Why Your Back Might Not Be Getting Better

Why Your Back Might Not Be Getting Better

There are many reasons as to why people develop back pain and luckily, conservative treatment can help most all of them.  Only in the rarest of instances is surgery needed.  The problem with treating back pain is that all too often the practitioner focuses so much on the pain that he/she doesn’t actually address what is causing the pain.  We’ve all been guilty of this!

I could write volumes on contributing factors to back pain but this blog was written to address one common problem that we are seeing more and more: a hypermobile sacroiliac joint (SIJ).  Now, the naysayer will try to suggest that this does not occur, but with over 18 years of treating sports and back injuries, I can assure you that it does, and it does with frequency.  I’ve seen this problem in active kids to my professional athlete clientele base.  It is usually not properly diagnosed as few practitioners know how to assess it.

A properly trained physical medicine practitioner can identify a hypermobile (too much movement) from a hypomobile (fixated) sacroiliac joint (SIJ) and develop a care plan to address the problem.  Failure to identify this problem can lead to disc pathology in a relatively short period of time.  As the forces from ground contact (foot hitting the ground with walking)  are transmitted up the leg and into the hip and above, if the sacroiliac joint cannot properly absorb and transfer the forces due to it being damaged, then excessive forces move up into the lumbar spine and destabilize this region. This leads to low back pain.  Too many physical medicine and medical practitioners tend to miss this problem as the focus all too often in on the lumbar spine.

Sacroiliac joint pain can be caused by a hypomobile (fixated) or hypermobile (unstable) joint. A proper diagnosis is required to help with recovery.

Dr. Kevin Hearon, the creator of the CCEP (Certified Chiropractic Extremity Practitioner) program, has a saying that I learned 20 years ago and it still applies today: if it’s fixated, mobilize it and if it’s hypermobile, stabilize it. Well, why is it that most all of us treating back injuries tend to mobilize the sacroiliac joints and the lumbar spine with very little attention ever being paid to determine if a SIJ is actually hypermobile vs. fixated?  Again, it comes down to the practitioner’s ability to properly diagnose the problem.

If you are a person who has low back/pelvic pain and have not been responsive to conservative care, it’s likely that your problem has not yet been properly diagnosed. Those who like to be active and feel great after treatments yet the treatments ‘do not last long’ are likely suffering not from a fixated SIJ but from a hypermobile one.  Those who have pain that worsens with activity and refers from the pelvic region into the back are likely suffering from a hypermobile SIJ.  Those who have weak gluteal musculature are more at risk of having sacroiliac joint issues as the gluteal muscles help to stabilize the SIJ.

Although it can occur, it’s unlikely that both SIJs will be hypermobile.  In fact, usually the hypermobile one has been compensating for something else wrong in the lower extremity.  In my experience, I have seen hypermobile SIJs as a result of old ankle sprains, knee surgeries, hip injuries, foot/gait problems, and more.  The key is identifying the underlying cause of the problem, eliminating it, and stabilizing the dysfunctional SIJ.  Only by treating the problem in this fashion can the patient recover.

If you been experiencing low back/pelvic pain that has not been responsive to treatment, consider giving our office a call.  All you might need is a different approach to your problem to help you get pain-free and fully functional again.


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