Sacroiliac Joint Pain
Article by John Miller
What is Sacroiliac Joint Pain?
Your Sacroiliac Joints (SIJ) are a critical linkage system between your lower spine and pelvis. The sacrum (tailbone) connects on the right and left sides of the ilia (pelvic bones) to form your sacroiliac joints.
Your sacroiliac joints should be a fairly stiff or rigid link between the pelvic bones, and allow only a few degrees of movement. In some people due to trauma or just extra mobility, your sacroiliac joints have too much uncontrolled motion. This allows your sacroiliac joints to adopt an abnormal or stressed joint position, which may result in SIJ pain.
When your sacroiliac joints are not moving normally due to either stiffness or excessive movement, it is referred to as Sacroiliac Joint Dysfunction, which normally results in sacroiliac pain.
It is vital that you have both normal SIJ movement and muscle control around this area to avoid SIJ pain and injury.
Commonly sacroiliac dysfunction can cause lower back, hip, buttock and sciatic pain.
What Causes Sacroiliac Joint Pain?
There are two main groups of sacroiliac dysfunction that cause SIJ pain:
Hypermobility issues are the most common and will be discussed further in this article.
Hypomobility is normally associated with pathologies that tend to stiffen your sacroiliac joints such as in Ankylosing Spondylitis.
What Causes Sacroiliac Joint Hypermobility?
Your sacroiliac joints should move a few degrees for normal movement. Like most joints, your surrounding muscles act to stabilise your sacroiliac joints during stressful or vulnerable positions. The most important sacroiliac stabilising muscles are your deep abdominal core muscles and your deep gluteal muscle groups.
Your core muscles: specifically the transversus abdominis and oblique abdominals through their attachments to the iliac bones help closure of the pelvis and improves the position, control and stability of the sacroiliac joints.
Researchers have discovered that contraction of the transversus abdominis muscle significantly stiffens and supports your sacroiliac joints. This improvement is larger than that caused by an abdominal bracing action using all the lateral abdominal muscles (Richardson etal 2002).
Further to this, researchers have discovered that your deep gluteal (buttock) muscles are important for controlling the lateral and rear aspects of the pelvis and hip. (Grimaldi et al).
When these muscle groups are weak or lack endurance your sacroiliac joints are vulnerable to excessive movement, which can lead to SIJ hypermobility dysfunction or instability and subsequent sacroiliac joint pain.
What are the Symptoms of Sacroiliac Joint Dysfunction?
How is Sacroiliac Joint Pain Diagnosed?
Accurately diagnosing sacroiliac joint pain & dysfunction can be difficult because SIJ symptoms can mimic other common back conditions. These include other mechanical low back pain conditions like facet joint syndrome or a bulging disc.
X-rays are of minimal diagnostic benefit. MRI may show signs of sacroiliac joint inflammation or eliminate other potential pathologies.
A thorough physical examination by your experienced musculoskeletal physiotherapist is the best method to assess for sacroiliac joint pain or instability.
How is Sacroiliac Joint Pain Treated?
PHASE I - SIJ Pain Relief & Joint Protection
Managing your sacroiliac pain is the main reason that you seek treatment for sacroiliac joint dysfunction. In truth, it was actually the final symptom that you developed and should be the first symptom to improve.
Managing your inflammation. Sacroiliac joint inflammation it best eased via ice therapy and techniques or exercises that deload the inflammed structures. Your doctor may recommend a course of non-steroidal anti-inflammatory drugs such as ibuprofen.
Your physiotherapist will use an array of treatment tools to reduce your sacroiliac pain and inflammation. These include: ice, electrotherapy, acupuncture, deloading taping techniques, a SIJ belt, soft tissue massage and temporary use of a mobility aid (eg cane or crutch) to off-load the affected side.
PHASE II - Restoring Normal ROM, Strength
As your pain and inflammation settles, your physiotherapist will turn their attention to restoring your normal pelvic alignment and sacroiliac joint range of motion, muscle length and resting tension, muscle strength and endurance, proprioception, balance and gait (walking pattern).
Your physiotherapist will commence you on a lower abdominal and hip core stability program to facilitate your important muscles that dynamically control and stabilise your sacroiliac joints.
Researchers have discovered the importance of your hip muscle recruitment patterns with a normal order of: deep, then intermediate and finally superficial muscle firing patterns in normal pain-free hips.
Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for you specific to your needs.
Please ask your physio for their advice.
PHASE III - Restoring Full Function
As your sacroiliac joint dynamic control improves, your physiotherapist will turn their attention to restoring your normal pelvic alignment and sacroiliac joint range of motion during more stressful positions and postures plus work on your muscle power, proprioception, balance and gait (walking pattern).
Depending on your chosen sport or activities of daily living, your physiotherapist will aim to restore your SIJ function to safely allow you to return to your desired activities.
Everyone has different demands for their sacroiliac joints that will determine what specific treatment goals you need to achieve. For some it be simply to walk around the block. Others may wish to run a marathon.
Your physiotherapist will tailor your sacroiliac joint rehabilitation to help you achieve your own functional goals.
PHASE IV - Preventing a Recurrence
Sacroiliac joint dysfunction does have a tendency to return. The main reason it is thought to recur is due to insufficient rehabilitation. In particular, poor compliance with deep abdominal and hip core muscle exercises. You should continue a version of these exercises routinely a few times per week.
Your physiotherapist will assist you in identifying the best exercises for you to continue indefinitely.
In addition to your muscle control, your physiotherapist will assess you SIJ, spine, hip and lower limb biomechanics and correct any defects.
It may be as simple as providing you with adjacent muscle exercises or some foot orthotics to address any biomechanical faults in the legs or feet.
Fine tuning and maintenance of your sacroiliac joint stability and function is best achieved by addressing any deficits and learning self-management techniques. Your physiotherapist will guide you.
What is Your Prognosis for Sacroiliac Joint Pain?
The success of sacroiliac joint pain treatment via pelvic joint re-alignment and subsequent dynamic stabilisation via a deep abdominal and hip core stability control programs is very good.
At PhysioWorks, we have a success rate that exceeds 90% within six weeks of commencing your treatment. For more information please contact your physiotherapist.
Sacroiliac Joint Pain Treatment Options
Sacroiliac joint instability occasionally requires additional passive support until your muscles successfully control the joint. Supportive taping is often beneficial during the initial pain reduction phase.
Longer term instability can be managed with a sacroiliac joint stabilisation belt.
If you have any questions please seek the advice of your physiotherapist.
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