Involvement of the sacroiliac joint

Low back pain is one of the most significant reasons for consultation in the medical field. It is all the more essential to classify it properly and thus offer the most appropriate treatments. This article will present the particular involvement of the sacroiliac joint in low back pain and other more specific symptoms.

Anatomy

The sacroiliac joint is found where the sacrum and the ilium meet. The sacrum is the extension of the spine and is located between the 5th lumbar vertebra and the coccyx. The ilium corresponds to the pelvis itself, articulating with the sacrum and the hip (greater trochanter). This joint offers very little movement, only a few degrees, but is very important for walking and sitting/standing.

Functions of the Sacroiliac joint

  • Lumbar stability
  • Muscle support and stability for the legs
  • Allows the transfer of strength and movement between the upper and lower body
  • Body weight support
  • Protection of genitals and viscera

Signs and symptoms

  • Local pain in the lower back near the buttock
  • Pain in the groin
  • Pain in the hip or posterior edge of the thigh.

Possible pathologies

Hypermobility (instability)

This dysfunction is often observed in pregnant women (secondary to hormonal changes) with the presence of general hyperlaxity.Pain can also be caused by repeated trauma or microtrauma. A simple movement in daily life can then be painful: bending forward, turning in bed, walking, squatting or lifting.

Hypomobility (blockage)

This dysfunction is the opposite of the previous one, but may be secondary to hypermobility. Indeed, the fact that a joint has too much movement increases the risk of blockage. Thus, hypomobility is characterized by a limitation of movement. The onset of symptoms may be gradual, sudden, or traumatic. Sudden twisting/rotating movements, a fall on the buttocks or a car accident can cause the joint to become fixed. The pain will increase with walking, changing positions and prolonged static positions.

Sacroiliitis

This condition is an inflammation of the sacroiliac joint. It may be secondary to a chronic disease such as ankylosing spondylitis. In other circumstances, it may be secondary to repeated heavy strain due to weight gain such as during pregnancy. An osteoarticular infection can also be the source of this inflammation. Finally, trauma directly to the pelvis or spine can cause this type of sacroiliac dysfunction.

Conclusion

The sacroiliac joint has many interactions with its surrounding structures (hips, spine, lower extremities). The biomechanics of this joint are greatly affected by injury, alignment and/or deconditioning of any of these structures, not to mention hormonal involvement. Thus, a specific physiotherapy evaluation is necessary to properly treat this type of condition. Often, this joint is little or not well known.

Other relevant chronicles:

Definitions

First, it is important to define the term SPRAIN, which is a very commonly used word. This pathology involves the stretching of the LIGAMENTS, with or without tearing.

Ligaments provide PASSIVE stability to joints. They help to keep the joints aligned during movements, which are induced by the muscles. Ligaments have viscoelastic properties. In other words, they have the ability to deform/stretch (viscosity) and return to their shape (elasticity). They are not as elastic as tendons. This means that there is a “breaking point” when stretching. The ligament can become permanently stretched, or it can even tear if it is stretched beyond its breaking point.

Sprains occur when the movement is exaggerated (beyond its normal capacity). This can be caused by excessive speed or load, such as during a car or sports accident. Holding a maximum stretch can also lead to prolonged stretching of the ligament.

There are three degrees of sprains:

Grade 1: stretching
Grade 2: partial tear
Grade 3: complete tear

Mechanism of injury

Sprains are common in sports that require speeding up and changing direction quickly. Adding to this, unstable and uneven terrain creates the perfect setting for ankle sprains (ex. mountain hiking, trail running, backyard chores, and walking/running in the sand). The most common ankle sprain is an inversion sprain, where the foot turns inward.

