ISG blockage
Synonyms
Hypomobility of the sacroiliac joint
Sacrum and iliac obstruction, SIJ blockade, ISG blocking
SIG block, SIG block, sacroiliac joint blockage, sacroiliac joint blockade, sacroiliac joint blockage, sacroiliac joint blockade
General
The sacroiliac joint is one of the most therapy-intensive areas of the body affected by pain
60-80% of the population suffers from an ISG blockage and therefore from once in a lifetime Back pain.
Blockage of the SIJ can occur at any age and affects men and women equally.
The sacrum and iliac joint is the point of deflection of the uniaxial locomotor organ, the spine, to the biaxial locomotor organ legs. These transition zones are particularly prone to malfunctions.
Other transition zones in which blockages often occur are the head joints, the cervicothoracic transition (transition from the cervical to the thoracic spine) and the thoracolumbar transition (transition from the thoracic to the thoracic spine) and the thoracolumbar transition (transition from the thoracic to the thoracic spine) Lumbar spine).
introduction
Under one blocking one understands a reversible deviation from the normal joint function in which the joint play (joint-play) is restricted or eliminated within the normal, physiological range of motion of a joint. A joint blockage is caused by functional or structural changes in the joint surfaces or in the soft tissue covering. One or more directions of movement of a joint or movement segment can be affected. A characteristic of the blocking is that it always has a free direction of movement.
Illustration of an ISG blockage
ISG - blockade - conduction symptoms
- Sacrum-iliac joint
(Sacroiliac joint,
abbreviated ISG)
Articulatio sacroiliaca - Front Sacrum-iliac ligament
Lig. Sacroiliacum anterius - Iliac bone - Os ilium
- Sacrum - Sacrum
- Lumbar and sacrum kink -
Promontory - Fifth lumbar vertebra -
Vertebra lumbalis V - First lumbar vertebra -
Vertebra lumbalis I - Thoracolumbar junction
- Twelfth thoracic vertebra -
Vertebra thoracica XII - Hip joint - Articulatio coxae
Pain radiation areas:
A - lumbar spine (lumbar spine)
B - buttock region - Gluteal region
C - Groin - Inguinal region
D - front and back leg
E - knee
You can find an overview of all Dr-Gumpert images at: medical illustrations
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The spine is difficult to treat. On the one hand it is exposed to high mechanical loads, on the other hand it has great mobility.
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Therapy of an ISG blockade
At this point it should be pointed out that only a small selection of therapeutic techniques is to be described here and that completeness cannot be guaranteed.
A basic distinction is made between mobilization (soft technique) and manipulation (technique with short, fast impulses)
- Mobilization of the sacroiliac joint through the cross grip in the prone position
This technique is well suited for a joint that is blocked on one side (one-sided SI joint blockage). The patient lies on his stomach and the therapist stands on the opposite (not treated) side. The patient's abdomen should be padded to accommodate the Lordosis (normal position of the lumbar spine) to balance the lumbar spine.
During the execution, one hand of the therapist fixes the lower end of the Sacrum, the other hand lies close to the joint and mobilizes the SI joint to be treated forwards and sideways. - Mobilization of the sacroiliac joint in the lateral position
The aim of this technique is to achieve traction in the ISG. The patient lies on his side. The therapist tests the joint play by applying pressure to the upper iliac bone with the forearm. If the diagnosis of SIJ blockade has been made, you can go straight to treatment from this position. The pressure on the upper iliac bone creates a gap in the treated SIJ and the blockage is thus released.
If pain occurs during prolonged exposure, this indicates weakness in the ligaments. - Automobilization
In the case of an ISG blockage, there is also the option of eliminating the functional disorder yourself, with the patient standing on four feet on the patient bed.
By raising and lowering the thigh, which protrudes freely over the edge of the table, the ISG becomes unblocked. - Manipulation of the ISG in the cross handle
With this technique, the patient lies on their stomach and the therapist stands on the side not to be treated. With one hand he fixes the iliac crest on the posterior superior iliac spine and the other hand rests on the tip of the sacrum. After a short tension, the therapist gives a short impulse to the front and side.
