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  1. #1
    Join Date
    Oct. 1, 2002
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    Default Sacroilliac joint pain--injections? Fusion?

    A year and a half ago, during the [warning, sarcasm ahead] glorious snow storms that hit the Mid-Atlantic, I did something strange and not wonderful to my back. It was diagnosed by my PCP as sacroiliitis and I went to PT for four months. PT helped somewhat, but the symptoms never resolved, even though I did my prescribed exercises religiously.

    My pain flared back up this past winter and I went to a chiro. Things got better, then worse. I'm still seeing the chiro, but clearly I need more options.

    I'm seeing a physiatrist doctor at Hopkins next week and hoping for some more insight.

    Of course, I've been doing the five-word sentence that every physician dreads hearing (I've. Been. On. The. Internet.) and reading about SI injections and fusion. I don't even know for sure if I have hypermobility in the SI joint, but the fact that it's not getting better and even feels a little worse with chiro makes me think it isn't that it's stuck.

    I've got cramping muscle pain in my left QL muscle and it feels like someone's jabbing an arrow just to the right of my tailbone and right under my buttock. I have pain that radiates about halfway down my thigh and I can also feel it in my right calf. It's worst when I get out of bed and when I drive.

    I'd just love to be able to move without chronic pain.

    Anyone had SI injections or fusions? Did it help? How long did it last (if injections).

    I'm dying here.
    Life would be infinitely better if pinatas suddenly appeared throughout the day.



  2. #2
    Join Date
    Aug. 24, 2007
    Posts
    994

    Default

    I had Si joint pain, they couldn't tell me why, nothing showed up on MRI, my syptoms were different than yours but truly debilitating. I did the injections - it did nothing, I went to PT, didn't help much, I then started acupuncture and pilates and I am now pretty much all better. So, where our symptoms were different maybe injections would help you, but they were worthless to me...



  3. #3
    Join Date
    Oct. 14, 2010
    Posts
    2,816

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    I've had SI joint pain too. Also from one of those wonderful mid-Atlantic snowstorms. I had the injections pretty quick, as the morning I got up and couldn't move also happened to be the day of an appt with the physiatrist who keeps putting my neck back together. I've had it done a few times. Hurts like %$#@ sometimes & keeps hurting for another week. But it did help longer term. Regular deep tissue massages have helped me (lots of other issues) as well as the home tennis ball massage. Try googling "trigger points" Knotted muscles can cause pain far from where it starts. The other thing that helps, which surprised me, is riding.



  4. #4
    Join Date
    May. 4, 2003
    Location
    Canada
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    14,875

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    I wish you could get to my Physio - he fixed me after four years of pain. Just took a tweak of the legs...he teaches and of course everyone is different.



  5. #5
    Join Date
    Apr. 6, 2006
    Location
    Virginia
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    1,929

    Default

    My doctor (spinal surgeon) told me that if he fused mine I would not be able to ride anymore.

    I did injections at first, but then I found a wonderful PT who specializes in backs. I'm mostly sound now.

    See if you can find someone who does dry needling. It is amazing!



  6. #6
    Join Date
    Oct. 18, 2000
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    Last summer I was told in no uncertain terms that I had to have a fusion.

    Turns out I have facet joint pain and it's not even from the level where I "had to" have a fusion. Dr insisted the pain was from the disc, you see. disc disc disc. It was disc pain!!

    No it wasn't - it is facet joint arthritis and it often mimics the symptoms of disc pain/herniation.

    Got facet joint injections, started feeling better - especially the QL muscles. Had RFA last winter - got RFA on the other side a few weeks ago....... and I am pain free. Back to farm work - legging up two field hunters - I'm jumping again!!!!

    Massage, ActiveRelease, exercise as tolerated a good pain management dr who sees no need for surgery when less invasive methods provide relief..... and I'm good to go. Not 100% - but arthritis cannot be cured so I'll never be 100%. And I do have bad days.

    Before the injections the pain from the facets was so bad I was often unable to walk or dress without assistance - and that was with pain meds and muscle relaxants.

    Having surgery is like going to war. The outcome is uncertain. Try and exhaust other options if you can. Don't be afraid of trying injections, acupuncture, massage.

