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Sciatica or SIJ Syndrome?

Posted: Sun Jan 01, 2006 5:47 pm
by Jeanette
(My apologies in advance for the length of this post...and thanks for any shared experience and/or suggestions.)

As I’ve mentioned elsewhere, I’ve spent 2 or 3 weeks now reading Dean’s books as well as those of other authors, and I’ve explored the lower back and sciatica forums fairly extensively. As helpful as those have been in terms of offering cautions about the variety of medical interventions, I’m still not convinced that sciatica emanating from spinal “problems” is causing my confusion of aches and pains, especially the excruciating pain that getting out of bed after 2-3 hours brings on.

Here’s the short version: The current problem started about 3 months ago, not with major pain, but with a spreading and intensifying ache in the right lumbar-sacral area

An MRI was done in late October as well as a nerve conductivity study. The MRI shows a “broad disk central protrusion with annular tear.” There is also some foraminal stenosis and degeneration of L4/L5 facet joints — not unexpected, I would surmise, in a woman rapidly approaching 60 who has spent a lot of years working with horses — and, according to both the neurosurgeon my GP referred me to and the books and posts I’ve read, not uncommon. Also, as I understand it, the same or similar conditions have been observed in a statistically relevant number of people who display NO symptoms at all. However, if — and that’s a BIG IF — you’re one who hurts, “common” is no comfort.

Shortly after seeing the neurosurgeon in late November, the tingling and numbness down the leg began and, more significantly, the pain in the hip and/or down the leg that wakes me during the night. Then, those first several steps as I get out of bed are real doozies — the pain that winds down and wraps itself around my right leg is a real teeth-gritter! Standing up after sitting for awhile offers a milder version of the same.

I’ve not tried bed rest because I cringe at the idea of spending more time in bed than I have to. It’s no longer the fuzzy, purring alarm clock that gets me up in the morning, but pain. Activity has so far been much more user friendly for me, but it takes me an hour or more just to warm through the spreading pain the first weight-bearing step elicits. (Even a 45-minute nap leaves me with pins and needles and/or pain down the right leg.) I can do the cobra extensions, but only after I’ve warmed up considerably. I’ve laid off the stage 3 extensions altogether; flexion seems to be somewhat more tolerable.

Now to my questions:

:?: Is there anyone out there who’s experienced sacro-ileac joint (SIJ) pain? One of Dean’s resources pointed me to where I brought up the article on SIJ syndrome. From there I came across another article on SIJ at ... oileac.htm . Tho' I'm wary of self-diagnosis, both articles raised red flags for me, among them the fact that I’ve had a number of falls which have landed me splat on my fanny, hip, or the sacral-lumbar area. Only one fall was bad enough to land me in an emergency room and doctor’s office. With the others I probably hobbled around for a few days and/or nursed pretty significant bruises for awhile, but I was able to deal with the pain or discomfort on my own.

:?: What kind of physician is most apt to recognize SIJ syndrome if s/he saw it — or even to know the tests to rule it out? A physical medicine/rehab specialist, maybe? An orthopod? Neither my GP nor the neurosurgeon did any of the tests I’ve seen described for SIJ syndrome — or many others besides the standard raps on the knees and ankles.

I've become skeptical of specialists because they too often seem to have tunnel vision. To say “I’m frustrated” isn’t saying half of it! :?

:?: Does SIJ syndrome fall under the rebuilding program? Or should I be looking for something else altogether, different kinds of exercises, different ways to approach the problem? If that's the case, any ideas?

:?: Finally, maybe what I'm experiencing is indeed sciatica. Has the fact that I experience the worst of my symptoms at night lying down and when I first get up -- which I haven't seen expressed much by those posts I've read -- thrown me off the track? Maybe I just need to persevere?

After several visits to my GP and one to the neurosurgeon (each with their own co-pay, of course), I'm not terribly interested in playing musical doctors, so if I can learn from someone else's experience, I'm more than willing to listen.

Thanks for bearing with me.

Posted: Fri Jan 06, 2006 6:21 pm
by Dana
Hi Jeanette,

I'm not familiar with SIJ so I can't really comment on that. I think the RYB program should work for it since it's an overall back rebuilding program and several of the advanced exercises include the hips and pelvis. You might also want to look at the Pain Relief Manual book it's really great for all joint problems.

