Sacroiliac Joint Pain
Article by John Miller
What is Sacroiliac Joint Pain?
SI Joint Pain
Your Sacroiliac Joints (SI Joints) 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. Due to the huge weight-bearing forces placed upon this area, your sacroiliac joints are a fairly stiff link between the pelvic bones and allow only a few degrees of movement. But that subtle movement is normal and very important.
When your sacroiliac joints are not moving normally due to either stiffness or excessive movement, it is referred to as Sacroiliac Joint Dysfunction or SIJ Dysfunction, which normally results in sacroiliac pain. It is vital that you have both normal SI Joint movement and muscle control around this area to avoid SI Joint pain and injury.
In some people, due to trauma, muscle weakness or just extra mobility, your sacroiliac joints can have excessive uncontrolled motion. This allows your sacroiliac joints to adopt an abnormal or stressed joint position, which may result in SI Joint pain.
What Causes Sacroiliac Joint Pain?
There are two main groups of sacroiliac dysfunction that cause SI Joint 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 et al 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). Any of your gluteal muscles can be weak and effect your SIJ control. Your gluteal muscles that can be affected include gluteus maximus, medius and minimus, plus a few other muscles that are less well known. These include piriformis, gemellus superior and inferior, obturator internus and even quadratus femoris.
When these muscle groups are weak or lack endurance your sacroiliac joints are potentially vulnerable to excessive movement, which can lead to SIJ hypermobility dysfunction or instability and subsequent sacroiliac joint pain.
What Does Sacroiliac Joint Pain Feel Like?
Sacroiliac joint dysfunction can mimic numerous other back and hip injuries. It can cause lower back, hip, groin, buttock and sciatic pain. Sacroiliac pain is typically worse with standing and walking and improved when lying down, but not always. SIJ dysfunction can sometimes be painful to sit cross-legged and is normally painful to lie on your side for extended periods.
Bending forward, stair climbing, hill climbing, and rising from a seated position can also provoke sacroiliac pain, but this is variable. Sacroiliac pain is sometimes reported to increase during sexual intercourse and menstruation in women, but once again this is highly variable.
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. There are also many other systemic conditions that affect this region including the reproductive and neurovascular structures.
X-rays can exclude some other pathologies but an MRI is probably the diagnostic test of choice. MRI may show signs of sacroiliac joint inflammation or eliminate other potential pathologies, especially within the pelvis-hip complex.
A thorough physical examination by your experienced physiotherapist is still one of the best methods to thoroughly assess for sacroiliac joint pain or instability.
What is the Best Treatment for Sacroiliac Joint Pain?
PHASE I - SIJ Pain Relief & Joint Protection
While pain relievers or anti-inflammatory medications are often prescribed for acute SIJ dysfunction they will not address the true cause of SIJ pain. Chronic cases of SIJ dysfunction should be thoroughly assessed by a healthcare practitioner who has a comprehensive understanding of the biomechanics and muscular control of your SIJ, pelvis and hip complex. Managing your sacroiliac pain is the main reason that most people 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 in most cases. If this is the case, the prevention of a recurrence becomes your priority.
Natural short-term pain relief can often be achieved by using ice or heat packs applied to your SIJ's.
Managing your inflammation. Sacroiliac joint inflammation it best eased via ice therapy and techniques or exercises that unload the inflammed structures. Your doctor may recommend a course of non-steroidal anti-inflammatory drugs such as ibuprofen. Some seronegative arthritis condition can predispose you to sacroiliitis. Special blood tests can be arranged by your doctor to assist diagnosis in these conditions. Prolonged morning stiffness is a common complaint. See Ankylosing Spondylitis.
SIJ Protection & Support
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.
SIJ Stability Belt
Longer term instability may be managed with a sacroiliac joint stabilisation belt. However, an exercise protocol to specifically address your SIJ issue is normally more effective.
If you have any questions please seek the advice of your physiotherapist.
