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One of the challenges of the journey into later life for many people is unexpected and previously unknown disabilities and illnesses. While in earlier life a person can be pretty sure that they can plan ahead and make commitments, in later life disabilities can flare suddenly, and this gives rise to a sense of loss of control over one’s life.

There are a few conditions that present as “sitting disability”. Pain while sitting is a well known symptom when having inflammation or irritation of the bursa (sac) of the ischial tuberosity (sitting bone), trigger points in the Piriformis (a “pear” shaped muscle which runs across the buttock, giving a whole new meaning to “pear-shaped”), tail bone pain (coccydynia), failed back surgery and back pain in general. About nine out of ten adults experience back pain at some point in their life, and five out of ten working adults have back pain every year. Although most cases resolve quickly, 40% recur and 5% result in a residual disability after 1 year. Conditions like pudendal neuralgia and symphysis pubis dysfunction, which occurs following childbirth, causes severe pain and “sitting disability”.

Saraswathi suffered with severe pain in her left buttock for 3 months. She was in her sixth decade of life, and was gingerly when asked to take a seat in the waiting area. Her pain got worse on sitting down and she preferred remaining on her feet for most of her visit. When she actually did sit down, it was on her right buttock alone! Although pain when sat for longer periods had been an intermittent problem, it seemed to have flared up after her retirement two years ago. It was limiting her household activities significantly, and looking after her grandchildren was an ordeal. She appeared disheveled and became tearful while narrating her plight. The orthopaedic doctors have seen her and given her a few tips on back exercises and a clean chit as far as the spine was concerned. She had read in the Internet that certain “injections in the back” done in pain clinics might help, and wondered if we, at Atlas Painn Care, Coimbatore, would consider it.

She had undergone blood tests previously to rule out ankylosing spondylitis (anuncommon condition, mostly affecting males) and a few other diseases which canpresent in this manner. These tests had come back as normal. The pain, however, prevented her from doing back exercises. A detailed clinical examination raised asuspicion of left sided sacroiliac joint disease. Now, this is the largish joint between thespine and hipbone in the lower back. Fortunately for her, it was one of the conditionswhich do respond to injections into the joint. The X-ray guided injections are fairly straightforward; take 20 minutes, and lasts for a few months. The idea was to reduce her pain, so she could start her physiotherapy regimen.

Sacroiliac joint pain may account for close to 25-30% of all low back pain and this figure climbs significantly with increasing age. The symptoms are variable and no single diagnostic test is available. It can be overlooked, as often it is part of wear and tear changes involving the lower back. Careful history coupled with clinical examination and radiology may be useful. Like other chronic pain conditions a multidisciplinary approach is essential for effective management of Sacroiliac Joint pain.

The injection was simple. At Atlas Pain Care, the informed consent was taken and with her lying face down, the skin of her lower back was cleaned with an anti-septic solution. Local anaesthesia was infiltrated into her skin and a fine needle was guided under X-ray control into the sacroiliac joint. Contrast (dye) was injected into the joint to confirm needle placement. This was followed by injection of medicines into the joint. She was discharged home after an hour and was advised to take it easy for 24 hours. Two weeks later she called to report a 50-60% improvement in her pain and an ability to sit for at least 30 minutes without significant discomfort.

Our physiotherapist, meanwhile, had her started on electrotherapy, and simple stretching exercises. These exercises were introduced gradually and she was encouraged to seek domestic help for household activities that were of longer hours. She remains pain-free six months after her first visit to our pain clinic. Daily walking and stretching is part of her routine and she has shed some weight too. She opted for a pair of sensible footwear and is careful about her back at all times.

There is a strange relationship between suffering and gratitude. It is almost as though the very experience of suffering helps us to appreciate other things so much more, be they relationships, art, music and literature, creation in all its glory or life itself. Saraswathi had taken up her long forgotten hobby of playing the veena. When Beethoven could write some of his finest music when he was totally deaf; when Martin Luther King could turn his prison cell from a dungeon of despair into a haven of righteousness; why not her?