Before deciding on a technique, it must be investigated whether the cause of the discomfort lies in the joint or in other areas as part of a pelvic twist, e.g. in the muscles.
Infiltration of the ISG with a local anesthetic in combination with cortisone can also help improve symptoms.
In order to bring down the pain level, one should be supportive for a few days NSAIDs how Ibuprofen or Voltaren be given in combination with a muscle relaxant (e.g. Sirdalud®).
After the treatment, the patient is recommended to move around and to take local warming measures (warm baths, hot water bottles, cherry stone pillows).
In general, one must add that disorders in the area of the sacroiliac joints are mostly secondary. For this reason, causes in the spine and hips must be excluded.
If the symptoms do not improve after 2-3 treatments, inflammatory, rheumatological and Tumor diseases be excluded.
Solve the ISG blockade yourself
If there is an ISG blockage, a doctor should first determine which treatment steps are required by means of precise diagnostics and anamnesis. The blockage can be released or loosened immediately with specific grips. Multiple treatments are often necessary. In these cases, individual movements and exercises can be performed by yourself under the precise guidance of a doctor in order to release the blockage. These exercises aim at that To relax the joint region and the to strengthen the surrounding muscles.
In one exercise it can The affected leg is slowly pivoted back and forth in the extended state to relax the joint. You can do this by standing with your sound leg on an edge or an elevation, for example a step. In acute cramps and pain, they can on the Put your back and the Legs at a 90 degree angle one Put the chair up. This posture relieves the joint and alleviates pain in acute cases. With the help of self-performed muscle exercises, therapy can be carried out and future blockages can be counteracted. However, the exercises must not be used for self-therapy alone, but only as a supplement to therapy and under the guidance of a doctor.
Taping
With the so-called "Kinesio tapes“It is an alternative medical practice that is used by many orthopedic and sports medicine specialists today. It is used in the treatment and prevention of muscle problems, bruises and also in the stabilization of joints. It is a tight tape that is stuck to the outside of the skin. It takes some practice to use it. Initially, it should be done by a doctor or physical therapist. It is particularly difficult to apply the tape to your back yourself when you have an SIJ block.
By it glued from the buttocks to the middle back it exerts tension on the SI joint out and can stabilize and the Support muscles. In addition, it warms the covered muscle areas and relaxes the joint at rest.
Osteopathy
The Osteopathy is an alternative medical concept that tries to bring musculoskeletal problems into harmony with body, mind and soul. The osteopathic treatment sees itself less as a therapy of the movement system, but more than holistic therapy conceptwith which the musculoskeletal system is also brought into harmony.
When treating SIJ blockade, the osteopath tries to reach the patient on a spiritual level in order to reach the Self-healing powers to promote. Be there gentle, manual therapies performed with slight stretch the affected muscles. An osteopathic treatment of the SI joint blockade usually takes about 60 minutes. If osteopathy reaches its limits, if the symptoms persist or if the symptoms are severe, an orthopedic surgeon should still be consulted.
acupuncture
Also the acupuncture can be used as an alternative medical concept for the treatment of SI joint blockade. Especially in combination with osteopathy, it provides a gentle treatment approach for mild, chronic complaints. Originally it is a discipline of traditional chinese medicineIn today's alternative medicine, it is the procedure of greatest importance and application. To do this, fine needles are inserted into the skin at certain points on the body. After just a few stitches and treatments, an improvement in pain due to the ISG blockade is expected.
ISG block acupuncture brings many patients a feeling of improvement and healing. The Mode of action but it is not fully researched and proven. For severe and acute symptoms, acupuncture should only be used in addition to other treatments. Such a therapy plan must always be with you one Doctor.
anatomy
The ISG (medical: Articulatio sacroiliaca) is the articulated connection between the Sacrum The articular surfaces (facies auricularis) between these two bones are boomerang-shaped to c-shaped and are located between the 1st and 3rd sacral vertebrae. They consist of an upper and lower pole, the transition point of which is approximately at the level of the 2nd sacral vertebra. There is a kink between the upper and lower pole, the angle of which is 100-120 °.
