Pelvic pain

UNDERSTANDING PELVIC DYSFUNCTION IN WOMAN

Millions of women suffer from disabling pain conditions which are unique to females (an example is frozen shoulder) yet, they are treated symptomatically without looking at the full picture. In the lower quadrant, sacroiliac joint dysfunction plays a significant role in producing pain and other symptoms.

The pelvis provides the bony link between the flexible spinal column and the lower limbs, producing a stable platform from which these levers can act. The pelvis's function is to transmit and absorb forces between the spine and lower limbs (Vleeming 1995), as well as providing attachment sites for 35 separate muscles and protection for abdominal viscera. Approximately 60% of body weight is transferred onto the sacral base (S1) from the L5 vertebral body during stance. The joints of the pelvis, i.e. the pubic symphysis and the sacroiliac joints, must efficiently transmit these forces for normal function of the spine and lower limbs (Snijders et al 1993). An understanding of the structure of these joints provides insight into their function and possibilities for dysfunction.

The bones, ligaments, muscles and nerves of the sacroiliac joint (SIJ) may be damaged by direct trauma or by smaller, repetitive stresses. But, here we are going to consider females with multiple complaints without obvious trauma. Dysfunction of SI joint can refer pain to the SIJ, and SIJ pathology can refer pain elsewhere. Because of the varied and overlapping presentation of symptoms, a precise diagnosis of SIJ pain syndrome is often challenging. Physicians who recognize the condition early and offer prompt treatment (e.g., physical therapy, corrective exercises with mobilization) will make a definite contribution to improving their patient's condition and quality of life. At this point it is worth mentioning corticosteroid injections which have limited value and relieve pain that most of the time does not originate from SIJ itself. This dysfunction has a close link to pelvic floor disorders in females and can go unidentified and untreated. Statistics say that 1 out of every 5 American women of all ages will suffer from some type of pelvic floor disorder at some time in their life. More than 25 million American men and women suffer from urinary incontinence or involuntary loss of urine, women more than men.

We have found that the sacroiliac joint plays an important role in lower quadrant like the thoracic spine in the upper quadrant. We need to appreciate the fact that conditions like urinary incontinence, all types of pelvic pain may have a musculoskeletal in origin.  It is necessary to treat the sacroiliac joint/whole pelvic area first especially for women with multiple pain or other symptoms. Females are more prone to lower quadrant pain or dysfunction for the same reason they suffer from upper quadrant dysfunction. On top of this, the anatomy of the female pelvis is different; they are more mobile than men. Child bearing brings weakness and trauma to the pelvic basket/slings (muscles responsible for maintaining pelvic integrity). Dysfunction of the sacroiliac joint or pelvic floor muscles is interdependent of each other, for example, problems in the pelvic rim can cause problems in pelvic floor muscles and vice versa. Nearly every patient that has been referred or presented to us with the complaint of lower back pain or pain elsewhere in the lower quadrant not responding to traditional physical therapy show some form of pelvic dysfunction.

We continue to find sacroiliac joint dysfunctions in nearly all of our patients with lower back pain. This is not to say that this is the only source of lower back pain but in most cases it is a major source for pain. To get total resolution it needs to be addressed and included in the treatment plan for lower back pain. Lumbar facet dysfunctions are also highly prevalent issues. The relationship between lower back pain and sacroiliac joint dysfunction is often considered to be of little importance in the medical community. Often, bulging disks found with MRI's are thought to be a more valid consideration as a source for pain, but we have consistently found a direct cause-and-effect relationship between patient's with lower back pain symptoms/complaints and sacroiliac joint mal-alignment/dysfunction. We have also found that by correcting the alignment (i.e. sacroiliac joint rotation or sacral torsion) of this sacroiliac joint complex we can resolve or reduce low back complaints immediately.

At our facility we take the same unique approach to resolve patient complaints by finding and treating the source and cause of pain rather than simply treating the symptoms. We utilize the same approach in the treatment of all musculoskeletal pain and dysfunction. This is why we offer a consistently higher success rate and are able to treat multiple problems and complaints at the same time.

On a scale, I have a 1 if not pain free now. Sleeping was impossible before because pain would shoot down my leg. That's gone now; I can sleep throughout the night now. My posture is definitely better. I am more agile than before. My pain was around an 8 when I started. (Sherri, DuQuoin, IL)

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