SIJ

[Dr. Ice]

This is such a boring conversation topic but I can’t help myself. Why is there an obsession with SIJ as a pain generator? Why is it over diagnosed, over treated to the point of fusion. Like what is it? I remember 1st year out of fellowship asking this question to myself and others about unilateral ass pain…to this day I continue to wonder about ass pain and the obsession of SIJ as a go to diagnosis.

Are there any new studies, treatments, diagnostic pearls, let’s please not bore ourselves with “well what’s the exam, what’s the imaging like” I think most of us on here have been practicing enough to not dumb ourselves down to these ridiculous questions.

I’m talking about ass pain, no other reasonable explanation, presumably “SIJ” but why?

And please for the love of god don’t say things like glut med, piriformis, possible facet mediated, proximal hamstring, or whatever other nonsense..been practicing a long time for people to chime in on specifics of certain patients. I’m asking about the obsession of SIJ…why so much industry attention, must be because it is over diagnosed, over treated, etc. I just don’t get it. I helped Furman with the first SIJ atlas chapter in his first (red) atlas, and remember studying the joint in every way. In my experience, no one can really answer the question as to why? It’s just been dogma over years of interventional pain…ass=SIJ, fortin finger, “provocative” testing… but is it really SIJ? I just don’t think so

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[SSdoc33]

Anybody who says they understand the sij is either a liar or a fool.

Wtf is counternutation?

Agree that it is overdiagnosed.

 

[BobBarker]

SIJ is a cruel mistress.

 

[Ferrismonk]

You've studied asses more than I have, and I'm not an ass man, but here's my 2c.

SI joints are talked about so much because something hurts there, we all disagree about the cause, and there are things we can do to try to alleviate it (with varying degrees of success).

I'm in the underdiagnosed camp, but I treat a lot of golfers and people with poor posture/gait mechanics. I'm a DO and have felt restrictions to movement and seen relief of pain with restoration of movement.

 

[Dr. Ice]

You've studied asses more than I have, and I'm not an ass man, but here's my 2c.

SI joints are talked about so much because something hurts there, we all disagree about the cause, and there are things we can do to try to alleviate it (with varying degrees of success).

I'm in the underdiagnosed camp, but I treat a lot of golfers and people with poor posture/gait mechanics. I'm a DO and have felt restrictions to movement and seen relief of pain with restoration of movement.

I’m a DO too..what do you mean by restoration of movement? Are you manipulating these folk or sending them for manip? I would be open to that if there was success

Ah yes I fondly remember omt lab with “innominate” sheers and what not..never really cared to understand that ****e..maybe there was something to it

 

[Dr. Ice]

Btw love how the anesthesia folk are either rolling their eyes or like bro just inject that **** and move on with your life…I know I know, hence the first sentence in my post about boring topic. Y’all don’t have to look…or you can think about peripheral stim or however else you can put some wire in somewhere lol cause who really cares about that why as long as there’s a what right? I feel you dogs…keep stimming the good stim

 

[willabeast]

Just a guess, but when surgery fails helps to have a patsy - SI joint is convenient.

 

[NJPAIN]

This is such a boring conversation topic but I can’t help myself. Why is there an obsession with SIJ as a pain generator? Why is it over diagnosed, over treated to the point of fusion. Like what is it? I remember 1st year out of fellowship asking this question to myself and others about unilateral ass pain…to this day I continue to wonder about ass pain and the obsession of SIJ as a go to diagnosis.

Are there any new studies, treatments, diagnostic pearls, let’s please not bore ourselves with “well what’s the exam, what’s the imaging like” I think most of us on here have been practicing enough to not dumb ourselves down to these ridiculous questions.

I’m talking about ass pain, no other reasonable explanation, presumably “SIJ” but why?

