Strained pelvic ligaments

[Faith]

I have a lot of sacral pain especially on the left side. There are little "grisely" knobby spots along my sacrum. I think this must be my ligaments and I think my SI and possibly my ST/SS ligmaments are lax and overstrained from overly aggressive SI joint manipulations that set off my sitting pain. Nothing I have done helps it.
I've been to two physical medicine and rehabilitation doctors who specialize in pelvic pain, but neither diagnosed me with overstrained ligaments. They just kept saying I had SIJD so PT's kept manipulating my SI joints even though it did no good and just kept causing more flare ups.

My question is if my ligaments are overstrained and I have PN surgery wouldn't my PN just get re-entrapped from the lax ligmaents? If it is just my SI ligaments (and not my ST or SS ligament) that is strained can anyone explain how that could cause PN? Maybe it isn't, maybe I am entrapped somewhere and have lax ligaments.

Is there any other treatment for lax ligamaents other than prolotherapy? My fear of prolotherapy is that it will make my PN worse because it will cause scar tissue to form. Of course I can't do much core strengthening because of the PN pain.

Is there any one else on here who had had surgery and had lax ligaments (prior to surgery) other than Violet?

[HerMajesty]

Although it is possible to have damage to the ligaments themselves, if you have been told you have SIJD and nobody has corrected it properly, the tone of the ligaments will be off due to the displacement of elements of the bony pelvis. examples: in upslip ilium the S-T ligament will be notably lax as there is a reduction in the distance between the iscial tuberosity and the sacrum. In downslip Ilium, the S-T ligament will be taught, to the point where if you palpate it or sit on it, it will feel like a bone is present in the part of your behind that is all soft tissue and has no bone. this is because the distance between your sacrum and your ischial tuberosity has increased, pulling the ligament tight. In a lower pelvic fixation, one iscium will be angled laterally and one medially (like winshield wipers), which will lead to a taught ligament on one side and a lax ligament on the other, again due to the change in spacing between the ischial tuberosities and the sacrum.
Lax SI ligaments will not cause PN directly, but can lead to the S-I joint moving past end range and getting stuck there, creating a pattern such as upslip, downslip, anterior rotation, etc, which impacts the position of the rest of the structures hence causing PN.
The treatment for lax ligaments usually is in fact correction of SIJD. I don't think you were diagnosed wrongly but I think you received ineffective manipulations and your SIJD was never corrected. Lax ligaments are usually a hint to the pattern of pelvic joint dysfunction, not pathology in themselves. So if you change the ligament tone with prolotherapy, the SIJD which is mechanically entrapping the nerve is not going to go away.

[Faith]

I don't think you were diagnosed wrongly but I think you received ineffective manipulations and your SIJD was never corrected

I don't know HM. My PT and doctors have told me I no longer have SIJD. I am negative for all the provocative tests and do not have pain in the SI joint area. My pain is lower on the edge of the sacrum like more in the piriformis/ST area.

I just don't know how I could have received such ineffective manipulations when in fact the manipulations are what started my pain. I never had all this pain till a PT started manipulating my SI joint and now I am a mess. I had manipulations by a physiatrist who specializes in pelvic pain and 2 PT's who do manual therapy and specialize in pelvic PT. The first PT who I believe started my PN was using a high velocity manipulation (I've had 3 PTs and a physiatrist since say she shouldn't have done that) while I was still breastfeeding my 6 month old daughter. I believe she overstrained ligaments that were already hypermobile due to relaxin still being in my system. I will not let another PT manipulate my SI joints. It's just caused me too much harm. I will never understand why she manipulated my SI joint when I wasn't even having SI joint pain. She thought that was what was causing me postpartum intercourse pain. When I really have PFD. Now I basically have fibromyalgia too which I never had any symptoms of before all this. One physiatrist I saw at a major university hosptial who is well known in the pelvic pain community and has written articles said she thinks the PT saw something that wasn't exactly true. I have mild scoliosis and anteverted hips which she believes can give the appearance of SIJD.

I don't mean to sound bitter, but I am very frustrated. I know my loving Father has a plan, but it sure is hard to understand sometimes.