The surface area of the joint surfaces, the position of the sacrum in the pelvic ring and a number of ligaments are responsible for the stability of the SI joint. Because of these stabilizing factors, only small movements are possible in the ISG. Active movement in the ISG is not possible. Due to misalignments of the intestine or the sacrum, the affected ligaments are increasingly stressed. The consequence is an increase in tension in the ligaments, which can lead to a movement disorder of the SI joint and thus to a blockage.
The ISG is mainly innervated from the S1 root.
Figure ISG - joint
- Sacrum-iliac joint
(Sacroiliac joint, abbreviated ISG)
Articulatio sacroiliaca - Iliac bone -
Os ilium - Sacrum -
Sacrum - Anterior sacrum-iliac bone
-Tape -
Lig. Sacroiliacum anterius - Fifth lumbar vertebra -
Vertebra lumbalis V - Fourth lumbar vertebra -
Vertebra lumbalis IV - Tailbone -
Os coccyxis - Pubic bone -
Pubis - Femoral shaft -
Corpus femoris - Lumbar cruciate ligament kink -
Promontory
You can find an overview of all Dr-Gumpert images at: medical illustrations
causes
As already mentioned at the beginning, the SIJ like any other joint has a physiological joint clearance (joint-play). This is understood to be the sum of the passive movement possibilities that a joint can perform and is therefore a basic requirement for normal, healthy joint function. If this joint play is reduced, there is a blockage.
With regard to the sacroiliac joint, the cause of a blockage is usually a lifting trauma or, traditionally, stepping into space, for example when overlooking a step.
Blockage of the SI joint often occurs as an accompanying phenomenon in other orthopedic diseases, such as after hip operations or in the context of spinal diseases.
Also read: SI joint osteoarthritis
ISG blockage due to hip disease
The sacroiliac joint is anatomically closely connected to the hip. The hip bones are functionally closely related to the spine via this joint. In diseases of the hip, there is a frequent connection to changes in movement and posture in the pelvis and the occurrence of an ISG blockade. A long-standing one Osteoarthritis of the hip can represent such a disease. Likewise can Overstretching of the ligaments the hip, Connective tissue weaknesses and past pregnancies cause damage to the pelvis, creating an ISG blockage. Also Broken bones and other traumatic injuries can result in joint problems. The chronic inflammatory disease is less common ankylosing spondylitis behind an ISG blockage.
ISG blockage in pregnancy
Apart from the very stressful birth process, changes in the body can also take place during pregnancy, which favor an ISG blockade. Above all, that plays a role hormone Relaxin a major role. As the name implies, the hormone is released during pregnancy, to relax structures in the female body. This also includes muscles, fasciae and connective tissue in the woman's pelvis. By changing the force and traction ratios a Increased load on the sacroiliac joint with an ISG blockade.
Also the Weight load through the growing child leads to changes in the load on the muscular and bony structures in the abdomen and pelvis, which in turn can cause pain.
ISG blockage after delivery
The delivery of a pregnant woman is a heavy burden on the woman's body in the majority of cases. The SI joint joint can face particular challenges during and after a natural birth. In the natural birth the child is pushed through the small pelvis, which is smaller or larger depending on the anatomy of the woman Stress on the bones of the pelvis and pelvic floor muscles represents. The birth also puts a lot of strain on the SI joint. Hormones during pregnancy also loosen the structures of the pelvis to make the birth process easier. This is also at the expense of the spine and can trigger an ISG blockage.
With one through birth torn pubic symphysis ISG blockages can also occur some time after delivery. This is due to the body's efforts to repair and changes in the structures of connective tissue.
