BACK SPRAIN, SACROILIAC REGION |
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General Information
DEFINITION--Violent overstretching of one or more ligaments in the sacroiliac region of the spine. When the ligament is overstretched, it becomes tense and gives way at its weakest point, either where it attaches to bone or within the ligament itself. There are 3 types of sprains:
Mild (Grade I)--Tearing of some ligament fibers and associated muscle spasm. There is no loss of function.
Moderate (Grade II)--Rupture of a portion of the ligament, resulting in some loss of function.
Severe (Grade III)--Complete rupture of the ligament or complete separation of ligament from bone. There is total loss of function. A severe sprain requires surgical repair.
BODY PARTS INVOLVED
Ligaments of the sacroiliac region.
Sacrum (spinal region) and ilium (bones of the pelvis).
Tissue surrounding the sprain, including blood vessels, tendons, bone, periosteum (covering of bone) and muscles.
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SIGNS & SYMPTOMS
Severe back pain at the time of injury.
A feeling of popping or tearing in the sacroiliac area.
Tenderness and swelling at the injury site.
Bruising (sometimes) that appears soon after injury.
CAUSESDirect blow or stress on a ligament that temporarily forces or pries the sacroiliac joint out of its normal configuration.
RISK INCREASES WITH
Contact sports such as football or wrestling.
Weight-lifting.
Sudden movement while one leg is in front and the other is behind.
Previous back injury.
Obesity.
Poor muscle conditioning.
Inadequate protection from equipment.
HOW TO PREVENT
Build your strength with a conditioning program appropriate for your sport.
Warm up before practice or competition.
Tape vulnerable joints before practice or competition if you have been previously injured.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's care.
Physical therapy (moderate or severe sprain).
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the lower spine, hip and pelvis to rule out fractures.
POSSIBLE COMPLICATIONS
Prolonged healing time if usual activities are resumed too soon.
Proneness to repeated sacroiliac injury.
Inflammation at the ligament attachment to bone (periostitis).
Prolonged disability (sometimes).
Unstable or arthritic sacroiliac joint following repeated injury.
PROBABLE OUTCOMEIf this is a first-time injury, proper care and sufficient healing time before resuming activity should prevent permanent disability. Ligaments have a poor blood supply, and torn ligaments require as much healing time as fractures. Average healing times are:
Mild sprains--2 to 6 weeks.
Moderate sprains--6 to 8 weeks.
Severe sprains--8 to 10 weeks.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AID
Use instructions for R.I.C.E., the first letters of REST,
ICE, COMPRESSION and ELEVATION (if possible). See Appendix 1 for details.
Don't move the person until a litter or spineboard can be obtained for safe transport.
Don't allow the person to walk until the diagnosis is confirmed. The spinal cord may be injured with movement.
CONTINUING CAREIf the doctor does not apply tape or an elastic bandage:
Use an ice pack 3 or 4 times a day. Place ice chips or cubes in a plastic bag. Wrap the bag in a moist towel, and place it over the injured area. Use for 20 minutes at a time.
Wrap the lower abdomen and hips with an elasticized bandage between ice treatments.
After 72 hours, apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers or heating pads.
Take whirlpool treatments, if available.
MEDICATION
For minor discomfort, you may use:
Aspirin, acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe:
Stronger pain relievers.
Injection of a long-acting local anesthetic to reduce pain.
Injection of a corticosteroid, such as triamcinolone, to reduce inflammation.
ACTIVITYResume your normal activities gradually after clearance from your doctor. The following exercises are safe to do while back pain is present:
While lying on your back, bring one knee up to the chest. Lower it slowly, but do not straighten the leg. Relax. Repeat with each leg 10 times.
Bring both knees slowly up to the chest. Tighten the abdominal muscles and press the back flat against the bed. Hold knees to chest 20 seconds, then lower slowly. Relax. Repeat 5 times.
Clasp knees and bring them up to the chest. At the same time, come up to a sitting position. Rock back and forth.
DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATIONBegin daily rehabilitation exercises when pain subsides and supportive wrapping is no longer needed. Use ice massage for 10 minutes before and after workouts. (Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly in a circle over the injured area.)
Do the following exercises whenever you have a spare moment during the day, both to reduce tension and improve the tone of important muscle groups:
Rotate your shoulders forward and backward.
Turn your head slowly from side to side.
Turn your head down and to the right as if stretching to see your right armpit. Stretch your neck slowly up, around and down, switching to see your left armpit. Repeat, starting on the left side.
Slowly touch your left ear to your left shoulder, then your right ear to your right shoulder. Raise both shoulders to touch the ears, then drop them as far down as possible.
As often as you remember, pull in the abdominal muscles, tighten and hold them for the count of 8 without breathing. Relax slowly. Increase the count gradually after the first week, and practice breathing normally with the abdomen flat and contracted. Do this while sitting, standing and walking.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of a moderate or severe sacroiliac sprain, or a mild sprain persists longer than 2 weeks.
Pain, swelling or bruising worsens despite treatment.
You experience pain, numbness or coldness in the legs.
New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
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