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Sacroiliac Joint & Coccyx Pain - Treatment options
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Sacroiliac Joint & Coccyx Pain - Treatment options

I 'm a 25yr old female and had pain in my sacroiliac joints(SIJ) and coccyx for the past 4 years. The pain is sharp and I get clicking and crunching feelings. I also get clicking going all the way up my spine. I did not acquire an injury. I have been seeing a rheumatologist and Sports Physician. I have had 3 steroid injections into my SIJ and 2 into coccyx over the years. They provide immediate relief but they wear off after a few months and now they are not as affective. I have been having weekly physiotherapy and Pilates during the past few years but seem to be making no progress. Last year I was diagnosed with spondyloarthroapthy after results from a bone scan showing reuptake into SIJ, HLA B27 positive, ESR 24, CRP 8. Just recently I had an MRI and X-Ray and I have been told I do not have spondyloarthroapthy and my problem is mechanical. I have not found adequate pain relief from several types of medicines (analgesics, NSAIDs DMARDs, tens). I am currently looking for further options (prolotherapy) but I am unsure if this would help. MRI Sacroiliac Joints 8th April 2009 Technique: Axial and coronal T1 and T2 weighted scans were performed. Report: The sacroiliac joints are normal. No erosions are seen to suggest sacroiliitis. No bone marrow oedema or soft tissue oedema is evident. The vertebra at the lumbosacral junction is transitional. There is a small rudimentary intevertebral disc. There is partial fusion of the transverse processes to the sacrum. A plain x-ray would be required to confirm lumbar segmentation. The uterus is retroverted. Pelvic structures are otherwise unremarkable. X-ray Lumbar Spine 14th April 2009. Report: There are five lumbar type vertebral bodies and then a transitional lumbosacral junction with prominent transverse processes that are fused to the sacrum. There is a minor spurring of the superior endplate of the lowest separate vertebral body on the lateral. There is a minor occult spina bifida of "L6". The bones otherwise appear normal.
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I would suggest that you try more advanced physio including aquaphysio or aquatherapy.
You may also benefit from Pulsed RF lesioning to the SI joint area if you have had benefit previously albeit for only a while from the steroid injections.

Dr Prem Pillay
Director of Spine and Pain Services
Neuro Spine and Pain Center

www.spine-neuro.org
3 Comments
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Thought I might make an update on my situation:

I am about to begin seeing an osteopath and having a CT scan done in a few months time possibly. I have really bad pelvic malaignment, on standing one side is about an inch higher than the other side. When bending forward my sacroiliac joints don’t move properly on one side. My doctor has mentioned my iliacus, psoas, adductor magnus and gemelli are tight. Had some more steroid introjections into my coccyx but it didn’t work this time, either spot was missed or maybe it is referred pain from elsewhere? I bought this book called the malalignment syndrome and that book basically described my whole body and everything going wrong with it. I am taking higher doses of pain killers daily, they are taking my pain down from a 10 to a 6/7, so at least that is something, however I would prefer to not take them and just get this problem fixed.

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Further Update:

Been seeing a physiotherapist at my university, he is also using osteopathic techniques, manipulations to my pelvis and muscle energy techniques. He found a right sacral torsion which tilted backwards, and at first he believed my left SIJ was hypo mobile and right hyper mobile and I had instability problems. He also found I was anteriorly rotated on the right and posterior on the left (however now the opposite has occurred after the manipulations, although it is minor). After the second session of manipulations he reduced my coccyx pain by 90%. However after the fourth session he doesn't feel there is any more he can do to help my sacroiliac joints and that problem is still there, along with a small amount of coccyx pain.

I am in much better alignment; however I am still far from being in proper alignment. I am still doing a lot of stretches and exercises given by my physiotherapist, however I think at the end of the year I will get some prolotherapy. Pulsed RF lesioning is just going to reduce pain if anything and I am after a solution, fix the underlying cause which is my aim, but I will keep that as a last resort option.
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