Symptoms of an SIJ block
The leading symptom of the SIJ blockade is Back pain, which is often described as deep-lumbar and usually occurs on one side. Pain intensification after prolonged sitting and an improvement in symptoms through exercise and the application of heat are common.
Often there is a radiation of pain in the buttocks area, in the groin and in the lumbar spine area. A combination with abnormal sensations such as tingling and pins and needles is also observed. Knee pain should also make the doctor think about the differential diagnostic possibility of an ISG blockade.
The symptoms of SI joint blockade belong to the group of pseudoradicular pain syndromes.
Basically, you can radicular of the pseudoradicular Differentiate pain syndromes.
Pseudoradicular pain is pain that is not caused by root irritation. Traditionally, patients report back pain that radiates into the leg, can affect the front and back of the leg, but usually ends in the knee area. The back of the knee is often spared from the pain. Sensitivity disorders in the form of tingling and pins and needles can also occur. Since the spinal nerve is not affected in the pseudoradicular pain syndromes, the sensory disturbances can not be Dermatomes (the skin area supplied by a spinal cord nerve).
With radicular pain like it does with one Herniated disc of the lumbar spine occurs, the nerve root becomes irritated. Accordingly, the pain and sensory disturbances radiating to the extremity are dermatome related.
The second leading symptom of SI joint blockade, besides back pain, is the Groin pain. From a functional point of view, if groin pain occurs, the doctor should examine the following areas of the body:
- The ISG
- The hip joint
- The lumbar spine (often the L3 / 4 segment)
- The thoracolumbar junction
Read a lot more information on this topic at: Symptoms of an SIJ blockage
Tingling in the foot
If the SI joint is severely blocked, symptoms can spread and be felt in the hip, along the leg, and in the foot. Initially, the transmission manifests itself as a tingling sensation in the toes, this is also called "ant walking". A sensitive numbness follows, pain is less common. Knee pain is also typical with an ISG block. When forwarding these symptoms one speaks of so-called pseudoradicular Pain. The name means that the symptoms are similar to nerve damage to the spinal cord, but there is no such damage. The nerve is not affected, so the prognosis for healing is better. When the SI joint blockage is removed, the symptoms in the leg and foot should also stop.
There is an essential difference here from herniated discs of the lumbar spine, which express themselves with similar symptoms, but affect the nerve itself and can leave permanent damage.
SIJ blockage pain
The SIJ blockade can occur suddenly or creep in chronically. In any case, it expresses itself through one Lower back pain. This can be diffuse across the entire lumbar spine. It is not uncommon, however selectively on the Limited area of the SI joint blockade. In addition, the Radiate pain and pulling along certain lines into the leg, causing knee pain, or making the feet tingling or numb.
Painful is especially the Movement of the pelvisHowever, tilting the pelvis backwards often relieves the pain. Long periods of immobility while sitting, standing, or lying down also lead to pain and muscle stiffness. Lying down, especially with straight legs, is usually accompanied by severe pain. Depending on the cause of the SI joint blockage, pain in the groin or pubic bone can also occur.
Pain at night
The nights were torture for many sufferers of an ISG blockade. Lying on your back with your legs stretched out is a particular strain on the lumbar spine. Likewise, the symptoms of an ISG blockage worsen little movement. After a night lying down, like after long periods of sitting or standing in the same position, the pain is particularly severe and the surrounding muscles are stiff. If it is not too uncomfortable for the person concerned, the Legs bent at 90 degrees, lying on your back and put up. This relieves the SI joint blockage and relaxes the joint.
Pain after releasing the SIJ blockade
The SIJ blockage cannot always be completely cured by a one-off treatment by the orthopedic surgeon. Some patients suffer from chronic complaintswhich can only be slowly improved. In many cases got to an ISG blockage through active muscle building and Physiotherapy can be counteracted. Many therapy sessions may have passed until there has been a significant improvement, and even then pain may recur after a long period of inactivity or strenuous posture.
From symptom to diagnosis
The prerequisite for diagnosing an ISG blockade is first of all a good medical history, which gives important information about the correct body region and functional disorder.