PHASE II - Restoring Normal ROM, Strength
As your SIJ pain and inflammation settle, your physiotherapist will turn their attention to restoring your normal pelvic joint alignment and normalisation of the dynamic muscle control that affects the SI Joints.
While your sacroiliac joints only move a few degrees, any stiffness or additional movement can become a significant problem with respect to SIJ function. This normally needs to be addressed using specific SIJ mobilisation or alignment techniques.
In most cases, SIJ movement can be restored quite quickly and the dynamic muscle control becomes the focus of treatment and specific exercises prescribed and progressed with competence. Your physiotherapist will prescribe exercises based upon your individual assessment. They can include abdominal core, lower back, gluteal, hip and other lower limb muscles and functional training.
Please seek the advice of your physiotherapist based upon their assessment findings, since treatment and exercise prescription does vary widely between patients and the lifestyle demands of their SIJ function. Athletes will normally require higher level exercises to non-athletes.
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 maintaining sacroiliac joint range of motion during more functionally 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 is 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 if a thorough muscle control program is not undertaken. The main reason it is thought to be chronic and specific muscle weakness. Your physiotherapist will assist you in identifying the best exercises for you to continue indefinitely or periodically.
In addition to your muscle control, your physiotherapist will assess your SIJ, spine, hip and lower limb biomechanics and correct any deficits that may predispose you to SIJ pain and dysfunction. Fine tuning and maintenance of your sacroiliac joint stability and function are best achieved by addressing any deficits and learning self-management techniques. Your physiotherapist will guide you.
Is Exercise Good for Sacroiliac Pain?
Physiotherapists highly recommend an SIJ focused exercise protocol that is prescribed specifically to your assessment findings and the deficits identified. Weakness is nearly always identified as the main cause of sacroiliac joint pain, so addressing your specific weaknesses is normally highly effective in both the short and long-term relief from SIJ pain.
For more information please contact your physiotherapist.
Is Walking Good for Sacroiliac Pain?
Sacroiliac pain and how it responds to walking is variable. There does appear to be two distinct groups of SIJ dysfunction. One group that tends to improve with walking. Sadly, there is another group that walking annoys. Your physiotherapist's assessment is important to determine which group you fall into and your treatment with be adapted accordingly.
Is Running Good for Sacroiliac Pain?
Running is a common cause of SIJ pain, so it is not recommended as a treatment option until your physiotherapist has assessed your dynamic muscle control and its ability to safely cope with running.
Does Stretching Help SI Joint Pain?
Stretching of tight muscles within the hip-pelvis complex can sometimes help ease SI Joint pain. In particular, the piriformis muscle is commonly assessed as being tight or overactive. However, you must ask WHY your piriformis repeated tightens. If it is the only muscle working effectively, albeit excessively, then the long-term solution to your SI Joint pain may not be to continuously stretch your piriformis muscle.
Is Massage Good for SI Joint Pain?
Massage, dry needling and trigger point therapy of tight muscles within the hip-pelvis complex can sometimes help ease SI Joint pain. As mentioned earlier, hypertonicity needs to be addressed along with muscle strengthening, especially in chronic or persisting SI Joint pain cases.
Can Losing Weight Help SI Joint Pain?
It makes sense that losing weight will decrease the SI Joint forces and increase your ability to for your muscles to control your bodyweight through the SI Joint complex. Weight-loss is a positive long-term solution.
How Long Does it Take for Sacroiliac Joint Pain to Go Away?
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. Often there is instantaneous relief and improvement in function after the successful symmetrical realignment of your SI Joints. This will result in equal SI joint range of motion that then needs only requires effective muscular control to maintain. Relief on day one of your SI Joint treatment is a very favourable sign that your SI Joint position was causing your pain and dysfunction.
The long-term success then depends upon the effectiveness of the specific strengthening regime prescribed by your physiotherapist to support and control your sacroiliac joints.
For more information please contact your physiotherapist.
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