Lower Back Questions and Answers

Does your lower back hurt? Have you been told you have an “unstable sacro-Iliac?” Have you been cautioned that your pelvis or hips can go out at any time? I’ve become a sacro-Iliac (SI) skeptic. I used to mobilize the SI frequently but take a different approach now and stabilize most patients without treating their SI repeatedly.

The sacro-Iiac is one of your back’s main compensatory mechanisms. Pain is a liar. It hurts in one location, but where is the true source of the problem?  SI pain is likely to come from three primary sources.

The first are your lower lumbar discs. If you have a lower back problem painful enough to send you to a doctor, there’s a 50% chance you have a disc problem which will not show up on an X ray and may or may not be obvious on an MRI. A disc problem is relatively easy to diagnose by a practitioner who listens to your history and, using simple physical exam tools,  knows what to look for.

Your painful disc cannot heal if you are doing the wrong exercises and moving incorrectly. This results in repeated harmful re-injury. You’ll need to modify the forward bending exercises. Our office combines the correct rehabilitation with gentle low force mobilization, usually above and below the disc.

A second source of pain is Maigne’s syndrome. This little understood problem begins higher in your spine at the lower thoracic or upper lumbar. Few patients complain of pain at these levels, however the nerves that exit here, when irritated, create pain over the flank and buttock. Like the sacro-Iliac, the pain is usually on one side. Diagnosis is by physical exam. The solution is twofold. Manipulation unlocks the stuck places in your spine. You need to learn how to quiet the involved nerves. We’ll coach you how to YAP. YAP (Yank Away Pain) is a self-care model using specific suction cups methods to relieve nerve pain. All pain weakens the core, so you need to strengthen yours.

The third factor is your hips, where your upper thighbones meet your pelvis. Hips tend to get stuck forward and outward and may or may not hurt. When your hip gets stuck and stops moving, then the lumbar spine and sacro-Iliac move too much to compensate, and the back will hurt. STOP opening the hip; this is not the correct strategy. Many yoga fans get in trouble with this movement.

There is a caveat. True SI pain exists. It is more common in females, especially those who have had multiple babies and/or have loose ligaments. Severe trauma can also cause an SI problem. When the SI is the main problem, you need stabilization, not repeated mobilization.