After the inspection where changes in the posture pattern are recognized and documented, the physical examination follows.
There are a number of tests that the doctor can use to identify a malfunction.
A basic distinction is made between orienting tests, which give the doctor indications of a functional disorder, and joint play tests, which confirm the diagnosis of the blockage. It is always important to consider important differential diagnoses such as inflammation and tumorous diseases.
Once the SIJ blockade has been diagnosed and structural causes have been ruled out, a number of treatment techniques are available to the doctor.
Differential diagnosis / alternative causes
From a functional point of view, one differentiates between one Pelvic distortion and one ISG blockage
The Pelvic distortion is actually a normal process when walking. But if there are functional disorders that are not caused by the ISG, but e.g. In the spine or in the head joints, pelvic twisting can also occur as a compensation mechanism.
The pelvic twist is characterized by:
- an asymmetry of the pelvic position, the position of the pubic branches, or an indifference of the iliac spines on one side. The ISG block usually does not have these asymmetries.
- a positive forward phenomenon on the corresponding side, which disappears after 20-30 seconds with the trunk flexed to the maximum. In the event of a blockage, the advance remains constant.
- normal joint play.
In order to treat the pelvic distortion, the cause must be found and treated.
It must be differentiated whether the cause is in the joint or in the muscles.
The pelvic twist and SIJ blockade can also be combined.
ISG blockage or inflammation?
Inflammation is often a chronic process that first appears in early adulthood. Typical is a rather insidious beginning with no apparent cause. The pain is particularly severe when there is a sedentary lifestyle. Through targeted Laboratory diagnostics or a Contrasting MRI an inflammation can be distinguished from an ISG blockade. Therapy is more likely to be drug-based Anti-inflammatories, however, is also a regular one Exercise therapy important part of the treatment.
Duration
The duration of the SI joint blockade cannot always be precisely predicted. What matters is the cause for the blockage, the severity of the pain and the response to treatment by the orthopedic surgeon. A distinction must be made between acute and chronic blockages. The latter is also called "permanent blockade".
In acute cases of SIJ blockage, which is largely caused by muscle tension, a single therapy can sometimes be sufficient to eliminate the cause and the pain. A typical treatment, which consists of slow mobilization of the muscles or jerky manipulation of the joint, takes about 30 minutes a day. In acute cases the pain improves with each session and the blockage should be resolved after 2-3 weeks at the latest.
However, the pain can also increase chronic develop. That way he stays over several weeks and months consist. In these cases, the treatment benefits from extensive physiotherapy and consistent muscle building in the lower back. The training of the muscles should, if possible, be maintained for life. The pain and blockage usually go away after months of consistent muscle building.
Permanent blockade
If the cause of the SIJ blockage is not easily relieved muscle tension, other treatment steps must be taken. The pain often occurs over several weeks and not as a result of a one-off event. Likewise, the treatment and resolution of the pain are not guaranteed with a single visit to an orthopedic surgeon.
The mobilization and manipulation by doctors or therapists must be followed by exercise therapy and muscle building. As part of the targeted muscle training in the lower back, the patients strengthen the core and pelvic muscles. In addition, they get to know their movement options better or how to deal with the blockage and pain and gain a better body awareness.
The aim of therapy for chronic ISG blockade is freedom from pain and avoidance of medication.
How do I prevent an ISG blockage?
Preventing an SI joint blockage should consist of three important points.
First and foremost, one must sufficient muscles of the back and pelvis to be available. With strong muscles, connective tissue problems and bony stresses can be avoided or compensated in many areas of the body. Strong muscles protect ligaments and joints, especially in the heavily used pelvis.
Likewise should a adequate exercise with a healthy posture be done regularly. Sitting, standing or lying down for long periods of time in everyday life can damage many areas of the spine in the long term.
If there are problems with the spine, you can also relaxing exercises be performed. In order to counteract an acute SIJ blockage, the joint structures can be relieved and loosened through certain positions and movements.
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