BACK AND LEG PAIN

About back pain and the sacroiliac, or SI, joint, that bears and transfers weight and movement from your upper body to your legs.

Dr. Sarno says a lot about back, spinal, and leg pain in Healing Back Pain, but not specifically about sacroiliac joint pain.

Maybe Steve Ozanich or someone else with more medical knowledge about this subject can comment if it’s probably “just” TMS.




The back pain most surgeons won't find

By Dr. Nick Shamie, Special to CNN
updated 7:35 AM EDT, Wed September 18, 2013

Editor's note: Dr. Nick Shamie is Chief of Orthopaedic Spine Surgery at RonaldReaganUCLAMedicalCenter and is a professor of orthopedic surgery and neurosurgery at UCLASchool of Medicine. He is also President of the AmericanCollege of Spine Surgery.

(CNN) -- Tom wasn't accustomed to not knowing the right answer. A business executive in his 50s, he had been suffering from agonizing back pain for nearly two years, and all his doctors could tell him was that they couldn't find the cause or an appropriate treatment.
So Tom did what most people wouldn't -- he started researching to find a doctor anywhere in the world who could help him.

The problem, as it turned out, was that Tom's doctors were looking at his spine for the source of his pain, and that's not where it was coming from. He was suffering from sacroiliac joint dysfunction, the deterioration of the two joints on the side of the lower spine that connect it to the pelvis.

Studies have found that 20 to 25% of all chronic lower back pain comes not from the spine but from the sacroliac, or SI, joint, which bears and transfers weight and movement from your upper body to your legs. When the ligaments wear out and the SI joint becomes unstable, it can generate a similar kind of sharp back pain -- or sciatica-like pain down your leg -- as a ruptured disc.

Most spine surgeons, however, aren't trained to look at the sacroiliac joint; they generally don't learn about it during their residency or fellowships. And it doesn't occur to most patients to ask. Then X-rays, MRIs and CT scans of aching, aging backs show narrowing spinal discs, without actually showing whether these discs are producing pain ... further confusing the diagnosis of the suffering patient.

As a result, many people progress through the usual stages of back pain treatment, from physical therapy and chiropractic treatment to injections, laser procedures and finally to surgery, without ever addressing the true source of the pain.

One study found that among "failed" spinal fusion patients -- people who had their lumbar vertebrae fused and were still in pain afterward -- the SI joint was the real culprit in more than half the cases.

When you know to look at the SI joint, finding out whether it's the source of the pain is usually pretty easy. If an injection of the local anesthetic Lidocaine into the joint produces temporary pain relief, then that's likely where the problem resides. If so, all the treatments previously misdirected at the spine -- chiropractic, physical therapy and medication -- can be aimed at the proper target.
If those treatments don't work, the next step is often surgery. Up until recently, that meant a major open fusion procedure, followed by several months of recovery.

However, a new, minimally invasive procedure is now available that uses small titanium implants to stabilize the joint. The tiny incisions mean patients recover much more quickly. The procedure is being done regularly here at UCLA and at other top spine centers around the country.

It worked for Tom -- he's living pain-free and is back in control of his life. And there are millions more Toms out there living with chronic back pain who could benefit from knowing more about where that pain may be really coming from and how it can be dealt with effectively.

If you are suffering from lower back pain, make sure to ask your doctor to examine your SI joint in addition to the routine examination. You may want to seek out a spine surgeon who has experience with sacroiliitis -- the Internet is a good place to start but referrals are also valuable.

Ask the surgeon directly if he/she has experience operating on patients with SI dysfunction in the past year. And don't accept a lumbar fusion surgery performed for back pain alone (versus leg pain) without having your SI joint checked out by an expert.

 

Well, this article doesn't say just how long "Tom" is going on without pain? What about the pain returning two years after surgery? Furthermore, if my lower back pain and sciatica were due to SI joint instability how come my pain is going away and range of pain-free motion is improving dramatically by using Dr Sarno's TMS approach? Heck, even the strength in my legs is coming back again. My own thought is that seeing those titanium disks in an X-ray or MRI would function as a very strong placebo for the patient who would immediately think some structural problem was fixed with the operation. I would like to see a double-blind study and follow up of patients who've undergone such an operation. Do many of them have IBS, torn rotator cuffs, foot problems? From what I've read, the problem with back surgery is that it doesn't really work in the long or short run. Do you have to be "careful" after undergoing this SI joint surgery? Let's see some solid statistics without a bunch fear mongering and advertising hype.

 

Si joint dysfunction was my possible diagnosis as the physio therapist wasn't 100 percent sure. I'm confused whether it falls under the TMS category or not. Dr Sarno doesn't mention it in his books and im waiting for Steve Ozanich's book to come in the mail...