Clinical manifestations

Depending on the grade of injury, certain signs and symptoms may be observable following an ankle sprain:

  • Local pain with difficulty putting weight on the ankle
  • Swelling
  • Redness and warmth
  • Local AND more extensive ecchymosis (foot, outer leg, heel)
  • Numbness
  • Weakness

Collateral damage

Beyond the ligament damage, it is common to see additional injuries that coincide with the ankle sprain itself. Here are some examples:

  • Partial tear of the tendons (fibular/peroneal)
  • Avulsion fracture
  • Nerve irritation

Treatments

First of all, it is important to apply the PEACE & LOVE principle, a concept we’ve previously described in one of our columns.

Next, the sprain and other possible injuries should be examined more closely. Usually, ankle sprains are treated in physiotherapy using the following:

  • Massage to bring down swelling
  • Muscle release to treat nearby tension
  • Ultrasound
  • Taping
  • Mobility, flexibility, strengthening, and balance exercises
  • Education on pain and injury management, followed by a gradual return to activity

Although a sprain may seem trivial, it is important to address it quickly. Early treatment with physiotherapy promotes faster recovery and—more importantly—limits the after-effects and the risk of recurrence. With the right advice and exercises, you can get back on your feet faster!

Mountain biking has soared in popularity in recent years. Terrain can vary wildly, requiring different levels of physical and technical skills in riders. For example, some climbs are more demanding – and descents require a good mastery of the bike.

While practicing, many will experience discomfort and mistakenly think that it’s normal to be uncomfortable on the bike. Injuries sometimes occur from a fall, but also from repeating the pedaling motion for long periods of time. Despite the fact that mountain biking offers a more relaxed posture than road biking, with riders changing position more frequently, the pressure applied to the hands, rear and legs is significant. Mountain biking also requires significant forces for the rider to effectively ascend slopes.

Did you know that in addition to increasing your comfort on the bike, cycling positioning in physiotherapy allows you to perform better on climbs and safer on descents? Regardless of your fitness level and technical skills, a correctly sized bike and proper positioning will make you a better cyclist!
For example, the positioning of the feet allows better energy transfer and optimizes the load on ankle and knee joints. A properly adjusted seat increases stability on the bike and lends support on climbs. Adequate distance between the seat and handlebars promotes a firm and secure grip to confidently enter turns.

The physiotherapists providing bicycle positioning services at Physio Atlas will listen to your needs and advise on how to optimize your positioning. Remember: it’s the bike that adapts to the rider, not the other way around. With bike season fast approaching, positioning is THE way to improve your comfort, performance and pleasure.

It’s common to think that pain not only has a physical aspect, but that it’s also “in our head.” We often believe that we can modulate pain according to our state of mind or our will. But what does this really involve?

The brain, an extraordinary computer, with just a few flaws

In fact, it’s both true and false. The brain is an incredible machine that has the power to send commands for action and for feeling to the entire body. Its function is to control and to protect. It controls your muscles, allowing you to walk, move, smile and talk. These actions made are possible because the brain receives information from the outside (the immediate environment) which it analyzes and integrates in order to respond to it.

We have five senses: smell, hearing, taste, sight and touch. When the body is injured, an emergency system, which we call inflammation, takes over. The brain then orders the management of the emergency by sending chemical mediators to control the inflammation and thus to promote healing. A normal process of protection.

The brain doesn’t really know the difference between physical and psychological pain. For example, stress leads to more rapid breathing, sustained muscle contractions (e.g. trapezius muscles), certain facial expressions and a higher heart rate. This puts the body in a situation similar to a physical injury. The brain then sends comparable signals, without really identifying the original trigger.

The social environment, something not to be neglected

If we return to the concept that our brain collects information from our environment in order to respond to it, the contexts and situations in which we live can greatly influence the creation and/or aggravation of pain.

Take, for example, a person on medical leave from work whose relationship with his/her employer is very tense or who has a significant fear of being injured again when returning to work. The brain perceives this to be a dangerous situation, thus triggering or intensifying the body’s protective reactions. In order to manage the threat, the brain will send chemical mediators similar to those it sent during the original physical injury.

