Sacroiliac Joint pain

Sacroiliac joint pain

Inflammation of the Sacroiliac joint causes pain in the lower back and buttocks, usually on one side only. Here we explain the symptoms, causes and treatment for Sacroiliac joint pain.

Symptoms of Sacroiliac joint pain

  • Symptoms of Sacroiliac joint pain consist of pain at the bottom of the spine, usually located on one side.
  • Sometimes it is described as a band of pain across the lower back.
  • The pain can range from a dull ache, to a sharp pain which restricts movement.
  • Sacroiliac joint pain may radiate out into your buttocks and low back, groin and occasionally testicles.
  • Difficulty turning over in bed, putting on shoes and socks and pain climbing in and out of the car.
  • Stiffness in the lower back when getting up after sitting for long periods or getting up from bed in the morning.
  • There may be tenderness on palpating (pressing in on) the ligaments which surround the joint.

Read more on Sacroiliac joint pain diagnosis.


What is Sacroiliac joint pain?

The Sacroiliac joints are located at the very bottom of the back, one either side of the spine and help make up the rear part of the pelvic girdle. They sit between the sacrum bone and the Ilia or hip bones. SIJ dysfunction is a term which is commonly used when talking about sacroiliac injuries. This dysfunction refers to either hypo or hypermobility (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.

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 symphysis (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 are still controversial.


What causes Sacroiliac joint pain?

Causes of Sacroiliac joint pain can be split into four categories; traumatic, biomechanical, hormonal and 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.

Biomechanical – 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, overpronation, twisted pelvis and 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.


Treatment of sacroiliac joint pain

What can the athlete do?

  • Rest from any activities which cause pain, particularly running.
  • Wearing a sacroiliac support belt which may help take the strain off the joint and provide relief from symptoms. It works by applying compression around the hip and across the joint, protecting it from further injury.
  • If muscle spasm around the area is suspected use a heat pack to help them relax. Sports massage may also help reduce muscle tension.
  • Don’t heat if acute inflammation of the joint is suspected though as this will make the condition worse. In this case, cold therapy may be more effective.

What can a sports injury professional do?

  • A doctor may prescribe anti-inflammatory medications such as ibuprofen which can help reduce inflammation and relax muscles.
  • A therapist who specializes in back conditions can do a full assessment and diagnostic tests to discover the cause of the problem ruling out medical diseases such as Ankylosing Spondylitis.
  • Electrotherapy such as ultrasound or interferential may be used to treat soft tissues and if indicated and safe to do, level the pelvis via sacroiliac joint manipulation and mobilization.
  • Sports massage may help relieve any soft tissue tension in the area.

Joint mobilizations

Mobilizations are techniques used by professionals such as physiotherapists, chiropractors, and osteopaths to help promote fluid movement at a joint. Due to the specialist knowledge required and room for error, these techniques should not be attempted by anyone who is not suitably qualified.

Rolled up towel technique

  • Using 2 rolled up towels placed correctly under the pelvis, it is possible to encourage the offending rotated ilia to return to its correct position.
  • The patient should be lying in the prone position with one towel located under the Anterior Superior Iliac Spine (ASIS) and the other towel lower down under the opposite Anterior Inferior Iliac Spine (AIIS), which are bony landmarks on the Ilia.
  • The patient’s body weight will encourage the ilia to rotate and if this is accompanied by soft tissue massage work to the low back and gluteal muscles this will further encourage rotated correction.
  • In order to place the towels in the correct position, the correct diagnosis has to be made. The wrong diagnosis will make things worse.

Articulating the SIJ

  • The therapist places one hand under the patient located across the sacrum and ilia joint. This is in preparation to feel the quality of movement between the 2 bones.
  • Using the leg as a lever the knee can be gently rotated round in circles to mobilize the SI joint.
  • In order to engage the joint, you may have to use more hip flexion and an element of compression whilst rotating the limb.
  • Movement can be detected with your hand across the joint whilst mobilization occurs. This should continue until the quality of movement is detected across the SI Joint.

Straight leg mobilization

  • With the leg straight, the therapist uses their body weight to mobilize the leg forwards and backward.
  • This helps to improve the mobility of the sacroiliac joint.

Exercises

The aim of exercises for treating Sacroiliac joint pain is to correct and 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.

Stretching exercises for the muscles of the hip, particularly the hip abductors (on the outside) and gluteal muscles can help if done gently, however, too much stretching with a hypermobile joint can inflame the joint and increase pain.

This article has been written with reference to the bibliography.