    I hope you feel better soon.

    eta.. I did have a minor back surgery years ago - for a bad disc herniation that was not resolving and I was losing control of my left leg. Though that pain did go away I'm not eager for another surgery.
    Brothers and sisters, I bid you beware
    Of giving your heart to a dog to tear.
    -Rudyard Kipling



  7. #7
    Join Date
    Oct. 1, 2002
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    Cow County, MD
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    Default

    JSwan, what's RFA?

    Coincidentally, riding does not hurt, although I feel like I can't get my right leg on the horse, and I definitely drop that hip. I do a lot of riding without my left stirrup to force myself to stay straight.

    I would love to be able to do some real aerobic exercise. I used to run, but the compression KILLS my sacrum. I feel great right afterward, and then a couple hours later I can barely walk.

    Grrr.
    Life would be infinitely better if pinatas suddenly appeared throughout the day.



  8. #8
    Join Date
    Oct. 18, 2000
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    Riding usually didn't hurt either. I don't know why - maybe a nurse or doctor will chime in. I figured it was because we are usually using our core and our spine is pretty neutral when riding? I don't know.

    I can no longer run. Perhaps others can but I ran and played tennis for many years, so I did my time. (including military service) Those days are over. Same thing with any aerobic activity that involves twisting, weight over my head, jumping, or extensions. Walking, swimming, cycling, Pilates, Yoga, stretching, weights - all ok.

    RFA is radio frequency ablation. In the riders with disabilities forum I pm'd some other riders about it and they were REALLY helpful. So I was not too anxious about having it done. The dr performs diagnostic injections first (steroids) to confirm that the pain originates from the facets. If injections provide relief - you go on your merry way. If the pain comes back, you can have the injection performed again. If the pain comes back - then you can have the RFA. Not sure RFA is appropriate for what you have - but if it is it may really help.

    It is akin to having a root canal. The medial branch nerve - to that facet - is identified and the end of it is burnt off (using a needle) In my case multiple facets were ablated.

    You go home and avoid strenuous activity the rest of the day.

    When I say I am pain free -that's relative. I live with a certain amount of pain every day. That is my "normal". It doesn't even really register anymore. But that sense of being stabbed deeply with a knife? That is gone. The burning, the QL spasms and pain - gone.

    The thing about the QL muscles is that they really F up our position in the saddle - those spasms pull up the hip, compress nerves and make us ride lopsided. We get into this pain/spasm/guarding cycle and it causes more back pain - we just become a mess.

    I didn't fully appreciate SI and back pain in the horse until I became afflicted with similar pain. Poor horses!
    Brothers and sisters, I bid you beware
    Of giving your heart to a dog to tear.
    -Rudyard Kipling



  9. #9
    Join Date
    Oct. 1, 2002
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    Cow County, MD
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    Default

    Thank, J! What you say about the QL and SI is so true. I have a horse with a history of SI pain, and I am so much more sympathetic to his pain now--or I should say, I'm now empathetic because I now know exactly how he feels!

    Stetches and exercises help temporarily--as in for less than an hour. Then I am right back in contortions again.

    I do also think that a new bed and a different car would help, but it's simply not in the financial cards at the moment. I long for a sleep number bed and to have my SUV back. I drive a Hyundai Sonata, and the low-slung position gets very old after about 20 minutes. I try to drive DH's truck whenever possible, but with a 100-mile commute, that's a gas guzzler.
    Life would be infinitely better if pinatas suddenly appeared throughout the day.



  10. #10
    Join Date
    Oct. 18, 2000
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    Yeah - I know exactly what you are talking about.

    Once I got past the "you must have a fusion" thinking, and I explored other options, I found there are just so many alternatives to surgery (though there is nothing wrong with surgery!) I was really really really wanting to avoid fusion for as long as possible - preferably the rest of my life.

    I wonder if you can break that spasm/pain cycle you're in - if you feel a little better. For me - that did not happen until I received injections and finally, the ablation. Once that cycle was broken, I could start to exercise, stretch, and work on healing as much as possible.

    Maybe others have had different experiences - but one thing that also helps me a great deal is deep tissue massage - also Active Release. A COTH friend told me about Active Release - and there are techniques you can do at home with nothing more than a tennis or lacrosse ball. Perhaps that might help you too?

    I'm not a talented rider, nor do I show or aim for great things with my horses. I just foxhunt. But now that my back is feeling better - I find that I am riding better than I have in several years. It's sort of like having a horse with this decreased performance - nothing you can put your finger on - then a vet helps the horse and Zing - you've got your horse back. I feel a little like a horse that got his mojo back. A fat middle aged horse with a bit of mojo, anyway.

