I Can't Sit: A Case of Sacroiliac Instability

Updated: Mar 14, 2021

History

At the time of our first meeting, “Jane” was a 43 yo physical therapist who was unable to sit for longer than 20 minutes at a time which, was negatively affecting both her personal and professional life. This was primarily because of deep gluteal pain, posterolateral hip and low back pain that was now moving up her spine. She was unable to sit and have coffee with friends, go on dates with her husband or drive up to the mountains seated in a car. This pain and instability had worsened to the point that she was no longer able to work. She had been through 6 years of various treatments, including hip labral surgery, physical therapy, massage, osteopathic adjustments, spinal injections, piriformis injections, nerve blocks and even some prolotherapy.

When we got down to the origin of her symptoms, she recalled that she had two difficult deliveries that seemed to injure her sacroiliac (SI) ligaments and this region never seemed to recover.

Exam: Among other lesser findings, the primary finding was significant sacroiliac ligamentous laxity and instability. The sacrotuberous ligament was also tender and lax and there was some thoracic spinal muscle spasm as well.

Treatments

We initiated treatment with stabilization of the bilateral loose sacroiliac and iliolumbar ligaments with 2 separate rounds of dextrose prolotherapy and platelet rich plasma (PRP). 2 treatments were required due to the extreme laxity of these ligaments. In follow up we also treated the left sacrotuberous ligament 3 more times due to pain and instability as well as the gluteus maximus twice.

Outcomes

3 months out from the initial treatment her pain levels were significantly improved to the point she could sit for up to 1-2 hours and hike up to 4-5 miles. After about 6 months she was able to return to part time work and was able to sit for 2 hours and hike longer distances and was very pleased.

Over the next 6 months we did need to stabilize the gluteal tendons and thoracic spine regions a couple more times, but after a year she was in a whole new situation and was EXTREMELY pleased with her improvements in pain, function and her ability to return to work and hang out with her girlfriends for a coffee or a hike. She eventually returned to skiing with her family, Pilates, paddleboarding and even sitting on airplanes for long flights, which were all very difficult if not impossible in the years prior to our treatments. And if all that isn’t enough, I’m now glad to call “Jane” a friend.