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The sacroiliac joint, sciatica, and unexplained lower back pain

I often have patients come in with a “mysterious” chronic lower back pain. Sometimes it’s described as lumbar or hip pain. They’ve been to doctors and chiropractors, but it still persists. As soon as they put their hand on it (low and to the side, where the buttocks meet the back) it’s pretty clear that the problem is the SI – the sacroiliac joint.

Pelvis

The SI joint – where the sacrum meets the ilium – is a long vertical area on the sides of the lower back. Back pain is often centered at the top of the SI joint.

At the bottom of your spine is a triangular bone, the sacrum. Attached to that is your pelvis (made up of the ilium, ischium, and pubis). Your femurs, the long bones of your thighs, settle into a socket on the side of the pelvis. A complex set of ligaments and lots of muscles join all these bones. If one or more of these muscles is tight, weak, or spastic, it can throw the balance of the entire pelvic system off. A few of the major players are Iliopsoas, piriformis, and quadratus lumborum. These muscles keep us upright and help us walk, but when they go bad… I call them the Holy Trinity of Lower Back Pain.

Quadratus Lumborum runs from the lower ribs to the top of the ilium. There are also connections to the spine. This is your "hip hiking" muscle - imagine a "belly dance" sort of motion - but if course it's essential in walking and other daily movements.

Quadratus Lumborum runs from the lower ribs to the top of the ilium. There are also connections to the spine. This is your “hip hiking” muscle – imagine a “belly dance” sort of motion – but if course it’s essential in walking and other daily movements.

Iliopsoas starts at the front of the spine and the ilium, goes through the pelvic cavity, and attaches to the femur. It gets tight on people who sit a lot, particularly if you are tense while sitting (motorcylists and people who hate their jobs).

Iliopsoas starts at the front of the spine and the ilium, goes through the pelvic cavity, and attaches to the femur. It gets tight on people who sit a lot, particularly if you are tense while sitting (motorcylists and people who hate their jobs). When tight, it jams the bones together and creates stress on the joints.

 

Piriformis

This is a back view. The piriformis muscle attaches at the sacrum, and goes across the butt to the femur. The sciatic nerve passes under it or through it, depending on your personal anatomy. When the piriformis gets tight, it squishes the sciatic nerve and can cause electric shocks or pain running down the leg.

With every step you take, the sacrum “nutates” – it tilts back and forth in relation to the ilium. If the bones are jammed together and can’t glide properly, it causes pain. Sitting can also be a painful prospect: If the joint is inflammed, the altered pressure of a seated position can be excruciating. I understand this very well because I developed lower back pain and SI problems along with a L4-L5 disc herniation after my car accident in 2001. I wasn’t able to sit at all for the 6 months before I discovered acupuncture and Osteopathy.

There’s rarely only one muscle involved. Usually a primary dysfuction causes a cascade of compensation with other muscles. Nerves can be pinched by either tight muscles directly or by a bone pulled out of place by a tight muscle (bones don’t move by themselves).  Nerve impingement can lead to pain radiating down the leg or into the genital area. Motor control as well as sensation may be affected. The leg may go weak, or a patient may experience bladder or bowel incontinence (If this happens, get to the ER immediately – they will take steps to relieve pressure on the nerve and prevent permanent damage).

In most cases, the first thing we have to do is reset the tension on the muscles. Acupuncture and medical massage will work wonders here. Once the soft tissue is corrected, I can generally realign the bones with fingertip pressure. They just slide back home with no drama or fuss. Now it’s a matter of allowing the irritated nerve to calm down, which can take 20 minutes to months (or never, in worst-case scenario), depending on the extent of the damage. Whenever you are dealing with entrapped nerves, it’s important to get care immediately. Releasing them quickly gives you the best shot at a full recovery like mine. Getting the pain knocked down allows you to rebuild. Rehabilition exercises and stretches (plus some myofascial release) will make your muscles strong and supple again, so they work properly, which will keep your bones in the right places. I no longer have any back pain, and I’m back in the gym doing heavy workouts including Romanian deadlifts!