    Good luck to you.
    Brothers and sisters, I bid you beware
    Of giving your heart to a dog to tear.
    -Rudyard Kipling



  11. #11
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    Oct. 1, 2002
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    Default

    Mojo is a good thing! I want some mojo, too!

    Lots of good stuff to think about. thanks, JSwan! I will report back on next week's visit at Hopkins. Fingers crossed.
    Life would be infinitely better if pinatas suddenly appeared throughout the day.



  12. #12
    Join Date
    Nov. 16, 2006
    Location
    NC
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    640

    Default

    SMS- I have/had the EXACT same symptoms as you list in your OP. Mine had been going on for 3 years, MRI showed pretty much nothing so lots of PT was prescribed. It wasn't helping at all and I switched to a different doctor at the beginning of this year. When she went over my history and saw all the PT I had done with little to no success, she suggested an injection. I had my left SI joint injected (X-ray guided, took all of 10 minutes) and I was PAIN FREE! Whoo! That was in early February and I am just starting to have symptoms returning. My dr. thought I would get 6 months to a year of relief and I am at almost 7 months, which is pretty good considering how bad I was to begin with. She said if I get another injection before it gets really bad, its probable that it would last longer the second time. Its definitely worth a try!



  13. #13
    Join Date
    Apr. 2, 2009
    Location
    North Carolina
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    I am JSwan the Second, LOL. I had SI pain, was CONVINCED (I'm a biologist and we have the horrible habit of self-diagnosis, cause dammit, we know our physiology!) that it was an SI issue. I worked with a chiro too, he was good enough to refer me to an ortho when it didn't resolve as he felt it should. Turned out it was facet joint arthritis (I also have a bulging disc, we tried injecting around that first, but it didn't do anything). I'd actually previously read JSwan's story on COTH and it gave my skeptical brain permission to try the injections. I pushed for them, finally got a great ortho who did them (because the first one I got told me to just give up and that I was screwed, wtf???) and...

    After two sets, about a month later, I am pain-free for the first time in 8 months of trying to deal with this agony. Am working with a great PT and a massage therapist and they help even more.

    The injections themselves hurt like crap (bee sting my ass, unless you have bees the size of pterodactyls!) BUT I feel like I got my life back. I have a VERY physical job and I'm an eventer so I need to MOVE. As JSwan noted, the key to pain management is breaking the cycle, then beating it down mercilessly till it gives up.

    So (1) find a great dr. and (2) if injections are deemed appropriate, DO IT! :-)



  14. #14
    Join Date
    Sep. 3, 2007
    Posts
    51

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    Lived with this & found an amazing doctor. I have Piriformis Syndrome. Essentially the piriformis muscle has tightened over my sciatic nerve. This is hard to explain I was diagnosed and the treatment was botox injected into the muscle to paralyze it. This released my sciatic nerve. I was able to begin physical therapy to re-train my muscles to be normal again. I went undiagnosed for a long time & my body was forming the muscles on my left side to "survive". The longer I went incorrectly the tighter the piriformis muscle became. You will find a better explanation on the internet



  15. #15
    Join Date
    Oct. 1, 2002
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    Cow County, MD
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    Quote Originally Posted by wildlifer View Post

    The injections themselves hurt like crap (bee sting my ass, unless you have bees the size of pterodactyls!)


    I'll take it if they have the desired effect!

    I have Piriformis Syndrome. Essentially the piriformis muscle has tightened over my sciatic nerve.
    This was what my PT theorized. But I can do all the stretched for the piriformis with absolutely no pain, so chiro thinks sciatica.

    I am now really eager to get to this Dr on Wednesday. I was supposed to go Thursday but they called and said he had to cancel. I was devastated. On the other hand, it will give me chance to gather up all my records.
    Life would be infinitely better if pinatas suddenly appeared throughout the day.



  16. #16
    Join Date
    Jan. 31, 2010
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    Earth
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    Quote Originally Posted by Sing Mia Song View Post
    A year and a half ago, during the [warning, sarcasm ahead] glorious snow storms that hit the Mid-Atlantic, I did something strange and not wonderful to my back. It was diagnosed by my PCP as sacroiliitis and I went to PT for four months. PT helped somewhat, but the symptoms never resolved, even though I did my prescribed exercises religiously.

