SI joint treatment with orthoses “SacroLoc enables us to direct the forces”
Dr. med. Thomas Lang at the Outpatient Rehabilitation Center in Berlin sees the SI joints as the body’s powerhouse. Should the ligaments fail to support the sensitive structure, an external girdle around the pelvis must step in to act as a stabilizer.
Bauerfeind life: Is loosening of the ligaments due to pregnancy a typical cause of SI joint problems?
Dr. Lang: It is known that high estrogen levels and the increase in weight during pregnancy can cause the ligaments to loosen, which can even lead to hypermobility of the SI joints. Gynecologists are also aware of this. However, the present case is rather atypical due to the monocausality of the SI joint problems. The extreme consequences were also new to me.
The patient suffered from pain while walking for almost twenty years.
Dr. Lang: When a patient reports the same symptoms in the same place time and again, during the same movements, I have to take it seriously. There is no such thing as imaginary pain. Not everyone is aware of the role the SI joints play in terms of transferring all sorts of forces and information. At least one quarter of all back complaints are SI joint problems.
What are the red flags that need to be ruled out in a differential diagnosis of SI joint syndrome?
Dr. Lang: I have to look carefully at whether there is a relevant structural diagnosis, such as sacroiliitis in association with rheumatic disease, or whether there is a more serious disease of the organs in the lesser pelvis, which can cause pain and functional impairments in the SI joint. I must then check whether there is a real or functional difference in leg length, or pelvic torsion due to a functional impairment of the pelvis. Provocation tests help me not just as a manual therapist , but also during diagnosis (see box on page 21). The most important thing is to listen carefully to what the patient is telling me.
Other primary causes of SI joint discomfort include diseases of the lumbar spine and the hip joint. Problems in the anterior pelvic ring and the pubic symphysis can also be the cause of SI joint syndrome.
Symphysis rupture during childbirth can also lead to problems with the SI joints.
Fortunately, the pain did not become chronic in the present case.
Dr. Lang: This is astonishing and very fortunate – but it is also an indication that we are dealing with a purely mechanical problem here. The SacroLoc helped us in this aspect too. We know that it works and, in Ms. Lepke’s case, it enabled us to break the vicious circle before chronic problems set in.
How did you come to use the SacroLoc?
Dr. Lang: Although we are a rehabilitation clinic, so we don’t use quite as many medical aids as other clinics, as an orthopedist I still need to know what’s on offer. The SacroLoc is the only orthosis that has such a small opening and thus takes up little space. Once we’ve narrowed down the problem, we can achieve a great deal with it in a small space. And this has been further improved by the new generation, which is even more lightweight. I’m always pleased to end up with a small , effective aid that really helps to tackle the problem.
What , in your opinion, is the central point of action of the orthosis?
Dr. Lang: It works on several levels. The orthosis combines mechanical stabilization of the girdle with the proprioceptive effect of the pads, which establishes preliminary muscular tension. The great thing about the SacroLoc is that it does not replace the work of any muscles: It enables their forces to be directed correctly. The ultimate result is the stabilization of the pelvis and the SI joint.
Images: Annika Büssemeier