Avin Patel

SIJ Pain and Pregnancy

The SIJ is a strong joint that connects the pelvis to the base of the spine. It is considered a “shock absorber” rather than a joint of mobility.

The SIJ and its referral patterns

The role of the SIJ changes in childbirth. As the baby enters the birth canal, it has to turn in a specific way to navigate through the pelvis. This is made easier by laxity of the SIJ ligaments, and increased mobility throughout the pelvis. Movement is still small, but significant compared to what is considered normal at any other time.

The SIJ in Early Pregnancy

SIJ laxity is enabled by the hormone “relaxin”. It is produced in preparation for birth from the first trimester, at which point associated aches can arise. These might be focused around the lower back, or follow the pattern illustrated above: spreading to the buttocks and legs.

Later Pregnancy

As the bump grows, the centre of gravity shifts forwards. Typically, we compensate for this by leaning back. This can lead to tightness in the muscles of the lower back as they adapt to a deeper curve in the back. However, these muscles act around the SIJ, and increased tension through them can increase pressure on the joint. These changes can cause further irritation.

At this point, the factors irritating the SIJ will not ease until birth. It is recommended that symptoms are addressed sooner rather than later. Although some discomfort in pregnancy is unavoidable, excessive pain and limited function does not have to be tolerated.

Birth and beyond

Standard pregnancy-related SIJ pain often resolves at birth or shortly after. It may take longer if the joint became inflamed, or if the joint at the front of the pelvis was irritated in response. These complications occur in SPD, which is best addressed as early as possible, and definitely before birth. This causes acute pain in the front of the pelvis, and can limit options available in childbirth. Birthing positions with the legs wide apart are not recommended for women with SPD.

If you have lower back pain associated with pregnancy, make an appointment online to get it assessed.

Piriformis Syndrome

Piriformis Syndrome is a form of sciatica. By definition, sciatica is irritation of the sciatic nerve. The piriformis is a deep muscle in the buttocks, and when it’s tight it can irritate the sciatic nerve.

It’s not always possible to tell exactly where sciatica originates from. It could be from the back, in the form of a disc bulge, or it could be further down the leg. Sometimes it’s irritated in two places: a double crush. If we can be sure what’s causing the pain, we can work in a more targeted way.

One place that can be easier to identify as a cause is the buttock. There may be some movements that clearly exacerbate symptoms, or something in the way it started that tells your osteopath what’s involved.

Sciatic Nerve Irritation

When a nerve is irritated, it can become inflamed. This might lead to symptoms such as:

  • pins and needles
  • numbness
  • pain in a defined line following the nerve

Just like we all look unique on the outside, we have difference inside too. Some people have a sciatic nerve that just runs close to piriformis, but others will have a nerve that pierces the muscle. Neither is a problem in itself, but there are theories that the latter group might be more susceptible to developing the condition.

What Can Cause Piriformis Syndrome?

Straight forward piriformis syndrome is due to a tight piriformis muscle. This might be due to:

  • change in centre of gravity, such as pregnancy
  • sudden increased demand on the buttock, like starting an intensive new exercise
  • compensation after an injury


Effective management involves breaking the pain-protection cycle, in which the muscle gets tighter because of the pain. Of course, this cycle only gets worse.

Once the reason for the initial tightening has been discovered, that can be addressed to break the cycle and prevent future episodes of the same pain. Then the muscle itself can be treated in clinic and with exercises at home.

Piriformis syndrome responds well to acupuncture or dry needling. Your osteopath may also use massage and stretching techniques on the muscles around the buttock and into the lower back or leg.

The longer the pain has been present, the harder it can be to calm the nerve down. Techniques to target the nerve and reduce the “danger signal” have their place in clinic and in your home exercises. By addressing both parts of the cycle, we plan to get you back to normal as soon as possible.

If you have the symptoms of piriformis syndrome, don’t suffer another day. Book an appointment online.

Joint Pains

We all get aches and pains from time to time, sometimes coming out of nowhere. When should you get yours assessed or treated?