Let’s take the opposite example now of a person who has a “healthy” relationship with pain, for example, someone who gets injured while playing a sport he likes. When he feels an increase in pain following a new activity or exercise, he perceives this as a sign of making progress and he may even experience “pleasure” as a result. Not knowing the difference, the brain will send chemicals (endorphins, adrenaline) to relieve the kind of pain caused by strenuous activities, such as sports.

It’s all about perception

Studies show the importance of the psychosocial environment in the presentation of pain. It’s not enough to just heal a wound, the person, and the experiences that come with that person, have to be treated. This can make all the difference when it comes to recovery and avoiding chronic pain.

Never underestimate your mental health at the expense of your physical health, the two go hand in hand! You have to talk about it, you have to act so that your brain reacts appropriately and in your favor.

You have several bikes and want to be fitted for each one? You had a fitting for one of them, but would like to transfer the measurements to a second one? Be aware that different types of bicycles vary considerably in fit.

For bicycles with more similar geometries, such as road bikes and gravel bikes, the fitting will be done by considering the goals and expectations of the cyclist. The length of the outings, the type of terrain, and the level of performance sought for each bicycle are some examples that will determine the chosen fit. It is therefore possible that the measures for both bikes are similar and require only a few specific adjustments.

Road bike VS mountain bike

However, when we are comparing a road bike to a mountain bike, there are more variables to be considered. In fact, these bicycles have several different characteristics. First, the geometries of mountain bikes differ greatly from those of road bikes, because the playing fields are very different. In addition, mountain bikes are equipped with one or two suspensions of varying length. This equipment changes the position of the cyclist since it can be more or less compressed, depending on the force applied. The positioning will therefore be different depending on the type of mountain bike used by the cyclist. A good climber will not have the same position as another one practicing only descent.

Moreover, since the terrain in the mountains is very variable, it is difficult to position the cyclist for all situations. The fit will therefore aim to optimize the positions most often taken during rides.

Thus, the clinical reasoning of the physiotherapist, depending on the needs of the cyclist, will influence the adjustments on the bicycle. For these reasons, measurements on the road bike will probably not be transferable to the mountain bike.

To improve your comfort and performance with a bike fit, make an appointment with Émile or Carolanne, our physiotherapists trained by BikePT Bronze at our clinic in the Sherbrooke Jacques-Cartier neighborhood.

Are you a seasoned or novice triathlete? Do you experience pain, discomfort or numbness during your bike rides? Did you know that your positioning could have a big influence on your comfort, as well as performance levels?

In fact, the positioning on a triathlete’s bicycle facilitates the transition from bicycle to race (T2), increasing comfort for the cycling portion and optimizing the efforts exerted by the legs. The adopted position differs from that of the road bike mainly through the addition of aerodynamic bars and a more advanced positioning on the bike. Your physiotherapist will take these into account when making adjustments for your evaluation.

What’s the assessment?

The assessment and positioning will nonetheless follow the same steps as for a road bike, the functional and specific biomechanical assessment of the cyclist, positioning on the bike and personalized exercises according to known limitations. Everything will also be adapted to your current physical conditions and past injuries. Depending on shoulder, core, and leg flexibility, the positioning will be adapted to meet the cyclist’s unique needs and goals.

Because the biking portion comes after swimming, the shoulders have already been under considerable stress.As such, the arms must support the cyclist’s comfort and breathing, while aiming to streamline the profile and reduce wind resistance.

Don’t hesitate to consult our physiotherapists Émile and Carolanne, who offer cycling positioning evaluations at our Sherbrooke clinic in the Jacques-Cartier sector, before you start your season!

Simply put, bruxism is excessive, repetitive teeth grinding or jaw clenching. This excess pressure can cause pain in muscles and teeth. It can even lead to a tooth shattering. The jaw joint also suffers from this severe pressure, leading to premature wear of the articular surfaces. It is possible to engage in awake (or diurnal) bruxism or sleep (nocturnal) bruxism, with or without perceptible noise.

