ISG syndrome
definition
ISG syndrome is a disease of the so-called sacroiliac joint, which sits between the hipbone and the sacrum. Different causes mean that the movement in the joint can no longer be carried out without friction, which leads to pain.
root cause
The causes of ISG syndrome are above all Wedgesbetween the Hip bones and the Sacrum (Os sacrum) take place. Usually both bones are about one not swiveling joint connected with each other.The movement in the joint runs more or less smoothly. However, if the described wedging occurs, the usual everyday movements can no longer be carried out without further ado, which leads to the symptoms described.
Most of the complaints are also on Stretching and pulling movements of the strong muscles and Tapes in the area of the joint. overload by Bad posture lead to it just like e.g. also overload by Obesity. In today's time of sedentary, professional activities, these described incorrect stresses inevitably often occur. It can also get through arthrosisas with any other joint, these complaints can occur. Arthrosis is also caused by wear and tear and incorrect loading Joint damage.
Appointment with a back specialist?
I would be happy to advise you!
Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
But now enough is indicated ;-)
The spine is difficult to treat. On the one hand it is exposed to high mechanical loads, on the other hand it has great mobility.
The treatment of the spine (e.g. herniated disc, facet syndrome, foramen stenosis, etc.) therefore requires a lot of experience.
I focus on a wide variety of diseases of the spine.
The aim of any treatment is treatment without surgery.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.
You can find me in:
- Lumedis - your orthopedic surgeon
Kaiserstrasse 14
60311 Frankfurt am Main
Directly to the online appointment arrangement
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
Further information about myself can be found at Dr. Nicolas Gumpert
Symptoms
Symptoms of a ISG syndrome are Pain, the seizure at the Bow of the upper body or at Turning movements of the upper body occur. In advanced stages it can even be in Quiet to complain.
Are characteristic pulling from the left or right hip Outgoing pain that either spreads up the trunk or pulls into one or both legs. The pain can also spread to the abdominal area. The multitude of possible symptoms often makes the rapid diagnosis of an ISG syndrome very difficult. Through that often complex charisma i.a. Those affected often only give in the back Back pain on.
The pain of an ISG syndrome is much more delicate to distinguish from general back pain. Upon closer examination, the orthopedic surgeon finds out that the pain is mostly in the left or right Iliac bone can be specified. Patients are often noticed to be in a Relieving posture walking and, when sitting, usually put more strain on one side of the hip and less on the other.
ISG pain
ISG pain manifests itself in the lower third of the back. The pain often extends into the sacrum at the top of the buttocks and into the pelvic blades.
Pain can be found when you selectively press on the SI joint and also in the immediate vicinity, as the muscles are very tense.
In addition, the pain can also continue in the gluteal muscles, which presents itself as uncomfortable pulling in the gluteal muscles.
The mobility of the lower back and hips is often severely restricted by the blockage and tension.
In a healthy state, the sacroiliac joint absorbs loads and has a kind of resilient mechanism. The pain that those affected describe with an SI joint blockade correspond to those that are reported for lumbago or sciatica.
Radiation from the lower back to the hips and down into the legs to the knees has been reported.
Permanent or chronic inflammations of the SI joint often radiate into the groin and pelvis. In addition, patients report problems with sitting. The affected side is often relieved when sitting, so that only the other half of the buttocks is sat, which leads to further postural damage and pain.
Read more on the topic: Sacroiliac joint pain
diagnosis
For diagnosis, an attempt is first made to show how long the complaints have been present and, above all, with which movements they occur through targeted patient surveys. After that, the examiner will perform special tests on the patient to find out which areas of the spine are affected. Various pressure and provocation tests give the examiner a quick overview of the area in which the main pain is located. Imaging methods are only now being used. Here, magnetic resonance imaging is used as the diagnostic tool of choice. Because in addition to joint surfaces and cartilage, muscles and ligaments can also be shown.
Read our article about a MRI of the sacroiliac joint
If the diagnosis of SI joint syndrome is made, the associated diagnosis code is M54.1. In Germany, this is mainly used to transmit the diagnosis to the health insurance company and thus to be able to make an invoice.
When do I need an MRI of the SI joint?
In most cases, ISG syndrome can be confirmed by the treating doctor on the basis of a physical examination. If the symptoms are unclear during the examination or if the symptoms have persisted for a long time, an MRI scan can be helpful.
