Sacroiliac Joint Dysfunction
The sacroiliac joint (SIJ) is the interconnection between the middle triangular shaped sacrum and the left and right sides of the pelvis (iliac bones) located at the base of the spine. The function of the SIJ is to allow torsional or twisting movements when we move our legs. The concept of the SIJ causing lower back pain is now pretty well understood. However, due to the complex anatomy and movement patterns at the joints and area in general, evaluation and treatment of SIJ dysfunctions is still controversial.
SIJ dysfunction is a term, which is commonly used when talking about sacroiliac injuries. Dysfunction generally is associated with hypomobility (stuck, unmoving) or hypermobility (to loose). This can then lead to pain and dysfunction leading to a wide range of symptoms throughout the lower back and buttocks, or even the thigh or groin.
What are the Symptoms of SIJ Injury?
- Pain located either to the left or right of your lower back. The pain can range from an ache to a sharp pain, which can restrict movement.
- The pain may radiate out into your buttocks and low back and will often radiate to the front into the groin.
- Occasionally there may be referred pain into the lower limb, which can be mistaken ‘sciatica’
- Classic symptoms are difficulty turning over in bed, struggling to put on shoes and socks and pain getting your legs in and out of the car.
- Stiffness in the lower back when getting up after sitting for long periods and when getting up from bed in the morning.
- Aching to one side of your lower back when driving long distances.
- There may be tenderness on palpating the muscles and ligaments surrounding the joint.
Causes of SIJ Pain
Causes of SIJ pain can generally be split into four categories:
- Traumatic: caused when there is a sudden impact or jolt to the SIJ, which may cause damage to the articular structures such as the ligaments and cartilage. A common example is landing on the buttocks,
- Biomechanical: often caused by unbalanced stress and forces through the SIJ due to a leg length discrepancy (one leg longer than the other), excessive pronation (flattening of the arches) or muscle imbalances leading to a ‘twisted pelvis’
- Hormonal: in preparation for giving birth the ligaments supporting the pelvis become loose (laxity) and combined with increased weight can lead to excessive strain and subsequent pain.
- Inflammatory joint disease: often termed spondyloarthropathies refer to a chronic inflammatory condition of the spine and pelvis, which often leads to pain and arthritis and requires medical and pharmacological management
Treatment of SIJ Pain
What can you do to treat sacroiliac joint pain yourself?
- Rest from any activities, which cause pain.
- If the surrounding muscles have tightened up, gently massage the muscles use a warm-pack to help them relax (do not heat if an inflammatory condition is suspected)
- Anti-inflammatory medications may be helpful. Always check with your Doctor first.
- Try wearing a SIJ belt
Physiotherapy for SIJ pain
- The Physio will perform a detailed assessment and use diagnostic tests to discover the cause of the problem
- Rule out medical diseases such as spondyloarthropathies
- Aim to treat the cause as well as the symptoms through treatment modalities, which may include:
- Sports massage to release tightened muscles
- Needling techniques to furthur release tight muscles
- Electrotherapy to settle muscle spasm and reduce inflammation
- Joint manipulation or mobilization to unlock stiff or blocked joints
- Exercise and stretching to correct any muscle imbalance and improve or re-establish proper activation of the deep stabilizing muscles of the low back and pelvis. This is essential for optimal load transfer and motion control of the SIJ.
A good study by Richardson et al in Australia investigated how these muscles impact the SIJ using the Echo Doppler [a diagnostic ultrasound device, which can show if specific muscles are contracting]. The authors showed that when the deep core muscles (transversus abdominis and multifidus) co-contract, the stiffness of the SIJ increases thereby proving that these muscles are essential for compressing the SIJ and stabilizing the joint under load. It is critical that this compression occurs at just the right time. (Richardson C A, Snijders C J, Hides J A, Damen L, Pas M S, Storm J 2002 The relationship between the transversely oriented abdominal muscles, sacroiliac joint mechanics and low back pain. Spine 27(4):399-405).
Hence the knowledge of the Physiotherapist to apply reserach such as this is important to regain function and painfree motion. At Back in Action Physio Whistler our therapists have advanced training in Spinal Manipulative Therapy and Sports Rehabiliation. We regularly attend conferences and courses to ensure we are ahead of the game to keep our clients ahead of the game of life. “We keep you playing”