Aches and pains

Addressing minor aches and pains with check-ups

Just like you see your optician or dentist for regular check ups without symptoms, you can do the same with your osteopath. This means you can mention little twinges and aches that you might not otherwise make an appointment for.

Some problems develop from the way the body has adapted to other aches and pains. We can spot these changes at a check up and nip them in the bud.

An example of how mild aches and pains can affect the body


Our bodies change throughout our lives, and the demand we put on our tissues does too.

Childhood growth spurts to old age

Children can benefit from check ups too. Growth spurts can be associated with aches and pains, such as those at the top of the shin. This can develop into Osgood Schlatter disease if not prevented. Working to improve flexibility can minimise symptoms and allow your child to carry on as normal.

The incidence of “wear and tear” conditions like osteoarthritis increase with age. Often this can be managed well when caught early- even before it becomes symptomatic. Not only does this keep the affected joint healthy, but it prevents need for other joints to compensate.

Pregnancy, menopause, and other hormonal changes

We associate pregnancy with lower back pain, both due to hormones and changes to balance. The menopause is another time when hormones go through a major shift. This too can be accompanied by a number of aches and pains. For some women, menopause coincides with the onset of migraines, which might respond better to manual therapy than medication.

“Non-specific” aches and pains

Both neck and lower back pain can be defined as “non-specific”. This just means that the cause is not serious, and that it is suitable for treatment.

Mild twinges in muscles might be intermittent or recurrent and hard to pin down. Nevertheless, we can still assess the area even between symptomatic periods. These things don’t tend to happen in isolation, so your osteopath is likely to be able to find a cause of your symptoms.

We can also offer advice with the aim of preventing future episodes. This might be in the form of exercises to stretch or strengthen an area, or it might be more focused to first aid.

If you’re ready to address your aches and pains, book an appointment online.


Osteopathy is more than just muscles and joints. We may be able to improve your issues with digestion.


IBS (Irritable Bowel Syndrome)

IBS can cause a range of symptoms, but often it leads to abdominal pain. When we have abdominal pain, we often instinctively slouch forward. This can have a knock-on effect on the upper back and neck as we hold them in unfamiliar positions. Treating these uncomfortable areas around the spine may sound like purely symptomatic treatment. However, some patients with IBS report improvement of symptoms after spinal manipulation.

Your osteopath may be able to offer further advice to help you manage your IBS.

Autoimmune Conditions of Digestion

Not to be confused with IBS, some conditions are classed as Inflammatory Bowel Disease (IBD). These diseases are Ulcerative Colitis (UC) and Crohn’s Disease. They are autoimmune, meaning the body attacks its own cells.

Like other digestive issues, symptoms can include bloating. This can be painful in itself. Pressure on the diaphragm can cause discomfort, and may lead to referred pain in the neck. The good news is that the diaphragm is just another muscle. Like a tight muscle in a leg or an arm, it can be treated.

In terms of treatment for IBD itself, there are theories that working on the lymphatic system can benefit Crohns and UC patients. This idea can also be applied to other rheumatological conditions.

People with IBD are more likely to have other autoimmune conditions, such as Ankylosing Spondylitis (AS) or Rheumatoid Arthritis. AS is often misdiagnosed, but the presence of other autoimmune conditions makes it easier to spot. It may be your osteopath who first diagnoses your AS after drawing the link between IBD and back pain, so be sure to mention any issues with digestion.

Reflux and Heartburn

Reflux and heartburn are conditions in which stomach acid travels up into the oesophagus. This happens when the sphincter between the oesophagus and stomach fails to completely close. Although we can’t work directly on the sphincter, we can work on the diaphragm.

The Diaphragm

The oesophagus passes through a small hole in the diaphragm, meaning the diaphragm can play a role in the function of the area. It is considered part of the “antireflux barrier”, and local treatment may help to manage symptoms of reflux.

If you need help with the above symptoms, book an appointment today.