Diagnosis
For diagnosis, we first try to show how long the complaints have been present and especially during which movements they occur. Then the examiner will conduct special tests with the patients to find out which areas of the spine are affected. Various pressure and provocation tests provide the examiner with a quick overview of the area where the main pain is located.
Only now are imaging techniques being used. Here, magnetic resonance imaging is the diagnostic tool of choice. Because in addition to joint surfaces and cartilage, muscles and ligaments can also be depicted.
If an ISG syndrome is diagnosed, the corresponding diagnostic code is M54. 1 In Germany, this code is mainly used to transmit the diagnosis to the health insurance company and thus to be able to make a settlement.In most cases an ISG syndrome can be confirmed by the treating physician on the basis of a physical examination. If an unclear symptomatology is revealed during the examination or if the complaints have been persisting for a long time, an MRI examination can be helpful.
MRI can show fluid retention, muscles and other soft tissues well. This is important if acute inflammation is to be ruled out. During the inflammatory process, fluid accumulation occurs in and around the sacroiliac joint. If this becomes apparent on MRI, the cause of the discomfort is clear and can be treated accordingly.
Which doctor treats ISG syndrome?
The treatment of ISG syndrome can be diagnosed and also treated by different doctors. Many patients present themselves with the corresponding symptoms to an orthopedic surgeon. This can carry out the treatment in any case. But also the family doctor can diagnose and treat an ISG-Syndrome in most cases. Since in most cases the treatment is purely conservative with painkillers, exercise and physiotherapy, one does not have to go to an orthopedist.
Therapy
As a rule, the treatment of ISG syndrome is a conservative treatment. First of all, relieving exercises are used, which are taught to the patient during physiotherapy. Sitting on kneeling chairs and step positioning in bed (the patient lying on his back puts his lower legs up) are positions which have a pain-relieving effect and which, if performed regularly, can lead to long-term pain relief.
Massage applications, which primarily aim to relax the muscles of the IS joint, are rarely used today, but are described by some patients as helpful. Also among the conservative measures is the use of the numerous painkillers, which are mainly anti-inflammatory. By means of osteopathy, blockages in various joints can be released.
This often works very well, but is unfortunately not always a permanent solution to the pain. For the short to medium-term improvement of symptoms, the osteopath’s intervention usually helps very well. However, before an osteopath is sought, other possible causes, such as a herniated disc or an osteoporotic fracture, should be excluded.
If there is no contraindication, mainly anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac are used. Initially, the period of use should not exceed one week, as a stomach protection medication must be added for longer use (painkillers of the NSAID group have the side effect of preventing the build-up of the mucous membrane of the stomach, which can lead to gastric bleeding or stomach ulcers). Further conservative treatment measures are compensation for the incorrect load, e.g. through shoe insoles or sports.
Various and specially adapted corsets can also be used to limit painful movement in the affected joint. Under computer tomography view, various painkillers can also be injected directly into the joint, which, at least for a certain time, leads to a reduction in pain. Another measure is radiofrequency therapy.
In most cases, however, this therapy is not covered by statutory health insurance. If conservative measures are not sufficient to relieve the pain in the ISG, surgical measures can be carried out. These are mainly a stiffening of the joint, which should cause that the disturbing pain does not occur anymore during everyday movements.
There are some exercises that can help to release the blockage in the ISG joint. The first exercise takes place lying on your back with your legs straightened, for example in bed, on a 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 side and the erected legs are slowly dropped to the left side. One has practically twisted oneself. This is held for about 30 seconds.
And repeat this for the other side: head to the left side and let the legs fall to the right. The second exercise is a bit more complicated. You kneel on the floor and additionally support yourself with the palms of your hands.
Now move one leg carefully forward and place it between your hands.Stretch the other leg backwards so that only your toes touch the ground. Now lean your upper body over the bent leg. The more you stretch the front leg, the greater the stretch.
After 30 seconds you change the legs. The third exercise is started on all fours. Now you make a strong hump and look down.
The next step is to put your head in the neck and make a hollow back. Do this about 10 – 15 times. In addition, every form of movement helps.
Long and crooked sitting (e.g. in front of the PC) should be avoided or reduced. In general, taping should reduce the pressure load and irritation in the corresponding joint. There are several methods of applying tape.
One method starts with a tape (approx. 20-25cm) that is stuck horizontally over both ISG’s. This is done while the person is prevented.
The tape should be applied with a tension of about 80% 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 applied without tension. A second tape is folded and then the corners are cut off, resulting in two tapes with round ends.
The first tape is now glued to the ISG’s with tension. But the two ends are pressed on without tension. The second tape is glued to the other ISG.
The angle should point diagonally upwards inwards, so that both tapes meet in an imaginary line on the spine about 5-10cm above the horizontal tape. If you are unsure how to apply the tape correctly, you should consult an expert to avoid misuse. The prognosis of an ISG syndrome depends on various causes.
One is the age of the patient, the body weight and the existing accompanying diseases. And on the other hand also from the already tried treatment measures. If a heat application and physiotherapy as well as a light drug treatment with ibuprofen or diclofenac should not help, a protracted course can be expected.
In principle, even if the symptoms improve, a relapse can occur again and again. Heavyweight people who do little or no sport, patients with many concomitant diseases or patients who are sedentary (e.g. office work) have a much worse prognosis for the ISG syndrome to disappear permanently and not return than young people who do sport. Approximately 80-90% of ISG syndromes can be cured by warmth and, if necessary, with a light pain and anti-inflammatory treatment.
About 10-15% of patients have to undergo physiotherapy. The small remainder do not respond adequately to these therapeutic measures and may have to undergo surgical joint stiffening. In the best case, the selected therapy is effective immediately.
In some, but by all means rare cases, so-called therapy-resistant processes occur. In such cases, surgical procedures must be considered in addition to conservative measures. It should be noted that so-called uncomplicated ISG syndromes usually disappear after one or two painkillers. Patients who are not overweight, who have done a lot of sports throughout their life and who have no other previous orthopedic diseases are at an advantage. In the case of heavyweight people who have a severe strain problem, the treatment time is usually extended many times over.