And please for the love of god don’t say things like glut med, piriformis, possible facet mediated, proximal hamstring, or whatever other nonsense..been practicing a long time for people to chime in on specifics of certain patients. I’m asking about the obsession of SIJ…why so much industry attention, must be because it is over diagnosed, over treated, etc. I just don’t get it. I helped Furman with the first SIJ atlas chapter in his first (red) atlas, and remember studying the joint in every way. In my experience, no one can really answer the question as to why? It’s just been dogma over years of interventional pain…ass=SIJ, fortin finger, “provocative” testing… but is it really SIJ? I just don’t think so

I agree. I now have many patients sent directly for a procedure without an initial consultation. Many of them are sent for SIJ injection, often bilateral, as part of referring provider’s protocol for w/u and treatment of low back pain. Many have nothing more than pain near the PSIS. No PE c/w SIJ dysfunction. Many are patients in their 70s and 80s. In my mind I have to question does the SIJ of an 80 year old move enough to cause pain absent a predisposing factor such as lumbar fusion?

 

[SpineandWine]

What’s the differential, any other targets for unilateral ass pain?
-iliolumbar ligament, Ischial bursa, cluneal nerves, facets, piriformis, gluteal tendinopathy, radic
What’s higher yield than SI for unilateral butt pain?

 

[deleted131481]

 

[Ferrismonk]

I’m a DO too..what do you mean by restoration of movement? Are you manipulating these folk or sending them for manip? I would be open to that if there was success

Ah yes I fondly remember omt lab with “innominate” sheers and what not..never really cared to understand that ****e..maybe there was something to it

I have and continue to do manipulation for certain patients (if time allows, which isn't often where I work unfortunately) and friends/family. I've had reasonable success. I'll either do some muscle energy techniques or sometimes just a sacral spring to get the sacrum moving again. In my practice, I often just refer to our local OMT guys who do a great job. I live near MSUCOM so that helps a ton.

 

[Greenbayslacker]

Boomers hate the SIJ

 

[Dr. Ice]

I agree. I now have many patients sent directly for a procedure without an initial consultation. Many of them are sent for SIJ injection, often bilateral, as part of referring provider’s protocol for w/u and treatment of low back pain. Many have nothing more than pain near the PSIS. No PE c/w SIJ dysfunction. Many are patients in their 70s and 80s. In my mind I have to question does the SIJ of an 80 year old move enough to cause pain absent a predisposing factor such as lumbar fusion?

It doesn’t help that the PTs are constantly documenting SIJ or piriformis. I also can’t stand that they treat everything like disc. Like if I send a patient with facet pain and clearly state flexion based program, the patient comes back and says “well the PT had me do cobra pose and now my pain is worse.” Someone needs to eradicate the “D” in front of the the PT…

 

[Dr. Ice]

What’s the differential, any other targets for unilateral ass pain?
-iliolumbar ligament, Ischial bursa, cluneal nerves, facets, piriformis, gluteal tendinopathy, radic
What’s higher yield than SI for unilateral butt pain?

The problem is that it’s not high yield. Let’s say this hypothetical patient gets “relief” from the SIJ injection. But the pain comes back, oh I don’t know, like 6 weeks later. Was it really 6 weeks of pain relief, or are they just saying that cause it was ok for 2 weeks and then they ignored it then it took them another few weeks to come back to see you. So you inject it again…and some temp relief. What’s next? SIJ rfa? Is it covered? How bout SI bone, corner loc? I’ve told myself SIJ prp works well too. Had a guy that convinced himself that prp was the right treatment for his “SIJ pain” he had every treatment under the sun for his ass. Nothing worked. He came in begging for SIJ prp. I thought he was overly aggressive asking for it and was concerned about his overall demeanor.

I did it because as I charge literally nothing for prp I was still able to “sleep at night” and I knew he was gonna eventually find someone to do it so honestly why not me. He was 90% better in two weeks, which doesn’t even make sense.

Point is that SIJ pathology is unnecessarily driven into people’s minds without any real basis other than, well we can kind of treat it and we don’t know what else is causing your ass to hurt and we need to provide an answer cause that’s how life works….

