Understanding the SI Joint in Chiropractic Care

Are you struggling with lower back or hip pain? Wondering if your SI (sacroiliac) joint is the culprit? In this episode, Dr. Brant Hulsebus explains what the SI joint is, how chiropractors diagnose SI joint issues, and the best approaches for treatment and relief. Whether you’re an athlete, office worker, or just curious about chiropractic care, this video will help you understand your body better!

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Transcript

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Hello, Dr. Brant Hulsebus here and welcome to another edition of Ask the Chiropractor. Ask The Chiropractor is my little podcast that I do when someone has a question about chiropractic or chiropractic care, I try to answer. I'm a chiropractor here in Rockford, Illinois. I'm a proud graduate of Palmer College of Chiropractic, and I'm happy to be the team chiropractor of the Rockford IceHogs. Let's dive into it. welcome. Thanks for tuning in and enjoying another episode of Ask the Chiropractor. I try to come on, like I said, and answer questions about chiropractic care. Now I'm gonna talk about a condition or not being, not a condition, but a situation that patients come in all the time as a little bit of confusion on. They come in, they talk about their SI joint. They say, I got an SI situation. First let's talk about what the SI joint is. S stands for sacrum. I stands for ileum. Sacrum is more commonly called your tailbone. It's the bottom of your spine to triangle shape bone. When you were younger, your sacrum was six different bones. When you go through puberty, they fuse and form one bone. Now the ileum is more commonly known as the hip, and so we're talking about the SI joint. We're talking about the joint that's usually right along your belt line. And probably about an inch or inch and a half to two inches away from your midline. So right back there, right? Everybody points right back here. It bothers me. They'll point at it, they'll touch it and they'll say, this joint's really bugging me when I walk, when I go to get up. And I, when I climb stairs, it talks to me. I hear all different things about when it bothers them. Now a lot of people actually come in and tell me they're sciatic out and they point their SI joint.'cause people get confused what's what. But that's your SI joint. Now I've been a chiropractor since 2002, and we've learned lots of different chiropractic adjustments and different evaluations, and I've learned even more since I've graduated. And you go to the chiropractor, and the chiropractor almost always starts laying, you face down, checking your SI joint. Now, how do we check your SI joint? We look at your feet. We measure your feet. So if you ever watch a video of a chiropractor pushing on the bottom of someone's feet, we're looking for a long leg. In a short leg. And then a lot of times you'll see the chiropractor bend the knees up, so their feet are now pointing towards the ceiling. And we're we measuring the heights? So what are we doing there? This is called the Derefield check. Dr. Derefield came up with a way to analyze the hips and see what's going on. If you have a short leg and we bend your knees and that leg gets longer, we know that's probably the involved joint. We call that a PI joint, posterior and inferior is the way it moves. So we call that a pi. Now when we have a pi, then we start looking to see which way anterior superior rotation or inferior. Which way did it turn? Which way is it moved? So that's the next part of it, but let's just talk about that side first. So if I take your leg and you're short and I bend your knees and your short leg gets longer, I suspect it's that SI joint. If I bend your legs and your feet go, even then I'm thinking more. It's just the sacrum. And if I take a short leg and I bend. And the leg stays shorter than I just assume that you were born with a short leg. Now we could confirm all this. On x-ray, we take an x-ray analysis of your hips and we can see if you have a long or short leg. A lot of times patients come in and tell me their doctor's diagnosed 'em with a short leg. All they simply did was lay 'em down and see a leg was shorter, and so you have your short leg. Now, a short leg is a very common finding. Almost every patient comes in with it. The question is it really SI involvement? So how do we know if it's really the SI involvement when we do that deer field check or not? So you come in, we lay you down, you have a short leg and bend, your leg gets longer. So now I suspect you might have something going on with the SI joint. One way I would know for sure is if I had an x-ray of your spine with an x-ray of your spine. Today we have computer software. When I went to school, we had to use a little bit of geometry, algebra, and stuff like that. We could actually do a mathematical equation based on the rotation of your hips in different landmarks to determine whether or not you have a short leg. This was done by Dr. Gonstead up in Wisconsin, Ron on the state line here in Illinois, right across the border. So he was able to figure out a way to measure for a measured difference