Sacroiliac Joint pain

John Williams registered Osteopath and Sports Injury Therapist explains sacroiliac joint pain symptoms, assessment and treatment options including mobilization and sports massage.

Symptoms of SI joint injury

Sacroiliac joint pain is usually located either to the left or right of the lower back, although it is sometimes described as a band of pain across the lower back. The pain can range from an ache to a sharp pain which can restrict movement. Sacroiliac joint pain may radiate out into your buttocks and low back and will often radiate to the front into the groin and occasionally testicles. Very occasionally there may be referred pain into the lower limb which can be mistaken for sciatica.

Classic symptoms also include difficulty turning over in bed, struggling to put on shoes and socks and pain getting your legs in and out of the car. The patient will experience stiffness in the lower back when getting up after sitting for long periods and when getting up from bed in the morning. There is likely to be aching to one side of your lower back when driving long distances. There may be tenderness on palpating the ligaments which surround the joint.

See sacroiliac diagnosis & assessment for more details.

Sacroiliac joint injury explained

Sacroiliac jointThe 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 bone and the Ilia or 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). 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; traumatic, biomechanical, hormonal and inflammatory joint disease.

Traumatic

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.

Biomechanical

Foot biomechanicsPain 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, over pronation, twisted pelvis and muscle imbalances

Hormonal

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.

Treatment of sacroiliac joint pain

What can the athlete do?  

Sacroiliac support beltRest 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 though as this will make it worse. In this case cold therapy may be more effective. Anti-inflammatory medications such as ibuprofen may be helpful but always check with your Doctor first. Try wearing a sacroiliac back belt which may help take some of the strain off the joint.

What can a sports injury specialist do?  

A therapist who specializes in back conditions can do a full assessment and diagnostic tests to discover the cause of the problem. They will rule out medical diseases such as Ankylosing Spondylitis and treat the cause as well as the symptoms.

Assessing SI joint painElectrotherapy equipment may be used to treat affected tissues. If indicated and safe to do, level the pelvis via sacroiliac joint manipulation and mobilization.

Sports massage will help relieve any soft tissue tension in the area. They will also advise on a rehabilitation program to correct any muscle imbalances. This is likely to include pilates exercises which may help strengthen the core muscles of the trunk. If the above treatment fails, a Corticosteroid injection into the SIJ may be used.