It is therefore important to find practitioners who have a depth of knowledge in assessing the lumbar spine and pelvis as well as surrounding muscles and nerves, and who know how to treat the many different types of back pain. A thorough initial examination allows us to determine what the main sources of your pain and disability are, and this allows us to direct treatment appropriately. 85% of people will suffer low back pain at some stage in their lives.
The team at Sydney Spine and Pelvis are at the forefront of providing professional education, treatment and rehabilitation for pelvic injuries and back pain.
Low back pain has many sources:
- There is the person who has just hurt their back acutely from an incorrect lift or a sporting injury. Often the pain is muscular or due to a facet joint strain
- There is the person who has had a disc or nerve root injury and is struggling to sit or get their pants on, and can’t get their muscles to hold them up
- Sciatic nerve and pudendal nerve irritation can cause buttock and leg pain that limits walking and activity
- There is the person who has had grumbling back pain for many years. Over time they realize their back pain is making them do less at home, work, and play. They notice they have less strength but any time they try to exercise their back pain gets worse.
- There is the person who gets back ache from sitting and standing too long, and has pain every night when they go to bed or get out of bed in the morning
- There is the person who feels there back is weak, and knows their posture is poor but does not know how to improve it.
1. Disc injuries and Nerve root irritation
Treatment needs to be specific depending on your symptoms. Disc injuries with or without nerve root irritation can occur at any level in the spine. In its mildest form, a small broad based disc bulge is a normal part of aging and many of us will have this degenerative change without it causing pain. However, an acute focal disc bulge may cause inflammation that puts pressure onto the nerve root and this is often associated with referred pain, altered sensation, and difficulty weight bearing
Acute phase: Initially it is important to try to ease inflammation and pain, and to fully assess how the nerve is being affected.
Ongoing back or leg pain related to an old disc injury: There can be many reasons for ongoing symptoms that may linger long after the disc has healed or micro-discectomy surgery has repaired the protruded disc material. At this stage physiotherapy treatment should combine manual therapy to release over active muscles and improve nerve mobility, core and lumbo-pelvic muscle retraining to restore strength and endurance, and posture retraining to decrease any ongoing irritation of the nerve tissue and minimize the chance of re-injury
Physiotherapy post Lumbar micro-diecectomy +/- Lmainectomy
As stated above, treatment post surgery needs to be specific to ensure good healing and improvoemnt of neural tissue irritation. Here is our Sydney Spine & Pelvis Post- operation protocol that will help patients understand what they should and shouldn't do in the weeks post surgery Lumbar_Micro_discectomy_post_op_protocol_FINAL.pdf
2. Pelvic dysfunction and Sacroiliac joint injuries
Pelvic pain is often less understood than low back pain, and yet research shows that up to 30% of low back pain is related to dysfunction and pain coming from the sacroiliac joints, the pubic symphysis or tissues that attach onto the pelvis. Pelvic dysfunction often occurs after a fall onto the bottom or knee, a lifting injury, or may be related to pregnancy and labour. The symptoms of pelvic pain are varied, from pain with sitting and rising from sitting, pain in the pelvic and buttock region with walking or standing on one leg, groin pain or even altered control of bladder function. Both the sacroiliac joints and the pubic symphysis can be involved, and can decrease the effectiveness of core muscle activation so that your ability to cope with normal daily activities is dramatically reduced. The team at Sydney Spine and Pelvis are experts at assessing and treating pelvic dysfunction with a combination of manual therapy, muscle and nerve release techniques, and specific exercise rehabilitation to facilitate lumbo-pelvic muscle control.
3. Facet joint injuries and generalized low back pain
Low back pain can have many sources, but not all of these are easily picked up on x-rays or scans. As we have stated before, 85% of the western world will have back pain at some stage in their life. Often this relates to a muscle sprain or tight back muscles that are limiting the way the joints in the spine move. Poor posture and poor activation of your core muscles can leave your back feeling weak or unsupported.
The facet joints are 2 small joints at every level of the spine that allow a small sliding movement to occur every time you move your back. Repeated loading into extension can create a stress reaction, or stress fracture at the facet joints, and this is often an issue in sports such as cricket (bowling), gymnastics and tennis.
Degenerative changes (or arthritis) at the facet joints is a normal part of ageing and commonly occurs in the neck and low back. These degenerative changes can be shown on scans and are often asymptomatic (not painful). However, they can also become acutely inflamed and cause pain with movement. Treatment needs to be specific to ease the pressure on the irritated joint, decrease the inflammation and to re-activate the right muscles to support the joint during activity.
- 3RD(1998), 4TH (2001), 5th (2004) and 6th (2007) World Congress for Low Back & Pelvic Pain Dr Barb Hungerford has been researching the effects of pelvic injuries for the past decade and has presented her results at conferences such as
- Australian Physiotherapy Association Conference 2006, 2011
- Australian Pilates Method Association Conference 2006
- World Congress for Physical Therapy 2004