[paulette]

Faith,
I spoke with Vicki Sims, a nationally known PT who specializes in SIJD. I told her that before my SI fusion, I had such tightness and pain in the gluteal and pelvic muscles, that I had to see my PT every three days. He would use his elbow to massage the gluts and relax the pelvis. She asked me if this helped the pain. I said definitely. She said SIJD often irritates and inflames the piriformis muscle, causing it to spasm. She also said when the piriformis is in spasm, it can clamp down on the pudendal nerve and cause PN symptoms. According to Vicki, because the deep tissue massage helped relieve the pain and tightness, the piriformis could possibly be the culprit. So I have been trying to stretch the piriformis. Have you tried doing piriformis stretches?

I remember Violet saying her inflamed pudendal nerve was causing the piriformis to spasm. So it is one of those "which came first, "the chicken or the egg," questions. What I am wondering is, if a surgeon does PNE surgery, and upon opening the sacrotuberous ligament, doesn't find nerve entrapment, does he still cut the sacrospinous ligament? It seems like that would at least relieve some pressure on the pudendal nerve, even if the piriformis was "squeezing" it?

[Faith]

I believe you are exactly right. People who have SIJD are going to have tight spasmed piriformis muscles. Back when doctors/PT's said I had SIJD my piriformis was really tight. Now, not as much. I try not to stretch my piriformis as it flares up my burning pain. So my husband just massages it almost every night.

What I am wondering is, if a surgeon does PNE surgery, and upon opening the sacrotuberous ligament, doesn't find nerve entrapment, does he still cut the sacrospinous ligament? It seems like that would at least relieve some pressure on the pudendal nerve, even if the piriformis was "squeezing" it?

I have wondered that too. I would hope that they would especially if you explain your history. If I go through that invasive of a surgery I want it done right because most likely I won't do it again.

[paulette]

Faith,
Before I had my SI joint fused, I couldn't do the piriformis stretch exercises either. Even now, I don't do a true piriformis stretch, because I am afraid of ruining the fusion. But I do bring my knee to my chest, alternating each leg. It brings some relief, but I couldn't even do that before my SI fusion. It would cause the pudendal nerve to flare up like you described. Do you live on the East coast? Vicki Sims has helped a lot of people. There is a Facebook page titled, SACROILIAC JOINT DYSFUNCTION AND LOW BACK PAIN. I have learned a lot just reading the different entries.

[Faith]

So Paulette before you had your SI joint fusion did you benefit from sI joint injections? Did they relieve your pain for any length of time? Did you have both sides fused or just one...I'm not famliar with that procedure. I was just wondering since you've had your SI joint fused, but you still have pain then does that mean the SI joint wasn't your true source of pain?

[paulette]

Hi, Faith,
I have never had a pudendal nerve injection. I had an injection of the SI joint once, and it made the pain permanently worse. Since then, I have a hard time agreeing to injections. The SI fusion is called the i-fuse technique by SI Bone, Inc. My recovery has been complicated by the fact that ten levels of my spine are fused. That exerts a tremendous axial load on the SI joints. After the surgery, I also learned, as I wrote earlier, that many SI patients also have piriformis syndrome. I have found that although a great deal of my pain was coming from my SI joint, at least half is coming from the piriformis muscle. Slowly, but surely, the SI joint pain is disappearing. Before surgery, I had to see the therapist every three days for deep tissue massage. I would get so tight, I couldn't stand up straight and could hardly walk. I couldn't sleep more than six or seven hours, and I didn't dare lie down for a nap, or I would get tight. Now I can lie on the couch and even take a nap. But I still have a lot of pain in the middle of the butt and along the sacrum. That's the piriformis. I also still have numbness in the right "saddle area." That really worries me, because I believe it is the pudendal nerve. If I sit for more than five minutes, I feel like a nail is going through my "sit bone." I believe the SI surgery was a success, but SI dysfunction is not my only problem. This month I am scheduled for EMG's of the pudendal nerve and piriformis muscle in Denver. The following week, I am scheduled to see Dr. Antolak. I will not allow him to do injections, but I would like him to assess me. What have you had done in the way of workups and injections?

[paulette]

Faith,
I was wondering who did your injections. Will Dr. Hibner accept them, or will you have to have them done again?

[paulette]

Faith,
I am sorry I keep adding things. I noticed you asked how many sides I had fused. I had my right SI joint fused. The left does not give me much trouble.