Pain during Getting up or down

[sanagupta]

Hi!
I have come across many clients who have lpain along the iliac crest while sitting and getting up..Sometimes even turning at night.with no other low back pain.The age may range from 24 to 65..or any..
Can u help me in finding the reason for this pain..Hip musculature is in good length and shape,lordosis maintained.
Regards
Sana

[jerryhesch]

A few thoughts. It is never easy to give advise via this type of format - much better to have client in your presence. That being said, consideration should be given to a few things such as a neuropathy involving the cluenal nerves or iliohypogastric. Look into ADL's for possible inciting factors. Is belt worn too tightly, or a tool belt, work unigform, etc? Is there any behavioral cause, some repetitive motion, posture or man-machine interface that can apply subtle pressure? How old is their car and what is the quality of the upholstery. I used to keep my cars for many years and the wear pattern inthe upholstery was an inciting factor. Do a web search on Dr Maigne, the French physician who practices manual medicine. He is brilliant. He has written on a variety of topics to include T12-L1 junction syndrome. Screen that articulation and the 12th rib. Motion dysfunction in that articulation is typically an inferior glide fixation which responds to gentle superior glide maintained 2-5 minutes by just holding constant force of about 10-15lbs in a superior and slightly anterior direction (to be scientific one would use other terms such as Newtons, but being pragmatic you can easily practise on a bathroom scale - see studies such as Matayas and Bach in Physical Therapy 1992 (?)) Then check for medial and lateral glide of the rib,as well. Screen for trigger points, especially in obliques and quadratus L. If it does not quickly respond to intervention additional medical screening warranted.
Jerry Hesch

[sdkashif]

First of all look for possible sources for low back pain. Rule out any serious causes by subjective and objective examination. Don't forget the myofascial pain syndromes. Do the trigger point screening of the following muscles Logissimus thoracis, Iliocostalis lumborum, Iliocostalis thoracis, Multifidus. rectus abdominis.

Positional factors indicate the mechanical nature of the musculoskeletal pain syndromes. Pain is made worse or better by adopting the particular positions or postures that either stretch or compress the structure that is giving rise to pain. Various body or limb positions place different structures on stretch or compression and the resultant deformation produces an increase in severity of pain.

[marj]

Have you checked vertebral alignment and joint glides in the lumbosacral region? In my experience if L5 is maintained in a roated position, then it may be symptomatic with position changes.
Marj

[MrPhysio+]

Hi
In my experience, this pain is most likely to be Sacro-iliac in nature.
If pain also spreads to anterior thigh, or groin, plus erector spinae/piriformis is tight as a protective response, the SIJ should be treated. Reduce the muscle tightened areas, teach exercise for rythmic alternating hip raise in supine for two minutes. Chronic problem may need narrow 50mm SIJ rigid belt, to be applied and tightened when in supine - only use the belt if not responding to other therapy.
MrPhysio

[OMT PT]

I agree with MrPhysio, it sounds like it could come from the Sacro-Iliac joint. Check the SIJ for a dysfunction and reproduction of the pain. A manipulation/mobilization could help.

[somasimple]

Hi All,

Spine. 2002 Jun 1;27(11):1202-7.
Histologic analysis of neural elements in the human sacroiliac joint.

Vilensky JA, O'Connor BL, Fortin JD, Merkel GJ, Jimenez AM, Scofield BA, Kleiner JB.

Departments of Anatomy and Microbiology, Indiana University School of Medicine, Fort Wayne, Indiana. [email protected]

STUDY DESIGN: The posterior ligament of the human sacroiliac joint was examined for nerves and nerve endings using histologic and immunohistochemical techniques. OBJECTIVE: To identify nerve fibers and mechanoreceptors in the posterior ligament. SUMMARY OF BACKGROUND DATA: According to the findings of previous studies, the human sacroiliac joint receives myelinated and unmyelinated axons that presumably conduct pain and proprioceptive impulses derived from mechanoreceptors and free nerve endings in the human sacroiliac joint. METHODS: Tissue obtained from six patients was stained with gold chloride and that obtained from six additional patients was stained using antibodies specific for substance P and protein gene product 9.5. RESULTS: The staining of joint tissue using the gold chloride technique showed myelinated and unmyelinated nerve fibers, two morphotypes of paciniform encapsulated mechanoreceptors, and a single nonpaciniform mechanoreceptor. Analysis using immunohistochemical staining for protein gene product 9.5 did not unequivocally show axons, nerve fascicles, or mechanoreceptors. Similarly, analysis based on immunohistochemical staining for substance P, one of several neurotransmitters known to signal pain from the periphery, showed reactive elements that may have been nerves, but because of background staining, could not be positively identified as such. CONCLUSIONS: The presence of nerve fibers and mechanoreceptors in the sacroiliac ligament demonstrates that the central nervous system receives information, certainly proprioceptive, and possibly pain from the sacroiliac joint. Although it is not known how the central nervous system uses such information, it seems reasonable to speculate that the proprioceptive information is used to optimize upper body balance at this joint. In addition, because the staining techniques used generally to show nerves and nerve elements in periarticular connective tissue are nonspecific, the distinction between neural and nonneural should be made on the basis of both morphologic and staining characteristics.

PMID: 12045518 [PubMed - indexed for MEDLINE]

[rkinni7]

please check if there is anterior tilt or posterior tilt of the hip bone and lateral bending of the client.

[joyce]

It is also important to consider ITB syndrome in this case. Remember that the ITB originates at the iliac crest thru the TFL. ITB assists in flexion and extension of the leg at the knee joint which can be associated with sitting and getting up. Also, TFL and ITB abduct and internally rotate the thigh at the hip joint which can be associated with the symptoms noted when turning.

[sanagupta]

hello everybody...
Thanx for ur replies..i m sorry for my late reply to it..i'll reply to all ur suggestions in the order they are posted..
1.there was no precipitating factor of belt or tight uniform...many of them are simple house wives who don't drive...I'll screen for 12 rib ...that i have not checked..
2. there were no trigger points present..In one i did find in the superior part of the buttock???
3.there was no problem at L5- S1 region...
4. I was trying to treat this problem as SIjt. problem and took care of the piriformis..
5.no lateral bending was present...i m not sure of the tilts..i'll check and tell
6. i'll check for ITB
regards
SANA