SI joint, sacrum, psoas -- what is wrong?

I just posted this also in the Orthopedic section -- I'm sorry, I didn't realize that there was a section for patients!!


I'm a 48 year old woman. I've been told that I have a mildly herniated disc at L4-L5, another small herniation at L5/S1, and that I have some arthritis in my spine.

I've been dealing with lower back pain for almost 2 years, and have had this type of problem on and off throughout my adult life.

Four weeks ago, I got some epidural cortisone shots for the L4/5 area and also the sciatic nerve going down the right leg. Please note that I did not have any sciatic pain in either leg. My orthopedist gave me the sciatic shot on the right because I've been having some groin muscle pain on the right side and he said it was related to the nerve. After the shots, my left lower back began hurting when I tried to sit. There was also sciatic nerve sensitivity down the left leg (never had it before -- fortunately it is beginning to go away).

Something on the left side of my lower back just doesn't feel right. If I sit for a period of time, my lower left back hurts, near the SI joint area. I have been told in the past, by a physical therapist that my SI joint was stuck. I have also been told by an osteopath that my sacrum keeps getting twisted because of a muscle imbalance and tight facia on the left side. He also said he thought my psoas muscle was too tight.

My previous physical therapist used to do this test on me: put his thumbs by my pelvis, then stretch out my legs, have me raise my butt up and down, then put his thumbs by my pelvis again....at times he would tell me that something in my pelvis was not aligned. If so, he'd put me in pretzel position on the table, and rock me back and forth -- I think that he was trying to loosen something up in my pelvis or SI joint. All I know is that it often helped tremendously. When he did that "test" again he would often say that "it was better" or "better than before."

After getting the cortisone shots, my orthopedist wanted me to begin core abdominal exercises at a totally different physical therapy place. They had me tightening my lower abs and pulling on some light therabands with handles. Everything seemed fine until a few weeks later, when they had me put a 1lb weight on my ankles and keep my lower abs tight while raising one knee at a time. This really flared up my left lower back. I'm not sure why. But...I came across some info on the "stork test" for SI joint problems, so I wonder if, in putting weight on that ankle and raising that leg, I didn't irritate something related to my SI joint.

I'm just not sure what is going on with my left lower back. Sometimes it even hurts to put my hand on the side of my left hip and lightly press downward.

It seems to me that something is out of place. I'm not sure whether I should go to my former osteopath, to my former physical therapist, to the new physical therapist, or just chill out and wait for it to all settle down. The pain is better than it was a few weeks ago. I'm NOT going for anymore cortisone shots -- they seem to have affected the nerve and flared up my problems. In the weeks before getting the cortisone shots, I may have had muscle pain or tightness in my back, but not at the SI joint area. In fact, the SI joint area hadn't been a problem for almost a year!

From the way I describe these symptoms, can you guys help me figure out what the heck is going on, and the best way to fix it? I swear, it does feel like something is "stuck" back there. Is it the SI joint or something else or perhaps a combination of things?

Oh...another thing....I find myself chlenching my gluteal muscles WAY too much when I'm standing...to the point where I think the gluteal and surrounding muscles begin to tighten up from over-use. I have to constantly tell myself to stop clenching. From what I understand, clenching muscles like that is a "protection" mechanism. But I'm not sure what my body is trying to protect.

In my own, personal and professional experience, I have found that when the psoas muscle is tight, direct palpation and manipulation of it will help it to relax, an assist in creating length. Have you tried finding a massage therapist who is willing to perform this type of service? Typically, for best results, a therapist may choose to follow up with some PNF stretching. If you choose to try this, I would interview your therapists carefully, and make it very clear that you are seeking this specific service.

Hi Flutterby,

I have had some trouble with SIJ and lumbar spine too. One thing that really helped the SIJ was this simple youtube clip:

YouTube - SI Joint Treatment

Give it a go and see if it helps. In terms of hard research, there is no evidence to support the SIJ being out of alignment because the movement in SIJ is very very minimal. That doesn't mean that it can't be a source of symptoms or that it doesn't respond to manipulation/mobilisation. But yeah this just means that the SIJ is not really understood.


This is also a good video about muscle imbalances:

YouTube - Muscle Imbalances