Question
It has taken three years to get to this point.  I have an SI joint that is unstable
and everytime I change postion or even walk my right butt muscle goes into
spasm.  I also have nerve pain down my leg.  I have done Pilates and that has
helped but I still have pain of about 3/10 eveyday.  Currently I'm suffering
from an acute flare-up and just finished a steroid pack and am taking
Neurontin.  Today I think my doctor figured the whole thing out.  My SI joint
is not held in place with any type of movement, my muscles try to hold it in
place and go into spasm which then squeezes my nerve that sents pain down
my leg.  It all makes sense to me finally.  She has ordered a MRI with thick
cuts over the pirformis muscle (15 of people have the nerve run through the
muscle instead of under it).  She is recommending a SI joint injection and a
piriforis nerve block.  After this has calmed down I'm looking at prolo-therpy
for a long term cure to this problem.  What do you think of the treatment
plan?  Can you suggest anything else??

Answer
The MRI is a good place to start.  Controlling the Piriformis spasm, and working on the ligaments of the SI joint are crucial to the proper function of that joint.  Prolotherapy can work very well; the joint injection, as we have seen, has "iffy" results.  You may want to consider a chiropractor if you haven't already, to assess the joint mechanically, and possibly adjust and set up a rehab program to strengthen the core and low back.