Sacroiliac Joint Dysfunction

Sacroiliac Joint Dysfunction, What is it?

Sacroiliac Joint Dysfunction is one of the most common issues people will suffer in their lifetime. 80% of the American population will experience low back pain at some point in their lifetime; however, the good news is most low back pain symptoms resolve quickly, often within 3 to 6 months of onset or sometimes even sooner.   In most circumstances, low back pain will resolve with conservative care, like physical therapy (PT), and without needing injections, strong medications, or even surgery.

Determining the primary cause of low back pain requires an assessment by a health care provider such as a physical therapist (PT) or physician. The lower back is a complex area of the spine where multiple bones and joints, muscles, tendons, ligaments, and nerves collectively work together to help protect sensitive structures and provide stability, and yet at the same time allow for movements like twisting and bending.

 

The sacrum is a triangular shaped bone, containing five bones that are fused together. This provides greater stability to the area.  The ilium is the name for the bony part of the pelvis on the upper back side.  It is the bone that is felt when one “puts hands on hips,” and one is present on each side.  Where these two bones meet is called the sacro-iliac joint.

Although the surface area of this joint is small, it is relatively stable and therefore has little movement. The SI joint is designed this way because its main purpose is to be a shock-absorbing structure that transmits forces from the upper body to the hips and legs for standing and walking.

Sacroiliac Joint Dysfunction occurs when the joint becomes either too lax (also called hypermobility) or too stiff (known as hypomobility). If the joint has too much movement, it can irritate and inflame the cartilage between the bones as well as the ligaments in and around the area. If the joint becomes too stiff, it may cause muscle strain, or even imbalance, in the area leading to pain and dysfunctional movements. With this joint, there is a fine balance between being stable yet mobile.

What causes SI joint dysfunction?

Sacroiliac Joint Dysfunction occurs in less than 25% of the population, but some research shows it being even less.  It has been estimated that in no more than 10-14% of patients with back pain, that the Sacroiliac Joint is the responsible joint.   More women than men are affected, mainly due to hormonal changes and is frequently associated with pregnancy and trauma, which can affect both men and women.

Hormonal changes associated with pregnancy, and to a lesser degree, monthly cycles, can contribute to pain in the Sacroiliac Joint as the ligaments can be become relaxed, or hypermobile.  With increased laxity, the joint may become less stable, and pain can occur due to increased strain on the tissue or changes in the joint position.

Hypomobility, or limited mobility, is less common for the Sacroiliac Joint, but it too can cause pain which may lead to dysfunctional movement patterns.

Although rare, a more common cause for hypomobility of the Sacroiliac Joint is a form of arthritis called ankylosing spondylitis, which is an inflammatory disease of the spine that may cause stiffening and possible fusing of the joints within the spine.

Sacroiliac Joint Dysfunction may also occur because of a traumatic injury such as a car accident or fall.  This can cause shearing of tissue leading to instability of the pelvis and low back region.

Symptoms of Sacroiliac Joint Dysfunction

Problems with the Sacroiliac Joint can mimic other low back and hip pain symptoms.  Early diagnosis and intervention is key to a speedy recovery.  It is essential to have a thorough assessment of the lumbar spine completed in conjunction with examination of the Sacroiliac Joint, as the lumbar spine can often refer pain to this area.

The following are some of the more common symptoms of Sacroiliac Joint Dysfunction:

  • Dull or sharp pain, but typically is one-sided within the area of the low back, pelvis, or hip region
  • Pain when sitting cross legged or shifting weight in sitting
  • Pain with transitional movements, like forward bending, stair climbing, and rising from a seated position
  • Tightness in the buttock muscle region

How is sacroiliac joint dysfunction diagnosed?

Because the lumbar spine and Sacroiliac Joint are very close in location and the lumbar spine and pelvis function together, there is a strong relationship between the two.  Pain in the Sacroiliac Joint area is often referred pain from the lumbar spine and a PT should examine both the lumbar spine and the pelvis as part of a comprehensive assessment for pain in this area.

X-rays have shown to be of minimal value in diagnosing this condition, but may be appropriate in the case of a trauma or fall. An MRI (magnetic resonance imaging) has limited benefit as a diagnostic tool for Sacroiliac Joint Dysfunction. An MRI may be used to rule out other conditions if they are suspected. Surgical intervention rarely treats SIJ dysfunction. Research shows conservative care, like physical therapy, is proven to reduce symptoms and improve function.

If there has been trauma or a fall, it is important to consider rapid medical attention to rule out a fracture of this area, especially in certain patient populations who are at greater risk for fracture.

A physical therapist (PT) is trained to examine and perform special tests for this condition to determine whether the source of symptoms is a within the SIJ or the lumbar spine, or if the primary cause of symptoms is something else. The evaluation will include asking questions about how the problem started, the length of symptoms, the pattern of symptoms, and one’s medical history.  The PT will perform a series of movement tests to determine the likely cause, and based on those findings, develop a treatment plan individualized to the patient.

Physical therapists are experts in the musculoskeletal system. PT’s are extensively trained in evaluation and treatment of conditions related to muscles, tendons, ligaments, bones, and nerves.

Treatment of Sacroiliac Joint Dysfunction

In the acute state of lower back or SI joint area pain, ice can be applied to the symptomatic area for 15-20 minutes, twice daily to help with acute inflammation.  Caution should be taken to protect the skin.

Research has proven early intervention may help alleviate symptoms sooner. A PT will evaluate the patient, and then work with the patient to develop goals and an individualized treatment plan, and progress toward return to the patient’s prior level of function as quickly as possible.  He or she will also provide education on posture, body mechanics, and activities that may help speed up recovery.

When starting PT, reducing pain symptoms and managing any inflammation are the first steps in care.  The PT is skilled in testing this area and is knowledgeable about specific techniques, stretches, and exercises which are individualized for each patient based on clinical findings. Sometimes, other strategies and tools such as taping or an SI belt may be of some benefit.

Progressing the program is an important part of treatment.  Advancement of exercises and other appropriate treatment techniques are introduced during ongoing care, as deemed appropriate by the PT based on ongoing assessment.  The patient will also be educated with home exercise program and taught posture and functional activities to minimize the risk of recurrence of symptoms.

If an injection is warranted, it is best for the patient to discuss the risks, benefits, and expected results with the physician providing the injection.  Most often, the patient will also continue PT in conjunction with the injection.  These two strategies work well together, and an injection by itself does not address any structural or musculoskeletal issues that are contributing to the symptoms.

Next Steps

As consumers of health care, patients have a choice in finding the right provider for their own individual needs.

In all states, patients can see a PT first, without a physician’s order.  However, every state has different regulations and insurance carrier coverage may vary.  Physical Therapy Direct Access By State offers information on direct access in each state.

Find A Clinic will direct patients to a physical therapy provider in their geographical area and will help them identify one in their region that has top national outcome rankings for spinal and SI joint care.

 

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