Dr. Dall answers patient’s most commonly asked questions
Q: What are the most common causes of lower back pain?
A: The first thing most people assume is that the pain is coming from one of the muscles in their low back, and they wonder if they strained a back muscle. The important thing to know about muscle pain is that as long as you don’t repeat what caused the discomfort, it usually will heal up in a short period of time. If the back pain lasts longer than a week, then you likely have to start thinking of structures in the spine that could be causing the discomfort. The two most common spine structures that cause lower back pain are the lumbar disks and facet joints. These are the joints that allow movement between the spinal bones. However, those areas typically heal within 6 weeks if the strain isn’t repeated. If the pain is below the lowest bone or vertebra in the spine, then it could be coming from your Sacroiliac (SI) joint.
Q: What causes SI joint pain?
A: Much of SI joint pain is considered iatrogenic, which means we don’t know exactly what causes it. However, SI joint pain in many is caused by trauma. This can be caused by a fall directly on the buttock or in instances where your SI joint is impacted, such as, extending your right leg while braking your car before a head on collision. The impact goes right up your leg and into your SI joint. Another common cause of SI joint pain is pregnancy. This happens because ligaments holding the pelvic ring together stretch at the symphysis pubis and SI joints prior to giving birth. Some women experience SI joint pain from pregnancy, but after about 6 weeks post-partum, almost half of them still feel discomfort. After 6 weeks, if the pain is still there, it usually occurs on one side and may require treatment such as physical therapy.
Q: When is it time to see a doctor?
A: First of all, it’s important to understand the difference between acute and chronic pain. Acute pain usually resolves on its own in about 6 to 12 weeks. In my opinion, if your pain lasts longer than two months, it’s time to see your primary care doctor, Physical Therapist (PT) or Chiropractor. PTs and Chiropractors are very good at diagnosing and relieving SI joint pain. If the pain does not decrease after 6 to 12 weeks, your pain may be considered chronic. At which point, it may be time to see an orthopedic spine surgeon or a neuro surgeon. Make sure to bring up SI joint pain and to specifically ask the surgeon if the SI joint is part of your problem.
Q: How will my doctor determine if I’m a candidate for SI joint fusion surgery?
A: First and foremost, your doctor should perform the Fortin Finger test, which is described in my book Sacroiliac Joint Pain: For Tens of Thousands the Pain Ends Here. The doctor will push on this specific spot of your back and, if painful, has to decide if the SI joint is a pain generator or not. You can also do this test at home. Simply reach back and push on the small prominent bone just above and to the right or left of the crease of your buttock, and if you hurt there, it is possibly your SI joint causing the pain. The definitive test doctors use next is to inject the joint. The injection is a combination of steroids and a short acting anesthetic. If the SI joint is the cause, the anesthetic will numb up the pain for two hours or more. If during that time, your discomfort goes away, then it’s a strong indicator that your pain is coming from the SI joint. Keep in mind that both SI joints can hurt at the same time.
Q: Do I need to have my SI joint adjusted by a chiropractor or a physical therapist before I have it fused?
A: The answer to that is currently controversial, and there has been no science that has been dedicated to answering that question. My experience is that if a CAT scan is performed on a SI joint before a manipulation and then again after there appears to be no gross change in alignment. That said, what is really happening with realignment? That has not been scientifically tested or demonstrated, so the work still needs to be done. During my career of fusing hundreds of SI joints the outcomes were not different in those individuals who chose to have manipulations before surgery and those who did not.
Q: How do I know if SImmetry is the right procedure for me?
A: The SImmetry Sacroiliac Joint Fusion System is a minimally invasive, lateral approach that goes through the true SI joint. The goal of SI joint fusion is to relieve the symptoms of SI joint dysfunction by eliminating movement in the joint. The SImmetry System uses proven orthopedic principles, including joint preparation, bone graft delivery and fixation to achieve fusion in the joint. The threaded implant is placed through the densest part of the bone surrounding the SI joint, stabilizing the joint to allow fusion to occur