Can Your Back Really Go Out???
Anyone who knows me knows that I'm not really one to rock the boat. I'm happy to let things go so as to not tick off anybody or in most cases, I just don't deem certain things important enough to make a huge fuss about.
But I can't hold my tongue on this anymore. I think it's time to let my opinion (more likely the facts) be known about what many individuals assume is their "back going out."
You see words matter. My frustration with individuals believing and practitioners telling them that their "back is out", their "back went out" or their SI joint is "out of position" is not so much that they might be right or wrong, but it's in the fact that how we diagnose something should determine how we treat it.
If someone is being told and they literally believe that their "back is out" their mind has strong beliefs about what is happening and what is "wrong" with them. Those beliefs strongly effect their pain response, what they think they need to improve, and potentially causes them dependency on a practitioner to perform certain treatments that only they can do to "put your back back in."
What I mean is that if you constantly believe that any time you have back pain it's because you are "out" and your treatment revolves around your back being "out" then you may not only be misdiagnosed but your treatment will likely not be appropriate for you either.
So what are we talking about here? Many times what people feel or report as going out is technically their SI (sacro-iliac) joint. So while there is definitely pain for a reason, the problem with the argument of something being out is that the SI joint really doesn't move that much at all (research indicates sacral movement as little as 0.3 degrees and translation of 3 millimeters). AND it's very, very challenging to get or force the SI joint to move.
Check out this video from physioanswers.com to explain what I mean...
So if the SI joint doesn't move, doesn't go out, and is hard to "force movement" into, why does it hurt?
The answer is complex, however, as simply put as possible...the SI joint still takes on shearing forces and takes on stress AND is surrounded by soft tissues that have to work very hard to keep the transfer of weight and energy from the legs to the body and vice versa. So things including tight hips, weaker glutes and core stabilizers, poor movement control or coordination, and excess force applied to a sit bone or hip (think a fall on ice) all still apply force to the SI joint (sometimes more one side than the other since we have 1 on each side).
Pain in that area is really an output from our brain telling us that the area is taking on more stress than it has the capacity to handle without being threatening. BUT it rarely if ever means that your SI joint or hip is out or dislocated.
This also doesn't mean that joint manipulation or chiropractic adjustments aren't beneficial...it just means that why they are beneficial may be completely different from what you believe or have been told.
That's important to understand especially if you feel like certain treatment techniques give you short term relief but then you go back to square one.
SO, if you have back pain that is one sided and undpredictible, please don't assume or believe that your SI joint is "out" but instead seek someone who will help you understand why that area has more stress on it that it has the capacity to handle.
A good thorough examination that tests hip mobility, hip and core strength and stability, movement patterns, soft tissue quality, balance and stability, and addresses your understanding of what pain really is is a great place to start.
It is my biased (yet quite scientific) belief that if someone tells you your SI joint is "out" and they need to "put it back in place" for you AND you'll need to come back often to have it "put back in place" I would highly recommend running (if your back allows) in the opposite direction.
And if I rock some boats with this post, all I can say is GOOD! We need this boat rocked.
Yours in health,
P.S. If you're struggling with low back pain that is recent or has been going on for a while and you are fed up with how it's limiting your mobility, your pleasure in life, and how you look when you walk or run, then please apply for a FREE DISCOVERY SESSION to get your questions and concerns answered here...http://www.motusrx.com/free-discovery-visit
P.P.S. If you're not ready to apply for a discovery visit but would like more information on how we analyze, treat, and help others just like you with back pain, check out our Low Back Pain Page.