Headache & migraine treatment options

Got a headache? The biggest cause is dehydration, so first, have a drink of water. Other common causes are caffeine withdrawal, high blood pressure, stress, low blood sugar, and tight neck muscles. If you have persistent or severe headaches, you should get them checked out by a healthcare professional (If only so they can say “It’s not a tumah!”), but for minor annoyances you can treat it yourself with acupressure (points listed below).

Human skull bonesI usually find that migraines are caused by hormonal imbalances, or by neck muscle tension pulling on cranial bones. Our skulls are not a giant fixed globe: There are lots of different plates and oddly shaped bones that make up our brain protection. The joints (called “sutures”) are shaped like jigsaw puzzles.

My favorite cranial bone, the sphenoid. It barely shows at the side of the head, but inside it makes a gorgeous butterfly shape. When torqued, it also gave me a monstrous migraine headache!

My favorite cranial bone, the sphenoid. It barely shows at the side of the head (it’s pink in the other picture), but inside it makes a gorgeous butterfly shape. When torqued, it also gives me a monstrous migraine headache! I keep my sphenoid happy by getting care for my neck, and using the acupressure points below when one threatens to attack…

Our bones move with a subtle pulsing called the craniosacral rhythm. If the neck muscles attached to the skull get too tight, they can jam up those joints and cause migraines. The fix: Acupuncture and medical massage for the muscles involved. Craniosacral therapy by a skilled practitioner is also wonderful, but be sure to see someone who’s thoroughly trained. A weekend seminar is not enough! If there are hormonal causes, acupuncture is superb for that as well.

We can also discuss some lifestyle changes that may help, like dietary changes, or glasses that mute florescent lights to reduce migraine occurence.

Here’s a handy acupressure point for any headache, including a migraine: It’s in that “second piercing” spot, below the anti-tragus. Press firmly for a few seconds. If you have an earring in, you should remove it if possible, at least until your headache passes. For more information on ear points, check out this article. Also, look at LI-4KD-1, and GB-21 and TB-5  if you have neck tension. There’s another point on the side of the lower leg than can be helpful for migraines: Run your fingertip up and down the outside of the shin to find a tender spot. And definitely read this if you’re considering a Daith piercing. 

Press firmly with a fingertip or fingernail. It will hurt, but it'll be worth it!
Press firmly with a fingertip or fingernail to stop a headache or migraine. It will hurt, but it’ll be worth it!

Ear seeds – Radishes for reflexology!

If you ever attend an event with me, soon you’ll notice people walking around with funny little stickers on their ears. Ear seeds are my mobile acupressure strategy. When people come up to me and ask what I can do about their back pain in the middle of a party… BAM! On go the ear seeds. These are radish seeds on a tiny piece of band-aid tape. There’s nothing magical about the radish – they are just the right size and shape to apply acupressure to any of the 100 points on your ear (map below).

You’re familiar with reflexology, right? You know how your entire body is reflected on your hands and feet? Same deal with the ears. I can treat pain or dysfunction anywhere in the body, emotional upheaval, anxiety, etc. This is why I’m not a huge fan of lots of piercings. It’s also why ear massages are like getting a full body massage, and terrific for immediately calming someone down. Try it the next time your migraines act up, your dog is freaked out, or your sweetheart has road rage. :) Just gently rub the entire ear – don’t worry about hitting specific points for this purpose.

Once the seeds are on, they are working. They will last 3-4 days, and you can shower normally. If you want to give the treatment a boost, and can’t feel them on your ears, give them a gentle squeeze to wake them up. If you are already aware of them, leave them alone… they will probably be pretty tender to the touch! Sometimes people find the ear seeds annoying or sore, particularly if they are side-sleepers or they are working superhard (the more active a point is, the more it can hurt). In that case, just take them off. The point is to make you feel better!

I never charge for ear seeds. Ask me for them anytime – I always have them in my purse, and you are welcome to drop by the clinic for a quick installation.

Note: Some people use ear staples for quitting smoking, weight loss, etc. I prefer earseeds, since sending someone out with an open wound is an invitation to infection. Acupressure is hugely powerful and hurts less, too!

There are about 100 points on the ear, so I can treat nearly anything. Ear seeds are quick, portable, and give you a few days of acupressure.

There are about 100 points on the ear, so I can treat nearly anything. Ear seeds are quick, portable, and give you a few days of acupressure.