Fluid deposits, muscles and other soft tissues can be shown well in the MRI. This is important if acute inflammation is to be ruled out. In the course of the inflammatory process, fluid accumulates in and around the sacroiliac joint. If this shows up on an MRI, then the cause of the discomfort is clear and it can be treated accordingly.
Which doctor treats ISG syndrome?
Treatment for SI joint syndrome can be diagnosed and treated by different doctors.
Many patients present to an orthopedic surgeon with the corresponding symptoms. He can definitely carry out the treatment. But the family doctor can also recognize and treat ISG syndrome in most cases.
Since painkillers, exercise and physiotherapy are treated conservatively in most cases, you do not have to go to an orthopedic surgeon.
therapy
As a rule, the treatment of ISG syndrome is one conservative treatment. Here, relief exercises come first, which the patient during the physical therapy be taught. Sitting on kneeling chairs and stepping in bed (the patient lying on their back puts their lower legs up) are positions that have a pain relieving effect and, if performed regularly, become one long term pain relief being able to lead. Massage treatmentswhich are primarily aimed at loosening the muscles of the IS joint are rarely used today, but are also described as helpful by some people affected. Also one of the conservative measures is the use of the numerous here in particular anti-inflammatory pain medication.
Osteopathy
With osteopathy, blockages in various joints can be released. This often works very well, but unfortunately it is not always a permanent solution to the pain.
For the short to medium-term improvement of the symptoms, the intervention of the osteopath usually helps very well.
Before looking for an osteopath, consider other possible causes such as a herniated disc or an osteoporotic fracture can be excluded.
Read more on the topic: Osteopathy
Painkiller
If no Contraindication exists, come above all anti-inflammatory drugs (NSAIDs) how Ibuprofen or Diclofenac for use. The intake time should initially not exceed a week, as a prolonged use Gastric protection drug must be added (painkillers of the NSAID group have as a side effect that they prevent the build-up of the lining of the stomach, which leads to Bleeding in the stomach or Stomach ulcers can arise).
Other conservative treatment measures are Compensate for the incorrect load e.g. by Shoe insoles or Sports. Also diverse and special can be customized Corsets are used to ensure that the painful movement in the affected joint is restricted. Under Computed Tomography- Various pain relievers can also be injected directly into the joint, which, at least for a period of time, becomes one Complaint relief leads. Another measure is that Radiofrequency therapy. In most cases, this therapy is not covered by the statutory health insurance.
If conservative measures are inadequate to relieve pain in the SI joint, it may be operational measures be performed. These are above all one Stiffening of the jointwhich should ensure that the annoying pain no longer occurs in everyday movements.
Exercises for an ISG block
There are a few exercises that can help release the blockage in the SI joint.
The first exercise takes place lying on your back with your legs up, for example in bed, on the carpet or on a yoga mat. The arms are stretched out to the sides and placed on the floor. The head is turned to the right and the erect legs are slowly dropped to the left. You kind of twisted yourself. This is held for about 30 seconds. And then repeat this for the other side: drop your head on your left side and your legs to the right.
The second exercise is a little more complicated. You kneel on the floor and additionally support yourself forward with your palms. Now move one leg carefully forward and place it at an angle between your hands. The other leg is stretched backwards so that you only touch the floor with your toes. Now you lean your upper body over the bent leg. The more you stretch your front leg, the greater the stretch. After 30 seconds you switch legs.
The third exercise begins on all fours. Now you make a strong hump and look down. The next step is to put your head back and make a hollow back. This is done about 10-15 times. Any form of movement also helps. Long and crooked sitting (e.g. in front of the PC) should be avoided or reduced.
How is an ISG block treated with tape?
In general, the purpose of taping is to reduce pressure and irritation in the joint.
There are several ways in which the tape can be used. One method begins with a tape (about 20-25cm) long being stuck horizontally over both ISG's. This happens while the person is leaning forward. The tape should be attached to about 80% tension in the area between the two ISG's. The protruding parts of the tape, which stick to the lateral parts of the back, should be glued without tension.
A second tape is folded and then the corners are cut off, so that two tapes with round ends result. The first tape is now stuck on the ISG’s with the train. The two ends are pressed against without tension. The second tape is attached to the other ISG. The angle should point upwards at an angle inside, so that both tapes would meet in an imaginary line on the spine approx. 5-10cm above the horizontally glued tape.