 

[SpineandWine]

The problem is that it’s not high yield. Let’s say this hypothetical patient gets “relief” from the SIJ injection. But the pain comes back, oh I don’t know, like 6 weeks later. Was it really 6 weeks of pain relief, or are they just saying that cause it was ok for 2 weeks and then they ignored it then it took them another few weeks to come back to see you. So you inject it again…and some temp relief. What’s next? SIJ rfa? Is it covered? How bout SI bone, corner loc? I’ve told myself SIJ prp works well too. Had a guy that convinced himself that prp was the right treatment for his “SIJ pain” he had every treatment under the sun for his ass. Nothing worked. He came in begging for SIJ prp. I thought he was overly aggressive asking for it and was concerned about his overall demeanor.

I did it because as I charge literally nothing for prp I was still able to “sleep at night” and I knew he was gonna eventually find someone to do it so honestly why not me. He was 90% better in two weeks, which doesn’t even make sense.

Point is that SIJ pathology is unnecessarily driven into people’s minds without any real basis other than, well we can kind of treat it and we don’t know what else is causing your ass to hurt and we need to provide an answer cause that’s how life works….

What do you think is most likely causing unilateral ass pain then and what’s your algorithm/treatment you offer then in your practice

 

[Dr. Ice]

What do you think is most likely causing unilateral ass pain then and what’s your algorithm/treatment you offer then in your practice

I don’t do anything different than anyone else. My point is not to say what I do is any better than others, I’m just saying the pathology is over diagnosed and has led to a lot of industry driven potentially harmful and unnecessary treatments.

 

[Ducttape]

Point is that SIJ pathology is unnecessarily driven into people’s minds without any real basis other than, well we can kind of treat it and we don’t know what else is causing your ass to hurt and we need to provide an answer cause that’s how life works….

such treatment focuses on exercise and stretches, and telling people to focus on non-interventional treatment doesn't generate income and may give bad reviews. patients expect "fancy" injections or other such treatment. and, to be honest, an interventional pain doctor may - for whatever reason - not feel right to not rely on the point of their quincke.

and all those other treatments make money.

 

[MitchLevi]

Some of the worst pts I've ever seen are s/p SIJ fusion.

There's a strong correlation between SIJ pain and anxiety.

 

[Magnus Acus]

What are you all seeing as far as objective findings and their correlations to reported SIJ pain?

In other words, how often does the SIJ looking perfectly healthy with “SIJ pain” vs terrible SIJ and no pain.

Is there any metric that would make the majority of you think “Ok, this is ACTUALLY SIJ”

 

[drusso]

Anybody who says they understand the sij is either a liar or a fool.

Wtf is counternutation?

Agree that it is overdiagnosed.

It's not that deep...

Home |Principles of Manual Medicine| MSUCOM

 

[SSdoc33]

It's not that deep...

Home |Principles of Manual Medicine| MSUCOM

ugh. dont show me the greenman stuff. im having SIJ PTSD. if you start talking about moment arms and prostetic placements, i am gonna put my fist through the screen.


my commentary still stands, though. which category do you fall into?

 

[drusso]

ugh. dont show me the greenman stuff. im having SIJ PTSD. if you start talking about moment arms and prostetic placements, i am gonna put my fist through the screen.


my commentary still stands, though. which category do you fall into?

I've referred exactly 2 patients for SIJ fusions in 17 years.

This will be discussed this week in Chicago and a group of brave, pioneering researchers will be doing "field research" on the epidemiology of SIJ dysfunction in occupationally high risk acrobatic pole dancers...

 

[jsaul]

I've referred exactly 2 patients for SIJ fusions in 17 years.

This will be discussed this week in Chicago and a group of brave, pioneering researchers will be doing "field research" on the epidemiology of SIJ dysfunction in occupationally high risk acrobatic pole dancers...

View attachment 376876

I did research in residency about personal nerve palsy in this same patient population.
The risks are real for occupational musculoskeletal injuries in this patient population. Further research is necessary