Sacroiliac Joint Dysfunction

January 28, 2015 | By | Reply READ MORE...

– Dr. Hasan Sayed

Do you have one sided pain in your low-back/ groin/buttocks and/or side of the thigh? Do you have trouble getting into/turning in bed? You may be suffering from what is known as Sacroiliac Joint Dysfunction.

The Sacrum is a triangular bone at the base of the vertebral column, with its apex pointing downwards. On either side, the Sacrum forms a joint with the ilium bone, known as the Sacroiliac Joint (SIJ).

It transmits all the forces of the upper body to the pelvis and legs. These joints are relatively immobile as compared to the other joints in the body. However, certain actions or conditions may cause slight shift in the relationship between the two bones forming the Sacroiliac joint, leading to pain.

Sacroiliac Joint Dysfunction

SYMPTOMS:

  • Type of pain is deep, dull.
  • The pain is usually in the low back; most of the time it is one sided but can also be central.
  • You may also experience pain in one side of the buttock, back and sides of the thigh. This distribution of pain is some time misunderstood with sciatica (Pain due to sciatic nerve).
  • However, in case of SIJ, pain is rarely experienced below knee.
  • Sometimes, pain is experienced in groin.
  • Symptoms also worsen with-
  • Prolonged or sustained positions (i.e., sitting, standing, lying).
  • Change of position (sit to stand, getting out of the bed, turning in the bed)
  • Bending forward, stair climbing, hill climbing, walking on uneven surface and lying on side of pain.
  • Faulty posture (sitting with leg crossed or twisting and standing with weight on one leg)

CAUSES:

  • Traumatic injury to the Pelvis like Pelvic Fracture,
  • Motor vehicle accidents,
  • Falls landing on the buttocks,
  • Sudden jerk caused by inadvertently stepping off a curb, jump of bus/train
  • An overzealous kick (either missing the object or hitting the ground).
  • Cumulative injuries, such as lifting, twisting and running
  • Pregnant women: Female hormones released during pregnancy cause relaxation of the ligaments supporting the sacroiliac joint. This stretching in ligaments results in changes to the sacroiliac joints, making them hypermobile & painful.
  • Leg Length Discrepancy: If one leg is shorter than the other, it can cause uneven stresses at Sacroiliac Joint.
  • Scoliosis: Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt, just before puberty. Scoliosis, if present in lower back can lead to increased forces at one SIJ.
  • Sero-negative and HLA-B27-associated Spondylo-arthropathies: Spondylo-arthropathy is the name for a family of inflammatory rheumatic diseases that cause arthritis. The most common is Ankylosing Spondylitis. It is associated with HLA-B27 genotype. It starts with pain and stiffness of SIJ and low-back and in later stages, can cause bony fusion (Abnormal joining of bones).

DIAGNOSIS:

  • An early diagnosis is important to minimize the possibility of a long term problem. A detailed history, involving mechanism of injury, site of symptoms and pattern of pain is very important tool in diagnosis.
  • A case of Sacroiliac Joint Pain requires careful assessment of alignment of bones with respect to each other, changes in bony alignment with movement of trunk and leg, and muscles that support the joint.
  • Also, during assessment, it is very important to rule out other problems including low back disorders such as disc prolapse, lumbar canal stenosis, etc.

TREATMENT:

1. Reducing Pain & Inflammation:
Local Ultrasound Therapy to the painful joint will help reduce pain & Inflammation of the joint. Ice packs also help achieve same effect.
Sacroiliac Joint Dysfunction

 

2. Correction of Derangement:
The change in alignment of the sacrum & ilium with respect to each other can be corrected either by –

(a) Manual Therapy Techniques that involve methods to correct dysfunction and getting bones to their normal alignment by manual correction. Your physiotherapist can set the alignment into the correct position.

(b) Muscle Energy Techniques (MET) involves getting bones in their normal alignment by a very gentle muscle contraction.
This is a very effective technique, not painful and can also be done by patient himself.

Sacroiliac Joint Dysfunction
Sacroiliac Joint Dysfunction

 

3. Taping Techniques:
For SI Joint dysfunction, kinesio-tape can be used in initial stages for reduction of pain.Kinesiology tape is a thin, stretchy, elastic cotton strip with an acrylic adhesive designed to benefit a wide variety of musculoskeletal and sports injuries, plus inflammatory conditions.
Also once pain subsides, the same can be used facilitate or inhibit certain muscles as determined from your physical examination.

Sacroiliac Joint Dysfunction

 

4. Dry Needling:
Dry Needling is a technique which can be used to release Trigger points and tightness, that may develop in the Hip muscles as a result of pain caused by wrong alignment of SIJ.

Sacroiliac Joint Dysfunction

 

5. Flexibility:
Following mis-alignment of pelvic bones, imbalance develops in the muscle attached to the pelvic bones. Certain muscles like the Gluteii (buttock muscles), the inner thigh muscles etc. may become tight. This further increases stiffness across SIJ. Appropriate stretching of these muscles can improve flexibility and reduce stiffness.

Sacroiliac Joint Dysfunction
Sacroiliac Joint Dysfunction

 

6. Strength training:
Hip, Core & Abdominal muscles are essential for maintaining the stability of the Pelvis & Sacroiliac area. These muscles should be strengthened to maintain long term effects of the treatment & prevent recurrence of pain.

(a) Core stability training: Core muscles are the muscles that surround and support the Spine. Conditioning these muscles helps develop a ‘natural corset’ to support your spine. This helps reduce the stresses on the Sacroiliac joint and also increases the stability of pelvic bones.

Sacroiliac Joint DysfunctionSacroiliac Joint Dysfunction

(b) Sling training: The muscles that obliquely cross the Spine and Hip together form a network known as The Posterior Sling System. Strengthening of this Sling system is essential for SI joint stability and support.

Sacroiliac Joint Dysfunction
Sacroiliac Joint Dysfunction
Sacroiliac Joint Dysfunction

We, at PhysioRehab,believe in treating the cause of pain rather than symptoms. A detailed assessment is done before administering any treatment. In case of SIJ Dysfunction, correct diagnosis and treatment intervention results in early reduction in symptom and faster recovery.

Category: Articles

Leave a Reply