 

As a layman, without any medical training or degrees, I'd speculate that si joint dysfunction could be the result of muscle spasms caused by reduction in oxygen typically associated with TMS. Having your si joint "go out" doesn't sound much different than having your back "go out" due to spasms caused by TMS. Without any blunt force trauma or impact, why in the heck would your si joint "go out" anyway? It has to be muscle contractions that are pulling it out of its normal orientation. All these si joint problems sure sound to me like TMS pure and simple. That is, unless there's some preexisting medical condition causing the muscle weakness, but you sound as though you've already had that checked out.

 

In my experience, joints may shift out of position if the ligament or the joint capsule (a thin, fibrous container or 'sac' that holds fluid) has been weakened. The SI joint is primarily composed of ligament attachments. Tendons are the connection between muscle and bone. Ligaments are the attachments between bone and bone. A muscle contraction can affect the joint via the tendon, but ligaments do not contract or spasm.

My right fibula will occasionally 'roll out' slightly, causing instant pain. I have learned how to tap it back into place (a trick from a chiropractor). I also have a joint replacement in my foot. The joint literally died, and to compensate, bony material grew between the joint, trapping nerves. The pain was quite debilitating. It was a mess of growth that had to be shaved away to put in the replacement joint.

I do agree that many variations of pain can stem from psychological issues, but some pain can be very structural. Differentiating between the two is the key. In the process, addressing the psychological aspects is always a good idea, whatever the cause may be.

Little in life is pure and simple ... life is messy, much to my dismay I prefer tidy and organized.

with grace and gratitude,
^_^

 

No, life is not pure and simple. I find distraction helpful... it takes my mind off anything hurting or worrisome.

If there is nothing worth watching on tv, and there seldom is, I surf the web for information about lots of things.

Or I read a book. The Bible is always a good read.

Reading the TMS posts and watching the videos in the Mindbody video library are good ways to spend time
and distract ourselves.

 

I was diagnosed with SI Joint Dysfunction a couple years ago and was recommended to have the fusion surgery. Although I believed the "weak" SI joint theory, I decided I would keep searching for answers to make sure I tried everything before I opted for surgery. I tried all the usual doctors, PTs, shots, etc., but nothing helped. About six months ago, I came across The Mindbody Prescription, but because he didn't mention the SI joint, I didn't think his theory applied to me and I kept searching for answers and living with the pain.

Then, a few weeks ago, my pain suspiciously moved from my SI joint to my hip. That started me on a new quest and last week I re-read the book and decided to give TMS a chance. It's only been a week, but after two years of living with pain and putting my life on hold, I feel I am finally getting better and am on the right path. I recommend you give it a chance even if you're not sure it applies to you. I could have saved myself many months of pain had I just given it a chance when I first read it.

 

Thanks for the feedback, Dani - I think this will be helpful information for many who find the TMS Wiki and do a specific search for "Si Joint Dysfunction." (That is how I came across this particular post!)

I've gone to the chiro for the last 20 years, as needed, whenever my back would "go out." It was almost always my Si joint going out, and I always felt better when he would adjust it. It would come in a pattern - no problems at all for 6 months, and then boom, it would go out, and keep going out for up to a few weeks, and then finally it would settle down and "hold" the adjustment. This pattern never made sense to me. Now that I have a better understanding of TMS, it makes perfect sense.

I was scheduled for surgery (microdiscectemy) for herniated disks - I overnighted Dr. Sarno's books to myself, cancelled the surgery, and have been working on healing now for the last two months. Some days are better than others - I find that my mood/emotions/outlook has a lot to do with the level of pain. This board is very supportive and will give you a lot of help along the way.

Welcome to the board and please keep us posted on your progress.

 

I went to a chiropractor years ago and thought he was helpful for my back when I fell, but
I didn't like having to go so often and that the visits could last forever. I think the treatments
were more of a placebo than really anything more.

It's funny that now I accept TMS as a lifelong journey of progress. At least it's free and I can
work on it from home.

 

SIJ dysfunction is still under controversy even among traditional orthopedist. I don't think every back pain without MRI finding on back is due to SIJ issue, since TMS approach works for most of such pains. However, as we all know, we need to rule out any significant physical issues to confirm it's TMS.... I hope anyone who has professional medical knowledge on this comments on this!

 

Seraphina,

You may want to ask your quetion at this new feature here:

• Q&A with an Expert

 

Hi Dani!

I have an SI joint diagnosis as well and am trying to wrap my head around TMS. Would love to hear more about your story and/or if you've made any progress! Hope all is well.

 

Hi lolaskip!

It's now been around nine months since I took a chance on Dr. Sarno's advice and I'm even more convinced it is the answer. I still have an occasional pain in my hip, but the pain in my SI joint is completely gone. I hope you give TMS a chance. It's still difficult sometimes to think about the pain mentally rather than physically, but doing so has given me my life back. I recommend reading all of Dr. Sarno's books as well as those from other TMS writers. For me, having it explained from several different perspectives helped me get my head around it.

Please let me know if there are any specific questions you have. I'll try to log into the forum more often.