Question
I have a vague discomfort in my lower back that I only slightly notice through
the day. But,iIf I lay on my stomach and my wife bends my knees so that my
feet approximate my butt it makes the pain hurt worse and more on one side.
I do quite a lot of bending and lifting with my job that may have contributed
over the years. So my question is, do you think the pain is related to my
spine, my pelvic, or is muscle-related?

Answer
Dear Drew,

The pain you are experiencing likely has a component of all three areas you have mentioned, but a preference for the sacral articulations with the pelvic bones.  What you have described, "I lay on my stomach and my wife bends my knees so that my feet approximate my butt" is an actual orthopedic test used to stress the sacroiliac joint in the pelvis.  It is called Nachlas test.  

When this test is positive for pain, it is indicative of sacroiliac dysfunction and inflammation.  This usually means that the joint space is not moving in the proper biomechanical relationship which places stress on the surrounding ligaments, fascial structures and musculature which often results in pain.  The pain is usually local but can radiate down the legs if the inflammation is bad enough.

Here is the good news:  these issues respond very well to chiropractic care.  A few simple adjustments to the sacroiliac joint will often completely eliminate the pain and dysfunction.  The chiropractic physician needs to evaluate the joint further though to determine if the sacrum needs to be adjusted or if the ilium (lateral pelvic bone) needs to be adjusted.  Then exercises can be discussed and taught for flexibility to keep the joint functioning properly so that you can remain as pain free as possible and prevent long term degeneration in the joint space.  Ergonomics and posture may need to be addressed as well.

I would recommend that you find a good local chiropractic physician and get the problem taken care of.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net