Have you ever suffered from pain in your lower back? Bending makes the pain worse and sitting in one place for too long can cause back pain? What if I were to tell you that the pain was not actually coming from the lower back but from two joints called the Sacroiliac joints. About 10% to 25% of low back pain patients are thought to be actually experiencing pain from the Sacroiliac joint (SIJ) because the pain and symptoms can closely mimic those of low back pain(1).

The SIJ’s are located on either side of the spine and join the pelvis to your tail bone. The joints themselves are typically very stable as they have significant ligament support as well as being surrounded by some of the strongest muscles in the body.

When dysfunction occurs at the SIJ it can cause pain around the lower back, shooting or stabbing pain, as well as tenderness around the area. Left unmonitored or if not treated correctly, the pain can linger and escalate, making everyday tasks like bending or sitting a nightmare.
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It's important to see a physio and get the proper diagnosis so that the correct treatment can be commenced straight away. The correct treatment will help to reduce the pain and symptoms so that you can get moving towards your regular lifestyle.

A physiotherapist will conduct a comprehensive physical examination to evaluate the contribution of the SIJ and surrounding structures. This includes a biomechanical assessment to identify key contributing factors and to rule out other structures like the back and hip.

Once a solid diagnosis has been formed, treatment will initially consist of symptomatic management. This could involve managing inflammation, joint mobilisation, strapping or wearing a special belt to get symptoms under control. From there strength and stability will be the primary goal for rehabilitation of the SIJ disfunction.
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It is pretty clear that SIJ disfunction needs a completely different treatment strategy compared to low back pain, this is why it is important to get the correct diagnosis so your pain can get the treatment tailored to it.

The neck joints and muscles support the head, move it and our visual fields through space. Not just is the neck joint a pillar of support for the head but it is part of a complex navigation system giving vital data to the brain on movement, direction and speed of us and the world around us.

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All of the above can be part of a neck problem and Neck Dizziness or what we call Cervicogenic Dizziness. 

Dizziness or vertigo can come from many other potential sources. These include nervous system problems (neurological), heart and circulation issues (cardiovascular) and inner ear labyrinth disturbances ( peripheral vestibular). One form of inner ear vertigo we can treat is BPPV- Benign Paroxysmal Positional Vertigo. You can find more about this here on one of our other blogs.

Cervicogenic Dizziness is a sensory illusion of motion and disequilibrium. It is common, however people are unsure of what the symptoms mean, let alone that the neck is the source of this dizziness. It is important to correctly identify it and treat it as it does not settle without help. It can be associated with migraine like symptoms, headaches, neck sprain or strain, concussion or whiplash.

Some clues to diagnosis are:

• dizziness with head neck postures or certain movements.
• association with neck or head pains and relief of the dizziness when they pass.
• fluctuating levels of dizziness that last minutes to hours
• symptoms that come on about the time of neck injury.

Diagnosis is a process of elimination. There isn't a special test or scan to tell us if it is Cervicogenic Dizziness so examination by the physiotherapist or General Practitioner is to rule other causes out.

Physiotherapy Treatment is effective by doing the following.

• build healthy neck muscle activation and stabilisation patterns.
• reduce neck stiffness and pain.
• retrain the ability of the head and neck to re-find set positions.
• for some people the rehabilitation of the inner ear balance sensors is part of treatment. (1)

 Below is an example of a patient retraining head position accuracy. The video has been sped up.

Results from treatment are usually always positive. Those who struggle to improve do well with management that includes other causes for dizziness or where there are compounding illnesses or musculoskeletal issues.

Reference:
​1. Wrisley DM et al. 2000. JOSPT, 30:12. 755-66

​Please forward this to anyone who may benefit from reading this.

1. Manfredini, D., Winocur, E., Guarda-Nardini, L., Paesani, D. & Lobbezoo, F. 2013. J. Orofac. Pain.: 27(2), 99-110.
2. von Piekartz, H., Rösner,C., Batz, A., Hall, T. & Ballenberger, N. 2019. Musculoskelet. Sci. Pract.: 45, 102073.