Moreover, this condition can lead to a limited range of jaw opening mobility, which limits food options and can cause headaches. These signs and symptoms generally appear upon waking up or after a meal.

The Most Frequent Causes

Poor occlusion

Asymmetrical occlusion, or imperfect contact among the dental surfaces, is one of the main causes. The jaw is always in search of “perfect” occlusion. Poor occlusion can result from the dental morphology, a needed repair, or a missing tooth, which reduces the contact surface for chewing. This inconsistency can also cause uneven muscle strength, which may lead to bruxism.

Stress

Stress is a possible cause of bruxism. One manifestation of stress is the presence of para-functional habits (tics) involving the mouth, such as nail-biting, jaw-clenching, and excessive gum-chewing. All of these actions subject the jaw to asymmetrical force, which leads to exaggerated, inappropriate demands on the muscles.

Posture

Poor neck posture can be the source of inappropriate muscle tension. Neck posture affects head position, changing the contact point between the skull and the mandible (jawbone). This can, in turn, cause a change in articular pressure, impairing masticatory strength. As a result, the active muscles (primarily the masseter, temporal, and pterygoid muscles) are not optimally aligned and work asymmetrically.

Treatment and Prevention Options

If you suffer from bruxism, the first professionals you should consult are your physical therapist and your dentist.

Getting an oral health check-up to optimize your occlusion will be an important first step. If you wear dentures, your denturist will be have a role to play in your rehab process. In some cases, particularly if you have sleep bruxism, a biteplate may be an option.

Your posture, muscle tension, and the joint integrity of your jaw will need to be evaluated. With that information, we will be able to analyze the issue and choose from a variety of treatment approaches:

  • Internal and external manual therapy techniques: massage and joint mobilization;
  • Analgesic methods including ultrasound;
  • Posture and pain management recommendations;
  • Lifestyle recommendations: para-functional habits, eating (chewing, mouth opening);
  • Specific exercises;
  • Acupuncture (with needles) in physical therapy is useful in some cases
  • Orofascial and cranial approach

Bruxism is a multifactorial condition. That is why effective communication between health care professionals is such a high priority. Don’t hesitate to ask questions of your physical therapist or your dentist.

Transcranial direct current stimulation (tDCS) is a non-invasive method that stimulates the brain with electrodes placed on the scalp. An low-intensity electrical current circulates from one electrode to another, which allows the excitability of brain cells to be changed and persistent pain to be reduced.

During treatments, healthcare professionals use carbon electrodes which are inserted into sponges that are moistened with a saline solution. The electrodes are then deposited on the scalp and held in place with straps. The cathode is placed in the motor cortex (right or left, from the opposite side of the patient’s main pain) and the cathode on the forehead, on the opposite side. Approximately 50% of the current emitted by the device (2 mA) reaches the brain tissue. The rest of the current dissipates at the level of the skin and bones of the skull. The current enables cortical excitability to be adjusted in certain regions of the brain in order to stimulate the mechanisms of pain deceleration.

The increase or decrease in excitability can vary according to the protocol and installation of electrodes: the anode allows for an increase and the cathode, a decrease.

Who should use tDCS?

These treatments aim to reduce chronic pain, including:

  • Nociceptive pain (ex.: persistant musculoskeletal injuries)
  • Neuropathic pain (ex.: post-AVC pain, radiculopathy)
  • Mixed pains (ex.: lombosciatalgia)
  • Functional pain (ex.: fibromyalgia)

In practical terms: quite a few!

A tDCS session in physiotherapy lasts about 45 minutes, including the installation of electrodes, 20 minutes of stimulation, and 15 minutes of therapeutic exercises. Everything is repeated for 5 consecutive days. The increase in cortical excitability produced by the stimulation can last longer than the duration of the stimulation. It is therefore essential to take advantage of the post-stimulation effect to complete therapeutic exercises. Relief from pain is generally perceived after 2 or 3 sessions, and its effect tends to increase after 5 sessions, and in the weeks following the treatments.