I think I would give RYB a couple of months and see if you improve or not. Then maybe you could let us know if it works for sacroilliac problems.

Wish I could be more help,

Posted: Thu Jan 12, 2006 7:03 am
by randolph
Hello Jeanette!

Wondering if you've received answers to your many questions, especially regarding SIJ. In the beginning, we have lots of questions ... many of which are answered just by doing the exercises; so ... how is it going? :?:

Noticed no responses to your questions (maybe for the same reason I didn't - don't know nuthin), but also reading your very good, informative and encouraging posts to others. I'm assuming you're getting good results? :?:

Posted: Wed Jan 18, 2006 11:36 pm
by Jeanette
Hi Randolph -- Thanks for the reply. As you suggest, there probably have been no replies other than yours and Dana's because people aren't familiar with SIJ syndrome and, so, had nothing to say.

I have pursued SIJ syndrome with the physical therapist I'm seeing. (My doctor had initially referred me to a neurosurgeon, who did not -- to his credit -- recommend either surgery or injection, but didn't suggest anything else that was particularly helpful either), so I figured now it was my turn to choose the next opinion, so to the physical therapist. Short of a blocking injection to the sacroiliac joint, however, SIJ pain syndrome is pretty hard to diagnose. So, whether SIJ syndrome or just garden-variety sciatica, I'm reasonably sure the underlying injury is an old one (see my original post), one from which I have experienced 17 years of on/off aches, pains and occasional numbness plus edema over the right media sacral sulcus.

I am exercising. In fact, I've been working out regularly with a personal trainer (who's also a licensed rehab OT) for almost 2 years, and we're doing many of the exercises in Dean's RYB -- and, believe me, I'm doing them correctly because D. is death on form :twisted: . But I seem to have hit a wall with this sciatica thing, and we started looking for the hang-up.

Finally, we concluded that -- regardless of whatever impingement or pinched nerve(s) the MRI suggests -- the muscle building process has been impeded by damage that has been ignored for years -- by the doctors and me. Consequently, other muscles have been compensating, and the only way to overcome the problem and put the right muscles to the right job -- and provide back and pelvis with the support they need -- is to awaken those muscles up so they can respond appropriately.

The physical therapist I sought out works with techniques that "awaken" those "lazy" or debilitated muscles. She's then shown me exercises which I do daily, many similar or identical to some of the ones Dean recommends, to focus on strengthening muscles that have been weakened by disuse. Sound familiar?

Anyway, the progress isn't fast, but then the situation has probably been 20 years in the making. I can't measure my improvement day to day, but I'm better than I was six weeks ago. And even if I've taken a somewhat different route than Dean typically recommends, I've felt confident enough to do what works for me largely because his books and the experiences that others have shared on this site.

So, thanks again for your inquiry. And best to you, too, as you continue your own rebuilding process.


Posted: Thu Jan 19, 2006 8:01 am
by Dean
My way is definatly not the only way. I try to constantly stay open to new ideas and alternative methods. There's always room for improvement and nothing's ever perfect. That's why there needed to be a second edition to RYB... and that's why I encourage you to experiment with the exercises in the book.

What works for one person may not work for someone else especially when you're talking about sciatica. There are just too many variables.


Posted: Thu Jan 19, 2006 10:05 pm
by randolph
hi Jeanette!

Sounds like you're on the right track with your unique blend of RYB and your PT's program to rebuild those lazy muscles. Certainly worth a try, and you've apparently enough long-range vision to realize it's going to take a while. I'm remembering what the midwife said to my wife before the birth of our first baby: the baby comes just before you're sure you're going to die. Perhaps the sciatic pain finally goes just before you think you're going to die if you have to do those damned exercises one more time!! :D

Posted: Thu Jan 19, 2006 10:22 pm
by Jeanette
I'm remembering what the midwife said to my wife before the birth of our first baby: the baby comes just before you're sure you're going to die. Perhaps the sciatic pain finally goes just before you think you're going to die if you have to do those damned exercises one more time!!
Boy, that's about right... :D And labor pain is just about the only thing that comes close to the pain this sciatica has offered. And there hasn't even been a baby to look forward to -- not that I'd want to take that on at this stage of my life, thank you very much ... :P