“Detecting correlations”

In cases of low back pain, the sacroiliac joint is an influencing factor more often than may be expected. If left untreated, dysfunctions pose a big risk for chronic pain, says German Dr. Jan Marc Lemke, who has developed a five-day stabilization program that also includes the SacroLoc.

Dr. Jan Marc Lemke firmly puts his hands around the patient’s pelvis. His scrutinizing look is focused on the precise
positioning of the SacroLoc pelvic brace which Karola Kraft has been wearing for stabilization for a few days. “You can pull it a little tighter,” the orthopedist observes, corrects the fit and asks the patient to walk a few steps. “How does it feel since you’ve been wearing the brace?” It does not take the 84-year-old long to answer this question: “When walking, I have a much better feeling in my legs and feel more confident when taking the stairs. Sometimes, there is no pain at all.” She has been having problems in the lumbar spine for years. When they got worse after a fall, and she also started experiencing pain in her left leg and buttocks, she sought advice from her orthopedist. Dr. Lemke diagnosed lumbar scoliosis and significant wear of the lower lumbar spine that, together with her existing osteoarthritis of the knee, impacted the statics of her pelvis, triggering functional impairment of the sacroiliac joints, with the pain usually associated with it. In addition to manual treatment and physiotherapy, he prescribed the stabilizing pelvic brace to the pensioner for targeted relief. She is not the first patient who is benefiting from the SacroLoc and has never heard of the sacroiliac joint (SI joint) before.

Focusing on manual medicine

In early 2020, Dr. Jan Marc Lemke took over the orthopedic practice at Dickhäuterplatz square in Ettlingen near Karlsruhe and founded the “Orthopaedicum”. In addition to focusing on manual medicine/chirotherapy, he relies on acupuncture and osteopathy. His guiding principle: “You have to look at the whole patient and detect correlations during every examination that, in cases of low back pain, may even involve the knee joints and feet or the upper cervical spine. Psycho-social aspects also play their part in creating problems. So they have to be explored as well.” The 45-year-old diagnoses functional impairments of the sacroiliac joints several times a day. Most of those affected complain about pain in the lower back. But not only there. To find the cause of SI joint problems, Dr. Jan Marc Lemke asks targeted questions. When and in what way did the pain occur for the first time? Was there a triggering event like a careless step or an awkward turning or bending movement? “In older patients, it often starts with a fall,” the specialist has noticed. He then asks his patients to take off their shoes and pants so he can carry out provocation tests. They often show SI joint problems, frequently in correlation with lumbar pain and other findings. In those cases, immediate action is required because: “We can prevent the condition becoming chronic in a lot of cases of low back pain when the SI joint syndrome is treated early,” Dr. Lemke points out.

Stabilization program from the SI joint to the atlas

The orthopedist has developed a program for non-surgical treatment to achieve this goal. It is based on the three-pronged approach of loosening, stabilizing and maintaining, i.e. manual treatment, physiotherapy and exercises carried out by the patients themselves, usually supported by the SacroLoc pelvic brace. For five consecutive days, the manual treatment covers the whole spine: SI joints, lumbar, thoracic and cervical spine as well as the atlas vertebra. “I usually find correlated symptoms that have to be treated for long-term success,” explains Dr. Jan Marc Lemke and loosens the blockages. Right after the 20-minute treatment session, he sends his patients on a quick walk to loosen up. This is immediately followed by treatment provided by an experienced physical therapist who works in the same building. Here, it is extremely important to stabilize the abdominal and low back muscles and also to stretch hip flexors, buttock muscles and hamstrings. The physical therapist also works on trigger points and gives his patients “homework” to do, including exercises for stretching and strengthening, in particular the often weak spinal erectors.

Depending on the pain history and age, with most program participants being between 50 and 80, the SacroLoc is also used for SI joint problems. “Whenever I feel that a patient can’t quite manage the stabilization with their own muscles,” Dr. Lemke explains, “I recommend the SacroLoc brace. Then I demonstrate its easy use and what needs to paid attention to. The circumferential encompassing of the pelvis compensates for the lack of muscular stabilization. Additionally, the posterior ligaments are relieved – in a region with many pain receptors – thus resulting in significant pain reduction.”

This also applies to Karola Kraft. “It’s so important that the pads are located precisely in the right position,” the orthopedist reminds her during the check-up appointment. “It’s best if you put on the brace in front of a mirror.” According to Dr. Jan Marc Lemke’s experience, the SacroLoc should generally be worn for three months when the patient gets active in order to prevent any symptoms.

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.
3 Klima S., Grunert R., Ondruschka B. et al.: Pelvic orthosis effects on posterior pelvis kinematics. An in-vitro biomechanical study. Sci Rep 8, 15980 (2018). https://doi.org/10.1038/s41598-018-34387-7.

Images: Bauerfeind, Udo Schönewald