The Guidelines for Lower Back Pain

The following restrictions apply to a sacroiliac joint (SIJ) injury. Please consider these as special instructions to help guide you in developing your therapy regimen and in activities of daily living. The purpose of these instructions is to avoid opening the sacroiliac joints and/or stressing the sprained ligaments of the SIJ. You will notice that some of the movements to be avoided for the sacroiliac joint are the same ones that are recommended for the lumbar disc. Because both sacroiliac and lumbar disc injuries often exist at the same time, you may wish to treat the major symptomatic area first. If the disc is worse, the exercises and stretches may be done more safely while wearing a non-elastic belt that is not put on too tight.

1) Do not bring the knee across the midline. For example, crossing the legs while sitting by placing the knee of upper leg on the opposite leg. However, crossing the ankle or lower leg over the opposite knee wile sitting is okay. Also, while lying in bed; do not let the knee of the upper leg touch the bed. Rest the upper knee either on or behind the lower knee or, better yet, place a pillow between your knees.

2) 90 Degree Rule (eliminates many stretches unless wearing the Serola Sacroiliac Belt). The prohibited actions will cause the sacral base to rotate forward and the ilia to rotate relatively backward, opening the SI joint.

1. With knees straight, do not flex the trunk to, or past, a 90 degree angle with the legs.
2. With the knees bent, do not flex the knees closer than a 45 degree angle between the legs and chest. This should be remembered when tying shoes because most people bring their knee to chest during that action. Bringing the foot up to the trunk is okay if they bring the knee out to the side.

3) No trunk twisting past 25 degrees or to the point where mild tension is felt in the low back. This action causes the sacrum to rotate away from the ilia.

4) No hanging by the arms or feet. No lumbo-pelvic traction, with the exception of the Sacrotrac because its pull is from the sacrum. Hanging and conventional lumbo-pelvic traction pull the ilia and spine apart, stressing the SI ligaments.

5) No extending the back past neutral. For example, you can do back strengthening exercises, but you should not bend backwards at the waist past neutral; this action causes both the sacral base and ilia to rotate forward, but the lumbo-sacral area becomes compressed, and this causes the sacral base to go farther than the ilia, opening the joint.

6) No heat on the low back. Ice is fine at 20 minutes of ice every hour for three hours or more.