in an anatomically short leg. Now, the measured difference means that there's rotation going on and the rotations going on is showing up in the pelvis. Now, why would your pelvis rotate? Why would you have this misalignment in your pelvis? If you've listened to my previous podcast, I always talk about the righting reflex, like left and right, the righting reflex, the right reflex as our eyes stay level at the horizon at all times. So no matter what goes on in our back, if you hurt our lower back and our body shifts to the right, then something else is gonna shift to the left to bring us back centered again. If our eyes are not level, then we'll have lose our balance. We'll have. Blurred vision and we'll have slurred speech. So we'll almost come off looking like we've had too much to drink that night. So the writing reflects always self correct, and one of the number one spots that usually gets involved in this is the SI joint itself. So if you lay down and we find that you positive deer field check, there's a original checkout, the si. What I tend to then do is make a mental note of that. Make sure it's not your sacrum, just your sacrum again by if you've measured your knees and I bend them and they go even. And I think it's your sacrum, not the hip, not both joints, just the one. Another way we can double check that is having you lift your leg without bending your knee. If one leg was higher than the other, and now we know it's the sacrum. So let's say it's not the sacred, let's say just it just the sis going on. Do we immediately adjust the SI joint? I don't. I very rarely ever go to the SI joint. I usually say the SI joint the last, because of what we talked about the right reflex. So I'll go ahead and look at your lumbar, your spine, your lower back i'll at the thoracic spine where your ribs are. Then I'll check your cervical spine, otherwise the bone's in your neck. And then once all that's cleared out, I bring the table up and I have you take a couple steps and then come back on the table. I had to take a couple steps because I want to check the writing reflex. If you take a few steps and come back to the table, now you've recentered yourself innately to the writing reflex. So ideally, if I adjusted everywhere in your spine and your SI joint was tender because it was self-correcting with the writing reflex after we're done, when you lay on the table, you should be straight again. And this happens more times than not. So a lot of times I have patients that see me usually from a younger chiropractor and they've been putting their side and twisted a lot trying to get that SI joint to alleviate because they say This is where it hurts. This is the chiropractor does the check and sees it's misaligned and the chiropractor immediately starts going in with a very aggressive adjustment trying to correct this SI joint. In reality, this I SI joint was never the problem. The SI joint was simply counter rotating to balance off maybe a problem all the way at the top of your neck. Last week we talked about concussions and how it could affect the top bones in your neck. It's very possible to have a concussion and have a pelvic misalignment to balance out the damage that was done on top with the writing reflex. So like I said, I wait to the very, very end to check the pelvis. Now if I do all that and you are still showing positive tests, then we start off with the one adjustment with the table. Makes a popping noise. Maybe you've been at the chiropractic for the table. Pop. What is that? Isaac Newton taught us an optic of motion will stay in motion until it's acted on by outside forces. So if I grab your SI joint and I try to separate the I for the S I try to get on the ilium, try to put a little torque on there, and then slam the table down. In theory, the. The joint will slide into place and all of a sudden the table comes an abrupt stop, and then it goes into place. So it's not like when you hear like a chiropractor that does those and you hear the popping noise. This is more of a mechanical assisted adjustment using the table. Most patients tell me they don't feel next to nothing when we do this adjustment. I'm like, did you even do anything? Matter of fact, when I went to Palmer College, I got guilty of that. I told the, see, when you go to Palmer College, you have to get adjusted by other students.'cause other students have to do so many adjustments in order to graduate. So when I showed up, and I'm a son of an alumni, which means I get to go to the clinic at no cost. I got, my neighbor asked me to come see him 'cause he needed the credits. So I went and got adjusted and did that little pop to me. And I remember telling the professor, come on, gimme a real adjustment. Now, what I did not know at that time was that professor actually taught that class. And I got quite an earful, quite a lecture that day. I wasn't even enrolled in Palmer yet. I had just got accepted. And I already was put to work having to sit there and observe these adjustments and learn about this adjustment even before my first day as a student because I opened my big mouth too soon. So this adjustment's meant to free that joint up. Now I, my personal