You do not need a medical prescription to have access to tDCS treatments. Contact can be made with your family doctor or referral (specialist) to inform them and follow up on the treatment via courrier.

Contraindications

Patients must first be evaluated by a physiotherapist in order to learn if tDCS applies to their condition. Some contraindications exist, such as:

  • Pregnancy
  • Previous surgery on the head
  • The presence of a brain tumor
  • The present of neurological or neuropsychiatric disorders
  • The presence of metal plates on the skull (excluding fillings)
  • Wearing stimulators or electronic implants (ex.: pacemaker)
  • Suffering from epilepsy or having suffered recent or severe cranial trauma

Potential adverse effects of tDCS treatment:

  • tDCS generally does not cause adverse effects; when these do occur, they remain minimal (light headaches and fatigue) and short-term
  • The tDCS treatment is not painful

tDCS could be for you if:

  • You have persistant pain
  • You would like to find something to complement medication to treat your pain
  • You would like to improve pain management in order to optimize your physical capabilities

For more information, don’t hesitate to reach out to one of our physiotherapists: Amélie Boucher, Catherine Apinis, and Guillaume Léonard would be happy to discuss this treatment option with you.

First, let’s get our definitions straight!

What exactly is a “trigger point”? Simply put, a trigger point is defined as a hyperirritable spot found along a taut band of muscle. The trigger point may cause pain following compression, stretching, or excessive or lengthy stimulation. Each muscle has areas that are predisposed to trigger points; it is even possible to find several of them in the same muscle. A trigger point may be active or latent. In other words, it may or may not reproduce the patient’s pain upon consultation. Aside from the localized sensitivity, active trigger points can produce referred pain in specific, but distant, areas of the body. This radiating pain can be experienced as either pain or weakness.

In addition, it is possible to experience discomfort or pain exclusively within the muscle’s radiation area. However, it is essential to treat the pain at its source: the muscle associated with that radiating pain.

Here are the areas commonly linked to a trigger point in a nearby muscle.

Area where the pain is experienced Associated muscular trigger point
Teeth Mastication muscles in the jaw, including the masseter and temporalis
Temple and eye Trapezius muscle
Line from the shoulder down toward the elbow and back of the hand Rotator cuff muscles: supraspinatus and infraspinatus
Hip and sacrum Piriformis muscle
Behind, back of thigh, calf Gluteal muscles
Bottom of foot and heel Calf muscles: soleus

Explore the trigger point map

 

What can cause or sustain this type of condition?

The development mechanism behind trigger points is still poorly understood. However, the creation of these areas of tension is often linked to a lack of oxygen in the muscle tissues following excessive demand (such as a repeated muscle contraction or a posture held at length), resulting in muscular fatigue or pain. A direct impact or a muscle strain could also lead to this type of pathology, both during the inflammatory phase and during tissue remodeling in the presence of scar tissue adhesions.

This means that trigger points can develop in any number of everyday situations: an intense workout, sub-optimal posture at work, an awkward movement, or even the wrong sleeping position.

What treatments are possible?

The primary goal is to reduce muscle tension and promote better circulation locally.

Here are a few treatment options used in physical therapy:

  • Massage, rubbing, friction;
  • Dry needling;
  • TENS (electrical nerve stimulation);
  • Taping;
  • Heat;
  • Stretching;
  • Compression;
  • Reinforcement;
  • Advice (posture, lifting);
  • Modification of duties at work.

What can we do in terms of prevention?