    My pain flared back up this past winter and I went to a chiro. Things got better, then worse. I'm still seeing the chiro, but clearly I need more options.

    I'm seeing a physiatrist doctor at Hopkins next week and hoping for some more insight.

    Of course, I've been doing the five-word sentence that every physician dreads hearing (I've. Been. On. The. Internet.) and reading about SI injections and fusion. I don't even know for sure if I have hypermobility in the SI joint, but the fact that it's not getting better and even feels a little worse with chiro makes me think it isn't that it's stuck.

    I've got cramping muscle pain in my left QL muscle and it feels like someone's jabbing an arrow just to the right of my tailbone and right under my buttock. I have pain that radiates about halfway down my thigh and I can also feel it in my right calf. It's worst when I get out of bed and when I drive.

    I'd just love to be able to move without chronic pain.

    Anyone had SI injections or fusions? Did it help? How long did it last (if injections).

    I'm dying here.
    If you would like, I can refer you to the Pain Management doc I see now for the same pain you describe - oddly enough, I received my injury while working at Hopkins

    My doc used to be the head of Pain Management at Hopkins and now has his own practice in White Marsh. He does acupuncture as well as ultrasound-guided injections. I refer a lot of clients I work with for pain issues to him. He has written many books on women and pain and is hands down the kindest person I have ever met.

    I feel your pain...in fact, right now, I'm feeling your pain and it sucks. It is MUCH better than it was this time last year, but I have come to the realization that the extent of my injury is something I simply have to integrate into my daily life - some days are better than others. My life is definitely not the same and I doubt it ever will be. But, because of this doctor, it IS better.
    Horse sense is the thing a horse has which keeps it from betting on people.
    W. C. Fields



  17. #17
    Join Date
    Oct. 18, 2000
    Posts
    22,455

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    Piriformis syndrome effing hurts. I had it briefly after a fall a few year ago. Freaking miserable, I was.

    What this about bee stings, wildlifer? Mine were almost pain free, except where he had to fish around all the bone spurs with the spinal needle during the RFA. They give me a little happy juice, wheel me down the hall, la la la la la, I get to watch it all on the fluoroscope, la la la la, they wheel me out, I go home and crochet. The la la la la is because whatever they give me makes me a chatty cathy and I talk through the procedure. The fluoroscope was way cool and I could see the needles and everything.

    Your dr gave you the brush off too? WTF is up with that? I was told to sell the farm and my riding days were over. Screw that. Some folks have discussed that in that forum too.... Having to fight drs attitudes as well as fighting to get better and well it just ticks me off no end.
    Brothers and sisters, I bid you beware
    Of giving your heart to a dog to tear.
    -Rudyard Kipling



  18. #18
    Join Date
    Apr. 2, 2009
    Location
    North Carolina
    Posts
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    JSwan - I know, right? Why should we have to fight so hard to get such a simple thing which can give us our lives back??

    You got happy juice???!! I am so jealous! No, I didn't get anything -- I guess they felt like it wasn't worth it for 10 minutes in the fluoroscope suite, they just did it at the ortho office. I feel so cheated now. The steroid injection itself didn't hurt, but shooting the damn anesthetic in beforehand felt like someone poured fuming sulfuric acid into my spine, ow! But like I told the doc, who I named Mr. Stabby, I can do ANYTHING for ten minutes!

    I will probably do the ablation thing if/when the pain comes back. But I do want to say THANK YOU for posting your story because as I said before, it really helped me a lot as I was going through this process. I was terrified that I would never be able to jump/lift a hay bale/fill water buckets/lift a damn hoof pick ever again.



  19. #19
    Join Date
    Oct. 18, 2000
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    I'm happy for you. But don't thank me, there was a terrific person in the disabilities forum who helped me a great deal. And my pain management guy has a great outlook on things. He's all about getting you back to YOUR life. Not the life he imagines for you. And he said he gave up on riders years ago. We are all the same. Not sure that was a compliment.
    Brothers and sisters, I bid you beware
    Of giving your heart to a dog to tear.
    -Rudyard Kipling



  20. #20
    Join Date
    Jan. 31, 2010
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    Earth
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    I was told no sitting trot, but jumping and two-point were fine.

    I'm glad to hear stories about the ablation - my chiro told me about it - maybe I'll give it a go. Another thing that has helped was aqua-therapy.
    Horse sense is the thing a horse has which keeps it from betting on people.
    W. C. Fields



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