If you are unsure how to attach the tape correctly, you should seek advice from an expert to avoid misuse.
forecast
The prognosis of an SI joint syndrome depends on various causes. Once from Age of the patient, the body weight and the existing ones Comorbidities. And on the other hand, of the treatment measures that have already been tried. If the application of heat and physiotherapy as well as a light drug treatment with ibuprofen or diclofenac do not help, the course is more likely to be protracted. In principle, it can always come back to you even if the symptoms improve Relapse come.
Heavy peoplethat also little or no sport do, patients with a lot of comorbidities or patients who sit (e.g. office work) have a much worse prognosis that the ISG syndrome will permanently disappear and not come back than young athletic people. Approx. 80-90% of SI joint syndromes can through warmth and if necessary. be cured with light pain relievers and anti-inflammatory treatments. Approx. 10-15% of patients have to undergo physiotherapy. The small remaining portion does not respond adequately to these therapeutic measures and may have to undergo surgery Joint stiffening undergo.
Duration of treatment
In the best case, the chosen therapy works immediately on. In some, but less common, cases, so-called therapy-resistant courses. In addition to the conservative measures operational procedures be considered. It should be noted that so-called uncomplicated SI joint syndromes usually disappear after one or two pain medication treatments. Patients who are not overweight, who have done a lot of sport throughout their life and who have no other orthopedic pre-existing conditions have an advantage here. In the case of heavy weight people who have excessive stress, the treatment time is usually extended many times over.
prophylaxis
Most important prophylactic measure is lots of movement and a adjusted weight in the normal range. Furthermore, it is particularly important that any existing Incorrect loads in the Hip, Knee-, or Ankle be balanced. In sedentary jobs, you should ensure that you have enough breaks and leave your workplace during this time in order to exercise sufficiently.
Sports
To prevent ISG syndrome, are all sports, the no sudden stopping movements, but include regular sliding movements, make sense. Especially swim, Cycle (with adapted seat) or Walking. Ball sports such as soccer, tennis or squash cannot prevent ISG syndrome due to the risk of strains. If an ISG syndrome has occurred, you can muscle building sports be exercised in order to relax the muscles.
pregnancy
Due to the unusual and sometimes unphysiological weight distribution during pregnancy, there can always be increased pulling and stretching movements in the area of the SI joint.
The main weight lies in the front of the pregnant woman, an attempt is automatically made to shift the weight backwards in a compensatory manner, which causes the joints of the Basin and des move are heavily used.
Most often, back pain in pregnant women can be attributed to this cause.
Most complaints can also be managed well during pregnancy and will disappear shortly after birth.
The ISG syndrome in pregnancy is treated in the same way as in non-pregnant women. Only with the medication should be careful. So must be given during pregnancy Ibuprofen or Diclofenac be waived. Paracetamol is the method of choice.
Of course, surgical measures are not necessary due to the short duration of the illness and the expected full recovery.
Summary
A ISG syndrome is an orthopedic disease in which it is due to excessive Pulling or stretching movements as well as wedging in the joint between the iliac and sacrum leads to load-dependent pain. Beginning SI joint syndromes often only lead to symptoms after exercise. However, advanced ISG syndromes can lead to complaints even at rest.
Mainly for diagnostics Examination techniques of the orthopedic surgeon used to find out at what level the pain is emerging. Classic pain localization of ISG syndrome is the left or right hip area with possible radiation in the back or in the legs. ISG syndrome rarely leads to pure back pain. In addition, the patient survey is important, in which it is to be found out how long the complaints have existed, whether sports are played and whether sports have been overloaded before the symptoms began. A Herniated disc of the lumbar spine should always be included in the possible list of causes and excluded.
Diagnostic imaging can either be done with a X-ray or with one Magnetic resonance imaging (MRI of the lumbar spine or pool) be performed.
Once diagnosed with SI joint syndrome, there are various treatment options. First should be on Heat application and Protection the joint must be respected. Physiotherapeutic measures can be considered. Anti-inflammatory pain treatment is important and can often lead to discomfort relief within a very short time. Here, drugs from the NSAID group, such as ibuprofen or diclofenac, are mainly used.
In most cases, these treatment options will help. In a few cases in which the pain cannot be relieved or if the pain keeps coming back, an orthopedic operation must be considered. The IS joint is stiffened using a special technique. This prevents the annoying and painful pulling or shearing movements.
Preventive measures are adapted weight, sport and no incorrect orthopedic stress on the joints of the body.
