Sacral pain - is it torsion/SIJD?

[birdlife]

Its gone 4am here in London and I've given up trying to sleep. I have so had enough these last few days and nights. My sacrum hurts at certain angles, pelvis is uncomfortaby heavy, abdomen feels like its on fire, lower back is stiff as a board, and my thighs are so taught I couldnt squat down to save my life. Can anyone advise if this is typically symptomatic of sacral torsion/SIJD? And is SIJD another condition the average GP wont have heard of, and I'll have another battle on my hands? I've had chronically tight lumbar/pelvic/upper leg muscles for about 3yrs now, don't know why, so am always careful with lifting etc. My son moved house at the weekend and though I didnt lift I did do some careful pushing, and now everything has escalated. My sit pain has worsened too, no surprise there, but at the minute this lumbar area is taking precedence. Can't believe something else has overtaken the PN .

[birdlife]

Still awake . ..tried to set up a GP appointment this morning. My GP (yet again) is not in this week - nor is he available for a month. I asked for two of the other senior doctors at the practice, no not available either. Cant wait a month like this, am thinking of trying to see an osteopath or chiro or physio, would that be a better idea anyhow?
Any suggestions welcome as to what i can take to alleviate this sacral pain, got some old Baclofen in the drawer but that's it. Can't take anti inflams.
Thanks,

[Lernica]

Sorry to hear about your escalating sacral pain, Birdlife. If your doctor is unavailable for a month, I would encourage you to see someone who deals with muscle issues, such as a chiro, osteo or PT. It does sound like you need something or someone to soften up your tight muscles. Does sitting in a hot whirl tub or bath relieve the pain or tight muscles? Do you have a tennis ball or other massage device that you could use to self-massage the tight spots? A tennis ball works great on the buttocks, leaning into it against the wall. You could even try a rolling pin on your thighs. Roll from the knee up to the top of the thigh and back down again. My routine is to have a hot bath or shower first, and then to do my stretching/massaging routine.

Can you stretch your legs without irritating your PN? For instance, you could stretch your thighs by standing on one leg (like a stork) and bringing your heel up towards your backside. You could look at other stretches on Youtube.

Thinking of you.

[birdlife]

Thanks Lernica .. yes a hot bath helps muscle stiffness (hard surface doesn't do much for my PN though) but not for long. Arnica gel helps but not for long. I'm the triggerpoint queen so have 10 tennis balls dotted around the house at all times, plus a BodyBackBuddy for areas I can't reach with the ball or my hands .. Trouble is when the muscles get this supertight as fast I deal with one triggerpoint another one springs up in its place and stretching is very hard to achieve with so many knots. I am almost sure this extra muscle tightness is to do with the sacrum pulling them out of sync
Am going to ring the private sports physio I used to go to, at least he was TP aware, but he is expensive and a bit of a trek to get to him. Thanks for caring, bless you.

[Laura]

So sorry you're suffering from these extremely tight muscles. It such a horrible experience to not be able to get to sleep and therefore escape the pain. I know nothing about SIJD but can it also be your bodies way of protecting your pn?
In the meantime you need to break this cycle of tight muscles. I don't know how things work in England but isn't there an emergency room you can go to. That's what we call it here in the states. Emergency room doctors are use to dealing with all kinds of conditions. Maybe they can give you muscle relaxers to help break this awful cycle and just might help you sleep! I hope you get some relief.

[birdlife]

Laura, I think if this is sacral misalignment then it has a great deal to do with my PN because it will pull the surrounding muscles and ligaments out of sync, especially the glutes and piriformis. When the piriformis plays up, as with me, then it can put pressure on the pudendal nerve which lays underneath it. So rather than protecting my pn, I think it could be a root cause, or at the least a contributory cause.

Something more has happened in the sacral area in the last few days (does it pop in and out of alignment?) and all these TP's that have sprung up will need weeks of work yet. But if its a sacral problem causing the muscle tightness then I'll only be able to keep pace with it, rather than solve it.

Yes, we have hospital A&E departments here but all that would happen is that I would sit (I mean stand) there for about 4 or 5 hours, see a triage nurse who'd give me an unnecesarily high dose of cocodamol (uh oh, severe constipation ahead!!), then send me home to see my GP. Except I can't get to see him

Have found some 2.5mg diazepams in the meds cupboard, fingers crossed they help me sleep tonight. The baclofen (muscle relaxant) is out of date . Thanks for your good wishes ..

[Faith]

Its gone 4am here in London and I've given up trying to sleep. I have so had enough these last few days and nights. My sacrum hurts at certain angles, pelvis is uncomfortaby heavy, abdomen feels like its on fire, lower back is stiff as a board, and my thighs are so taught I couldnt squat down to save my life. Can anyone advise if this is typically symptomatic of sacral torsion/SIJD? And is SIJD another condition the average GP wont have heard of, and I'll have another battle on my hands? I've had chronically tight lumbar/pelvic/upper leg muscles for about 3yrs now, don't know why, so am always careful with lifting etc. My son moved house at the weekend and though I didnt lift I did do some careful pushing, and now everything has escalated. My sit pain has worsened too, no surprise there, but at the minute this lumbar area is taking precedence. Can't believe something else has overtaken the PN .