opinion, I find this adjustment works very well. If the SI joint was counterbalancing for something else, if the SI joint itself was actually the problem actually was a fixation, then we do more aggressive adjustment. Now you can always go backwards. You can always start off flight and then get more aggressive. But you can't get more aggressive then go light. So if I do those three drops and you're still off then we'll do a more aggressive adjustment, knowing that's probably the actual fixation. Now, who typically has the actual SI fixations? It's usually an athlete or usually someone that had a physical trauma done to 'em. I take care of the hockey team, right? So they have this a lot, but playing hockey. But if you're just having an office job every day, commuting back and forth, I imagine the SI joints, pain's probably more referred from somewhere else. Where if you're a soccer player and you're running around kicking and jumping and twisting a lot, then I think it might actually be the SI joint. Now people have proven me wrong in both cases, but that's typically the clinical finding that we see. So if you're an athlete or you're doing a lot of physical activity, even if you just go to the gym every day and work out, there's a good chance your SI joint might actually be stuck. But if you're feeling paid down there and that's not your lifestyle, there's a good chance something else is going on. So it's good to go get checked. Now, if your doctor. We talked about having the short leg in the long leg. If your doctor ever tries to give you a insert to your shoe without taking the X-rays and actually doing the measurements that we do, there's a good chance you're gonna make that SI joint worse. Because if your leg came up, 'cause your pelvic is rotated, and you put a lift under the leg that came up, that lift creates an upward pressure, not a downward pressure, and you're gonna keep. Moving that more pressure, that side joint. So a lot of times I'm not a fan of those until we've actually done the mathematical. Equation that we do on our x-rays to validate you actually need it. Now if you're a patient of mine, you're like, I've never seen 'em do that equation. I don't have to anymore. We have digital computers and X-rays now, and the computers, they do all the work for me. So we have a digital x-ray, we just tell to do hip analyzation, they'll gimme the number. So it's really easy to do today compared to what it used to be. So we don't have to get out the compasses and the protractors and everything and do all of our measurements anymore. Technology has taken that job from us, if you have SI joint pain and you wanna get to the bottom of it, don't just go somewhere and have 'em treat the SI situation. There's all often bigger questions. It's usually not just the SI joint, it's usually come a compensation from somewhere else and you could treat that SI joint all day long. Do all kinds of things to it. I've even heard people getting steroid injections into the SI joint. And the whole time they had a neck issue that was causing the problem. So if you feel like you have SI problems, a trip to the chiropractor with us at an x-rays, so they can actually measure your pelvis. Now if you have x-rays from your healthcare provider, you could bring them with you. They just have to be standing upright, pelvic analysis.'cause we don't want to try to analyze your pelvic. Rotation when you're laying down because we wouldn't see how gravity affects it. We wouldn't be able to tell if it's a measured difference or anatomical difference 'cause you're not standing up. So we'd have to have you standing up in an x-ray. But if you have a front to back view of your hips and an x-ray, we could measure that for you right away and tell you have a long leg or short leg. Actually it a fun story. When my grandfather was still alive on my mother's side, he had a prosthetic and they kept trying to measure it, tell him it was off. So I had him put it on, I did this x-ray and I was able to give him the exact millimeters, how to change the height of it to levels pelvis off, and he was quite happy after I did that. In fact, the prosthetic place often sent me other people to measure when they were struggling to get it right and we were able to help them. So I go see your chiropractor, have 'em do a pelvic analysis on you, and then also have them look at the rest of your spine. Because again, I fixed many SI joints over the years. I never even touched them 'cause I cleared out the rest of the spine. So if you're having si problems, make sure you follow up with your chiropractor. Hey, thanks for tuning in. And remember, if you have a question about whether you should seek chiropractic care, whether or not chiropractic care is good for you, the only person qualified to answer that question is a chiropractor. Nobody else studied chiropractic. If you asked them to do a Gonstead pelvic analysis of you, everybody would look at you with what are you talking about? You go to any chiropractor, they're like, oh yeah, no problem. We can do that. So make sure you go see a chiropractor for these things. All right everybody. Thanks for tuning in. Come back next week.