Are there any special considerations made in treatment and rehab when considering the actual cause of injury, for example, torsion vs. fall, or traumatic childbirth?
Certainly you must assess the amount of instability and it is possible to severely avulse or fracture the joint, with severe injury. However I remember one chap that was hit in the back with a bulldozer blade. He had gross instability, but it was essentially all in the long posterior SIJ ligament. I saw him four years after injury, convinced the WC what it was, and he went back to work as a heavy equipment operator after his SIJ fusion. This ligament is the weak link in the chain. When the SIJ goes out, this is where it goes out at. It sends you a pain signal that you can not ignore. It is acting like a reset button. Reset it in the proper position and most of the time the pain goes away. Even with rather severe trauma, careful correction can bring extreme relief, give you a clue as to the cause and direct you in the treatment. I found this to be the major cause of back pain in childbirth as well as most cases of LBP.
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