Sacroiliac Joint Pain: Treatment & Management
Updated: Nov 30, 2018
Lower back pain is one of the most prevalent conditions, affecting many people and athletes, with multiple structures in the lower back region being a possible cause of pain. An accurate diagnosis is vital to providing successful treatment of the spine injury.
The sacroiliac joint is a complex anatomic structure at the bottom of the lumbar spine that meets the pelvis and if injured can be a vital cause of lower back pain. Mechanical dysfunction, inflammation, infection,trauma, and degeneration can all be attributed to the sacroiliac joint.
Biomechanics of the Sacroiliac Joint
The function of the sacroiliac joint is to transmit forces of the spine through to the pelvis and vice versa. Although the main role of the joint is to provide stability, it has limited motion that allows it to transfer significant loads.
Dysfunction within the sacroiliac joint can often occur if the motion in the pelvis is asymmetric. Thus including leg-length inequalities, a unilaterally weak lower limb, tight soft tissue structures, and scoliosis. Hip osteoarthritis can also lead to sacroiliac joint pain. In addition, pregnancy often leads to stretching of the pelvis and the sacroiliac ligaments, possibly leading to dysfunction, hypermobility syndromes, and chronic pain.
Symptoms include pain - local and buttock pain. Also, pain radiating to the hip, posterior thigh, or even calf has been described.
Pain is often worse for sitting for long periods or when they perform twisting or rotary motions.
Pain quality: The pain is described as a dull ache or sharp, stabbing, or knifelike.
Pain distribution: Reported distributions are the buttocks, back of the thigh, and upper back; it can be unilateral or bilateral.
History: Importantly, exclude a history of inflammatory disorders (eg,inflammatory bowel disease, Reiter syndrome).
Fevers, weight loss, and pain in the night with night sweats: These are potential red flags for a systemic illness.
Pain that is worse in the morning (morning stiffness) and resolves with exercise: This pattern is consistent with an inflammatory disease.
Pelvis asymmetric height is common. Indicating possible unilateral restriction in motion of.
Limb lengths may posses inequality, lumbar spine may show scoliosis,
Palpation may be the most reliable indication of SIJ pain.
Neurological examination of motor strength, sensory examination, and reflexes in the lower extremities should be normal. However, sometimes, strength proves challenging, and the patient may exhibit weaknesses because of pain inhibition. True neurogenic weakness, numbness, or loss of reflex should alert the clinician to consider nerve root injury or pathology other than a mechanical dysfunction.
Causes of Sacroiliac Joint pain
Pain is often spontaneously and mechanical in nature. Many risk factors are associated with lower back pain, many directly associated with lumbar disk injury. Factors that can increase the likelihood of mechanical injury to the sacroiliac joint are often linked to compensation. Pregnancy is one particular condition attributed to dysfunction.
Certain biomechanical or muscle length imbalances may ultimately predispose a person to sacroiliac dysfunction and pain. Likely, this is a result of altered gait patterns and repetitive stress to the sacroiliac joint. These conditions exist in persons with leg-length inequality, scoliosis, a history of polio, poor-quality footwear, and hip osteoarthritis.
Other conditions may include sacroiliitis, inflammatory origins (eg, ankylosing spondylitis [AS], psoriatic arthritis). Laboratory studies are appropriate when an inflammatory disorder is suspected in a young patient.
Treatment of the Sacroiliac Joint
Rehabilitation - Acute Phase
This focuses on pain control. Therapies such as deep tissue massage, myofascial therapy, and muscle energy techniques are used alongside ice and heat. Pelvic myofascial stretching is used for relief of discomfort.
The recovery phase must include progressive rehabilitation. Often, sacroiliac injury leaves patients with significant deconditioning and muscle imbalances.
The correction of any mechanical or leg-length asymmetries should be attended with orthotic/shoe lift, stretching lumbopelvic muscles, and strengthening weak and inhibited muscles.
The patient is asked to take on more challenging tasks while progressing through the program. Stabilization exercises are performed with the patient in a more dynamic, functional position and often include balance and proprioceptive activities. Strengthening of the core muscles can be achieved in various ways.
Articulation, mobilisation and muscle energy stretching are used and can be very helpful.
Manipulation has been shown to be very effective in the treatment for acute lower back pain and also sacroiliac joint pain. As with other passive modalities, these treatments should be coupled with an extensive active rehabilitative program.
Chronic injuries, belts can provide compression asupport. Patients with ligamentous hypermobility can especially benefit from this.
For any further information in relation to sacroiliac joint pain and dysfunction please contact us Dynamic Osteopaths.
Sacroiliac joint diagnosis
Sacroiliac joint treatmnet and management
Sacroiliac joint rehabilitation
Sacroiliac injuries and pain.