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Clinically Relevant Anatomy
The Sacroiliac joints are located at the very bottom of the back. You have one either side of the spine. The Sacroiliac joints help make up the rear part of the pelvic girdle and sit between the sacrum (vertebrae S1-S5) and the Ilia (hip bones). The function of the SI joints is to allow torsional or twisting movements when we move our legs. The legs act like long levers and without the sacroiliac joints and the pubic symphesis (at the front of the pelvis) which allow these small movements, the pelvis would be at higher risk of a fracture.
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 sacroiliac dysfunctions is still controversial.
SIJ dysfunction is a term which is commonly used when talking about sacroiliac injuries. This dysfunction refers to either hypo or hyper mobility (low or high respectively). Or in other words, the joint can become ‘locked’ or be too mobile. This can then lead to problems with surrounding structures such as ligaments (e.g. Iliolumbar ligament) and muscles, which means SIJ problems can cause a wide range of symptoms throughout the lower back and buttocks, or even the thigh or groin.
Causes of Sacroiliac Pain
Causes of Sacroiliac joint pain can be split into four categories:
- Inflammatory joint disease
Traumatic injuries to the SIJ are caused when there is a sudden impact which ‘jolts’ the joint. A common example is landing on the buttocks. This kind of injury usually causes damage to the ligaments which support the joint.
- Pain due to biomechanical injuries will usually come on over a period of time and often with increased activity or a change in occupation/sport etc. The most common biomechanical problems include:
- Leg length discrepancy
- ‘Twisted pelvis’
- Muscle imbalances
- Hormonal changes, most notably during pregnancy can cause sacroiliac pain. In preparation for giving birth, the ligaments of the pelvis especially increase in laxity. Combining this with an increase in weight putting extra strain on the spine, may lead to mechanical changes which can result in pain.
Inflammatory joint disease
- Spondyloarthropathies are inflammatory conditions which affect the spine. These include Ankylosing Spondylitis which is the most common inflammatory condition to cause SI joint pain.
- 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 it is responsible for pain in the testicles among males.
- Occasionally there may be referred pain into the lower limb which can be mistaken for 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 ligaments which surround the joint.
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General Advice for a patient:
- Rest from any activities which cause pain.
- If the surrounding muscles have tightened up, use a warm-pack to help them relax.
- Don’t heat if an inflammatory condition is suspected.
- Anti-inflammatory medications such as ibuprofen may be helpful. Always check with your Doctor first.
- Try wearing a sacroiliac back belt
Health professional and Physio management.
- Use diagnostic tests to discover the cause of the problem.
- Rule out medical diseases such as Ankylosing Spondylitis.
- Treat the cause as well as the symptoms.
- Use electrotherapy equipment to treat affected tissues.
- If indicated and safe to do, level the pelvis via manipulation.
- Muscle energy techniques to help align the ASIS’s and PSIS’s.
- Sports massage will help relieve any soft tissue tension in the area.
- Advise you on a rehabilitation program to correct any muscle imbalances.
- If the above treatment fails, a Corticosteroid injection into the SIJ may be used