“The SI joint is a chameleon”

In order to identify functional abnormalities of the sacroiliac joint (SI joint), Dr. med. Volker Urban starts by listening to his patients. During the subsequent differential diagnosis, the experienced neurosurgeon relies on an unusual test to get confirmation: he fits patients with the SacroLoc.

On arrival at his joint medical practice for neurosurgery in Frankfurter Straße in Seligenstadt, Germany, patients suffering from severe back pain feel a sense of relief straight away: they see bar stools. That means a relaxed position that is gentle on the back, instead of having difficulty lowering oneself into a deep chair. Quite a few things are different here. When the time for the appointment has come, Dr. Volker Urban fetches his patients from the waiting room – with a personal greeting, but without wearing a white coat. “The diagnostic process starts in that moment for me,” the specialist explains. “I can see how patients are sitting, how they get up, and how bad their pain is.” At the same time, it creates an atmosphere of trust. To get a first glance at the patients’ gait, Dr. Volker Urban asks them whether they feel comfortable going on ahead into the treatment room. They can then tell their story.

Listening to patients

“The most important aspect of diagnosing SI joint problems is listening,” the experienced neurosurgeon admits. He and his seven colleagues cover the southern Rhine-Main region across four practice locations. “I get my answers by listening to what patients say about themselves.” That also works with Edmund Ruda on this Tuesday morning. The 68-year-old has come to get a second opinion and talks about diffuse pain when getting out of the car. This pain started to increase at some point. “Now it’s so bad, no matter what I do, it hurts.”

The patient’s MRI image, which was taken to exclude a herniated disc, an abscess or other causes, shows no pathological findings. That is why Dr. Volker Urban is assuming the problem is down to sacroiliac joint dysfunction. And this is why: “This type of functional impairment can’t be seen on an MRI. It’s best to identify it using further differential diagnostics,” he explains, and starts his physical examination. He asks Edmund Ruda to lift his legs individually, to get up, to bend down, forward, sideways and backward. He uses his thumb to exert pressure on his patient’s lower back and pelvis because: “Tenderness in this region indicates sacroiliac joint problems.”

After that, the spine specialist fits the patient with a SacroLoc, which securely surrounds the pelvis, and asks him to walk through the treatment room. “If patients then say they can feel an improvement, I can conclude the problem is related to the SI joint, and that the brace will help.” If patients do not notice any change, the SI joint may still be affected, Dr. Volker Urban says, but circular compression is not suitable to reduce pain in this case.

He describes the connection between the sacral bone and the iliac bone as a structure that is “often overlooked” during diagnosis. “Some SI joint patients complain about leg or groin pain, which would send the physician down a completely wrong track. The sacroiliac joint is a chameleon when it comes to its symptoms!” The trigger is not necessarily inappropriate mechanical stress but, in his experience, also changes during everyday life. This may include a new car with a different sitting position, a long vacation journey or a forearm crutch.

“Freeing up the SI joint by walking”

About one in three patients visiting the joint medical practice is affected by SI joint problems. CT-guided pain therapy to loosen the twisted joint and remove pressure often helps. For additional support, Dr. Volker Urban specifically prescribes the SacroLoc and instructs his patients to check with the medical supply retailer by phone if it is available so they can then make a follow-up appointment after two weeks of wearing the brace. “Healing can begin only when the pain has gone.” In addition, Dr. Volker Urban recommends the following long-term measures: “Pilates and going for a walk. They can free up the SI joint by walking! The changing movement from the left to the right leg relieves the SI joint – like with a jammed wooden drawer that can be freed up by jiggling it back and forth.”

Every year, the 62-year-old and his colleagues perform around 1,200 spine surgeries at Emma Clinic, one of their practice locations, as well as in other hospitals – in addition to 4,000 CT-guided infiltrations and 400 inpatient pain treatments. Nevertheless, the neurosurgeon discourages premature surgery. The joint medical practice founded in 2000 is therefore also valued by many general practitioners for providing a second opinion. “Unlike in emergency care, we have time to make a decision after careful consideration,” Dr. Volker Urban summarizes. “We can operate but we can also take the non-surgical path.” Edmund Ruda has made his decision. Relieved, he leaves the practice with a prescription for the SacroLoc and a tip that is accompanied by a wink: “Keep listening to your back!”

SacroLoc has a direct impact on the SI joints

Studies conducted by Leipzig University and Chemnitz Technical University have shown: the SacroLoc straightens the sacral bone, has been proven to influence nutation movement in the sacroiliac joint and provides relief to local ligaments, in particular the sacrotuberous and sacrospinous ligaments¹. The pelvic brace primarily realizes its therapeutic potential during dynamic situations and when it is being used for extended periods.² Several weeks’ intervention with the SacroLoc pelvic brace resulted in significant pain reduction and a clear improvement in quality of life. A considerable influence on mobility in SI joint patients was also established. During treatment, they developed a modified gait (higher cadence and walking speed) and improved postural stability.² White papers with summaries of selected study results are available from medical.affairs@bauerfeind.com

1 Sichting F., Rossol J., Soisson O., Klima S., Milani T., Hammer N. Pain Physician. 2014 Jan-Feb; 17 (1): 43–51. Pelvic belt effects on sacroiliac joint ligaments: a computational approach to understand therapeutic effects of pelvic belts.
2 Soisson O., Lube J., Germano A., Hammer K.-H., Josten C., Sichting F., Winkler D., Milani T., Hammer N. PLOS ONE 10.1371/journal.pone.0116739. published 17 Mar 2015. Pelvic belt effects on pelvic morphometry, muscle activity and body balance in patients with sacroiliac joint dysfunction.

Images: Michael Bause