  • It’s all a matter of balance between strength, endurance, and muscle flexibility. Proper balance between each muscle and its opposing muscle (for example, the biceps and triceps) is important as well.
  • Don’t forget to warm up prior to physical activity and to cool down after your workout.
  • Modifying your duties at work and your sleeping position can be essential elements of prevention.
  • Getting prompt treatment for trigger points also helps prevent compensation and allows you to avoid developing secondary pain.

Karate is a Japanese martial art. Depending on the style of karate practiced, the karateka (karate practitioner) will learn different techniques for warming up, physical training, strikes, self-defense, fighting and Katas (execution of techniques/movements against a fictitious opponent).

In karate, which muscle groups are most used and how can we train them?

All the muscles in our body are used, but more specifically the muscles of the legs (calves, quadriceps, hamstrings and glutes) and abdominal and dorsal regions. Indeed, the motions and techniques are initiated in the legs and the strength exerted from the ground is transmitted to the whole body. Good core stability will also help the karateka improve his/her stability and balance during different techniques.

Since karate requires power, speed, endurance and balance, muscle/physical training will be geared toward these components to enable the karateka to increase his/her efficiency. Acquiring these elements will also enable the karateka to improve his/her posture and facilitate all the physical tasks performed daily (e.g., transporting/lifting loads, static endurance)

What are the most common injuries when practicing karate and how are they treated?

Depending on the style of karate practiced (with or without limited contact during fighting), injuries may vary. The most common injuries occur in the wrist/hand/fingers as a result of multiple strikes (sprain and fracture), the ankle (sprain) and the knee (sprain, pulled muscle). Because of the blows that are dealt, bruised muscles and even a concussion may also be seen.

SPRAIN : pulled ligament. The severity of the injury depends on the grade of the lesion and proportionally influences the prognosis for recovery.

Signs and symptoms:

  • Pain
  • Swelling
  • Restricted mobility with or without a limp in the case of a sprained ankle or knee
  • Weakness
  • Diminished balance (stability)

Treatments:

  • Managing pain and inflammation: Ice, elevation, compression bandage, rest, electrotherapy and crutches are a few relevant treatments
  • Restoring joint range and flexibility: manual therapy and mobility exercises and stretching
  • Increasing muscle strength and proprioception: strengthening and stability exercises
  • Gradual return to activities and sports: Training tips and progress.

CONCUSSION : traumatic brain injury caused by an external force, resulting in injuries such as an impaired state of consciousness and cognitive, behavioral and physical disabilities.

Signs and symptoms:

  • Headache
  • Fatigue/sleep disturbance
  • Nausea
  • Dizziness/vertigo, feeling slow
  • Concentration or memory disorders
  • Blurred vision, sensitivity to light or noises and emotional lability.

When an injury occurs, it becomes a good idea to talk to your physical therapist quickly in order to have a detailed assessment of the problem, to determine a treatment plan and to seek appropriate advice for the situation to facilitate your recovery and your return to the sport.

Treatments:

  • Initial rest period lasting at least 48 hours:
    • Limiting intellectual activities that require concentration
    • Fostering a calm environment
    • Not participating in physical activities
    • Not consuming alcohol/drugs
    • Limiting driving
  • Protocol for a gradual resumption of intellectual activities
    • Resumption of home activities over a short period of time (15 to 20 min)
    • Gradual resumption of structured activities on a part-time basis (school/work/hobbies)
    • Gradual resumption of structured activities on a full-time basis (with adjustment if necessary)
  • Protocol for a gradual resumption of physical activities and sports (wait 24 hours between each stage), all as tolerated.
    • Very light activities without increased symptoms (15 to 20 min)
    • Light individual aerobic activities (20 to 30 min)
    • Individual exercises specific to the activity/sport
    • More demanding exercises/training (if no daily symptoms)
    • Unrestricted training (medical authorization needed for contact sports)
    • Return to competition

Did you know that one of our physical therapists, Jayson René, is a karateka himself? If you have further questions about this sport or about karate-specific physical training or to make an appointment with him, feel free to contact us directly at the clinic.