Your Sacroiliac Joints (SIJ) 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 the sacroiliac joints.
The SIJ should be a fairly stiff or rigid link between the pelvic bones, and allow only a few degrees of movement. In some people due to trauma or just extra mobility, the SIJ has too much uncontrolled motion. This allows the joint to adopt an abnormal or stressed joint position, which may result in pain.
When your SIJ’s are not moving normally due to either stiffness or excessive movement, it is referred to as SIJ Dysfunction.
It is vital that you have both normal movement and muscle control around this area to avoid pain and injury. Commonly SIJ dysfunction can cause lower back, hip, buttock and sciatic pain.
What Causes SIJ Dysfunction?
There are two main groups of SIJ dysfunction:- Hypermobility / Instability
- Hypomobility / Stiffness
- Hypermobility issues are the most common and will be discussed further in this article.
- Hypomobility is normally associated with pathologies that tend to stiffen the SIJ’s such as Ankylosing Spondylitis.
What Causes SIJ Hypermobility?
Your SIJ’s should move a few degrees for normal movement. Like most joints, your surrounding muscles act to stabilise your SIJ’s during stressful or vulnerable positions. The most important SIJ stabilising muscles are your deep abdominal core muscles and your deep gluteal muscle groups.Your core muscles: specifically the transversus abdominis (TrA) 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 TrA muscle significantly stiffens and supports the sacroiliac joint. This improvement is larger than that caused by an abdominal bracing action using all the lateral abdominal muscles. (Richardson etal 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 etal).
When these muscle groups are weak or lack endurance your SIJ’s are vulnerable to excessive movement, which can lead to hypermobility dysfunction or instability.
What are the Symptoms of SIJ Dysfunction?
SIJ dysfunction can mimic numerous other back and hip injuries. SIJ dysfunction can cause lower back, hip, groin, buttock and sciatic pain.
The pain is typically worse with standing and walking and improved when lying down, but not always. It can sometimes be painful to sit cross legged and is normally painful to lie on your side for extend periods.
Bending forward, stair climbing, hill climbing, and rising from a seated position can also provoke SIJ pain. Pain is reported to increase during sexual intercourse and menstruation in women.
The pain is typically worse with standing and walking and improved when lying down, but not always. It can sometimes be painful to sit cross legged and is normally painful to lie on your side for extend periods.
Bending forward, stair climbing, hill climbing, and rising from a seated position can also provoke SIJ pain. Pain is reported to increase during sexual intercourse and menstruation in women.
How is SIJ Dysfunction Diagnosed?
Accurately diagnosing sacroiliac joint dysfunction can be difficult because SIJ symptoms mimic other common conditions, including other mechanical low back pain conditions like facet syndrome or disc bulges.
MRI may show signs of SIJ inflammation or eliminate other potential pathologies. X-rays are of minimal diagnostic benefit.
A thorough physical examination by your experienced musculoskeletal physiotherapist is the best method to assess SIJ instability.
How is SIJ Dysfunction Treated?
PHASE I - Pain Relief & Protection
Managing your pain is the main reason that you seek treatment for SIJ dysfunction. In truth, it was actually the final symptom that you developed and should be the first symptom to improve.
Managing your inflammation. SIJ inflammation it best eased via ice therapy and techniques or exercises that deload the inflammed structures.
Your physiotherapist will use an array of treatment tools to reduce your pain and inflammation. These include: ice, electrotherapy, acupuncture, deloading taping techniques, soft tissue massage and temporary use of a mobility aid (eg cane or crutch) to off-load the affected side.
Your doctor may recommend a course of non-steroidal anti-inflammatory drugs such as ibuprofen.
PHASE II - Restoring Normal ROM, Strength
As your pain and inflammation settles, your physiotherapist will turn their attention to restoring your normal pelvic alignment and SIJ range of motion, muscle length and resting tension, muscle strength and endurance. proprioception, balance and gait (walking pattern).
Your physiotherapist will commence you on a lower abdominal and hip core stability program to facilitate your important muscles that dynamically control and stabilise your SIJs.
Researchers have discovered the importance of your hip muscle recruitment patterns with a normal order of: deep, then intermediate and finally superficial muscle firing patterns in normal pain-free hips. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for you specific to your needs.
Please ask your physio for their advice.
PHASE III - Restoring Full Function
As your SIJ dynamic control improves, your physiotherapist will turn their attention to restoring your normal pelvic alignment and SIJ range of motion during more 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 function to safely allow you to return to your desired activities. Everyone has different demands for their SIJs that will determine what specific treatment goals you need to achieve. For some it be simply to walk around the block. Others may wish to run a marathon.
Your physiotherapist will tailor your SIJ rehabilitation to help you achieve your own functional goals.
PHASE IV - Preventing a Recurrence
SIJ dysfunction does have a tendency to return. The main reason it is thought to recur is due to insufficient rehabilitation. In particular, poor compliance with deep abdominal and hip core muscle exercises. You should continue a version of these exercises routinely a few times per week. Your physiotherapist will assist you in identifying the best exercises for you to continue indefinitely.
In addition to your muscle control, your physiotherapist will assess you hip biomechanics and correct any defects. It may be as simple as providing your will adjacent muscle exercises or some foot orthotics to address any biomechanical faults in the legs or feet. Fine tuning and maintenance of your SIJ stability and function is best achieved by addressing any deficits and learning self-management techniques. Your physiotherapist will guide you.
What is Your Prognosis?
The success of SIJ and pelvic joint re-alignment using a variety of mobilisation techniques and subsequent dynamic stabilisation via a deep abdominal and hip core stability control programs is very good. At PhysioWorks, we have a success rate that exceeds 90% within six weeks of commencing your treatment.
For more information please contact your PhysioWorks physiotherapist.
For more information please contact your PhysioWorks physiotherapist.
Other SIJ Treatment Options
SIJ instability occasionally requires additional passive support until your muscles successfully control the joint. Supportive taping is often beneficial during the initial pain reduction phase.
Longer term instability can be managed with a SIJ stabilisation belt.
If you have any questions please seek the advice of your physiotherapist.
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