Rehabilitation (Sacro-iliac joint inflammation)

The guidelines below are for information purposes only. We recommend seeking professional advice before attempting any rehabilitation.

The aims of rehabilitation are:

Reducing pain and inflammation

Rest from activities which include running or placing any weight or force on the sacroiliac joint.
In the acute phase (usually 48 hours) apply cold therapy or ice (do not apply ice directly to the skin or it might burn).
NSAID (Non Steroidal Anti-inflammatory Drugs) e.g. Ibuprofen may help in the early stages. Always consult a doctor before taking medication. Ibuprofen should not be taken if you have asthma.
Apply interferential therapy. Four electrodes in a cross position with the centre of the cross over the inflamed joint.
Pulsed ultrasound can be used to reduce pain and inflammation over the affected joint.

Identifying possible bio mechanical causes

A common cause is a seized opposite sacroiliac joint. A physiotherapist, chiropractor or osteopath can perform tests to identify this problem.
Certain bio mechanical abnormalities may increase the risk of getting this injury or hinder in the rehabilitation. It will probably take an experienced therapist to identify the problem.
Leg length difference is one such possibility. If one leg is longer than the other then this may place a repetitive force to the sacroiliac joint greater on one side than the other. Eventually inflammation will result.
One method of measuring leg length is to lie on your back and have a tape measure placed from the bony bit on the front of the hip (anterior superior iliac spine) to the bony bit on the outside of the ankle. Measure from exactly the same places on the other leg. If there is a difference of more than a 15mm then a wedge may need placing in the shoe to equal the legs out. Some therapists would not correct the difference though.
Over pronation of the foot on one side may also increase the chance of SI joint inflammation.
Another bio mechanical problem is a tilted pelvis. If the pelvis is out of alignment undue stress may be placed on one side of the SI joint. It may require a therapist to mobilize / manipulate the pelvis back into alignment but you can help yourself by working hard at stretching the surrounding muscles.

Restore normal functioning to the joint

A general mobility programme of the lower back and hip can help recovery and prevent recurrence.
Mobility exercises for the lower back and hip can begin as soon as they can be done without pain. This may be after the first 48 hours of injury, it may be longer.
Initially mobility exercises should be done two to three times a day.
Mobility should continue long after you feel the injury has gone. This will help prevent the injury from recurring.
Sports massage techniques can also be used, particularly for the piriformis gluteus maximus muscles.

Strengthening exercises

The muscles surrounding the sacroiliac joint such as the gluteus maximus, piriformis an the psoas at the front of the hip all affect the joint.
The weak muscles need to be strengthened as well as the tight muscles being stretched to achieve muscular balance of the lower back and pelvis.
If you feel one side / muscle group is weaker when doing the exercises then start each session with the weak side and do not do any more exercise with the strong side than you managed on the weak.
Strengthening exercises should be done in conjunction with stretching and mobility exercises.

Return to full fitness

This should be a gradual process and should only start when you have no pain on moving the hip joint or doing any of the strengthening exercises.
Start with gentle jogging. Run one or two days in three and increase mileage by no more than 10% each week.
Continue to do mobility exercises throughout the rehabilitation programme.