Sacral torsion is not uncommon with SIJD. With pelvic joint dysfuntion there are several areas that can be involved including the SI joints themselves, the sacrum, and the pubic symphysis. If the SI joint is out of alignment (i.e. upslip/downslip or posterior/anterior rotation) then it will often pull the sacrum or pubic symphysis with it. Yes, your average GP will not know about SIJD. A lot of orthopedic doctors are ill informed about the SI joint, some even think it is not a moveable joint therefore it cannot come out of alignment. A good manual physical therapist or chiropractor is probably your best bet, but be careful (as you can see from my signature) PT's can often be too agressive without realizing it. If any manipulations hurt or put you in strange positions beware. Gentle muscle energy correction exercises are often most affective and all you really need. Here is a couple of sites that may help you understand SIJD and sacral torsion better http://thelowback.com/how.htm#biomechanics http://www.massagetoday.com/mpacms/mt/a ... p?id=13628

My low back is extremely tight on the left side (the side of my SIJD and most of my pudendal symptoms) and I believe this is due to my quadratus lumborum muscle overcompensating trying to keep my SI joint in alignment. My left gluetal muscle has atrophied and my brain has basically shut it off due to the pain. My hamstrings are as tight as guitar strings and my calves have so many knots in them I can't hardly stand sometimes. My neck even has knots and hurts a lot. I'm not surprised your sit pain is worse. Do you have pain directly around your sit bones? I do and I think this is because my ST ligament has become loosened due to SIJD (causing my PN(E) symptoms) and my hamstrings have become majorly tightened in order to compensate for the loose ST ligament. I've also read that the SS ligament connects partially to the piraformis muscle...that may be why so many people have piriformis pain post-op PN decompression.

I've recently discovered if I sleep deep for at least 8 hours I have less muscle pain and trigger points from the SIJD. I've been taking a small dose of Flexeril to help me sleep and most mornings I wake up feeling less overall muscle pain. I am in the process of getting adequate SIJD treatment and am hopeful it will greatly reduce my overall pain and maybe even some of my PN symptoms. SIJD can be just as painful and debilitating as PN. I'm so sorry you are dealing with this, but it's good you are being proactive. Send me a PM if you want to talk more specifically. Keep us updated!

[birdlife]

Faith, you're a treasure, thank you so much for this. A wealth of information in there and one thing from those links that comes up as a flashing red marker to me is that "the sacral origin of the gluteus maximus supports the ST ligament". Well since my PN is flared at the ischial spine by the ST and SP ligaments, and since my my PN seemed to start AFTER my lumbar and muscle problems, then sacral torsion/SIJD must be the prime contender for just about every single symptom I have: tight piriformis, tight glutes, sacral pain, heavy pelvis, chronic leg pain, and PN.

Like you I have a tight QL muscle, Faith. It was compensating for the piriformis being contracted and pulling my right side up. This was diagnosed by a sports physio I saw a year or so back, no NHS doctor or physio picked up on it. I work on 15 chronically tight lumbar, buttock and thigh muscles with TP massage at home. My neck also sometimes joins in, as in the last few days. And yes, I also have sit bone pain too.

Yes, Muscular pain is much less when I manage to sleep through the night (very rare). I didnt take those diazepams last night because I sometimes get sleep apnoea so the bottle says Dont. I took a bot bath with arnica soak in, then moisturised when dry, then applied arnica gel from waist to feet on both sides and I actually felt some improvement in muscle stiffness, enough to drop off to sleep anyway. Have to have sleep to stay positive!

I'm elated because now I know why I was so much better PN-wise for 7months after doing extensive triggerpoint massage, yet it all came back when I dug the garden up - now its obvious that torsion had a major part to play in that. This is just one of those eureka moments. Now I have a proper cause and effect, and a way forward. You are a complete star!

*Administrators - shouldnt this info on SIJD be more prominent on the Home page? There's a bit hidden away under PT but it really wouldnt point a newbie in the direction they might need to go.

[Faith]

So glad to be of help Birdlife! I agree I wish there was more info on this site and in general about the connection b/w SIJD and PN. PT's say it all the time and it seems the more people on here I come in contact with the more I find SIJD or hip pathology (like a labral hip tear) are often the cause of PN. But then again some say it is possible to get SIJD from PN and that may have been what happened with me, although I think it was more likely that I had a trauma/stretch injury to my SI ligaments which caused my full fledged PN(E) symptoms.

I have used Clair Davies' book http://www.triggerpointbook.com/ some to help with my trigger points. But they have come so widespread that I can't seem to keep them under control. I think until I get the dysfunction corrected it's almost no use. I am afraid however that my SI ligaments (including the ST ligament) are so loose that no amount of conservative therapy will help. But I'm trying.

How do you know that your PN is flared at the ischial spine? Have you had imaging or just based on symptoms?

Let me know how things go!

[birdlife]

I wish there was more info on this site and in general about the connection b/w SIJD and PN.

Agree, Faith. This site is tremendous, such a lot of info and support on here - bless everybody - yet I'd never before made a connection with the SIJD mentioned under the physio section on the Home page and my own muscle-based PN.
Whether it works the other way around and you can get SIJD from PN I don't know, but the neuromodulation link that Laura posted today on a different thread had an interesting part in the radioblog where Dr. Peters said "the sacral nerve downstream becomes the pudendal nerve as it dives deeper into the pelvis".. Aha! Food for thought.

Clair Davies's TP book has been my lifeline these last few years, its been the only thing to help me. I dont respond well to meds, well I think i over respond , so I was taking nothing for pain, sleep, muscle stiffness, etc. Then along came discovery of Clair Davies's book and tp massage has enabled me to free up my muscles to sit for much longer, sleep, and do some of the things I was curtailed in doing (like move furniture). Until now, that is . Now as you say its a neverending task to keep up with, evidently because of the sacral disfunction. But it still is the only thing that helps.

How do you know that your PN is flared at the ischial spine?

I was vaginally diagnosed at the National hospital (see my signature) and was verbally told this, but it wasn't put in writing. How were you diagnosed with loose SI and ST ligaments, was it a physio? Finding the right physio I know is going to be quite a hurdle, haven't found one yet in 3years. I do have a chiro appointment set up for March, dont know their expertise yet as it was a Groupon offer (do you have Groupon?) which I bought way back and havent used up yet.