The sacroiliac joint, sometimes called the SI joint, is an important joint right where your spine meets your hip. Though less well-known than other joints, it is key to supporting your upper body and distributing weight to your legs. When it is damaged or irritated, it may produce severe discomfort in the lower back, hips, and even down your legs. Falls, inappropriate lifting of large things, and repeated stress from sports such as jogging are common causes of sacroiliac joint pain.

Simple actions like rising up from a chair, climbing stairs, or even turning over in bed may be unpleasant when you have sacroiliac joint pain. It might make prolonged sitting or driving difficult.

The SI joint is an important factor in your body’s movement and stability. Proper maintenance and treatment are vital for allowing you to move freely and painlessly. Even if you are unfamiliar with this joint, sacroiliac joint pain is more frequent than you may realize, particularly among those with a history of lower back problems or pregnant women.

Pelvis:

This is the large bone structure at the base of your spine. It’s like the basin that supports all of your upper body’s weight. Your pelvis is made up of several bones, including the ilium, which is the part that connects to the sacroiliac joint.

Sacrum:

This is a triangular-shaped bone at the base of your spine, right between your hip bones. It’s like the keystone in an arch, providing stability and support for your spine. The sacroiliac joints are where your sacrum meets your pelvis.

Ligaments and Muscles of the Sacroiliac Joint:

The sacroiliac joint is supported by a network of strong ligaments and muscles that hold it in place. Think of these ligaments as sturdy ropes or straps that keep the joint secure, allowing only a tiny bit of movement. The main ligaments are:

• Anterior Sacroiliac Ligament: This is like a strong belt that wraps around the front of the joint, holding the sacrum and ilium together.
• Posterior Sacroiliac Ligament: This is like the heavy-duty strap on the back of the joint, providing extra support and stability.
• Interosseous Sacroiliac Ligament: This is like the hidden core of the joint, connecting the sacrum and ilium deep inside, keeping everything tightly bound together.

The muscles surrounding the sacroiliac joint also play a role in its stability and function. These include:

• Gluteus Maximus: This is the large muscle of your buttocks. It helps support the joint and is involved in movements like walking and climbing stairs.
• Piriformis: This small muscle runs from the sacrum to the outer hip bone. It helps with rotating the hip and stabilizing the sacroiliac joint.
• Iliopsoas: This is a group of muscles that includes the psoas major and the iliacus. They run from the lower spine and pelvis to the femur and help flex the hip, which can affect the sacroiliac joint.

Sacroiliac (SI) Joint:

This is where the magic happens! It’s the joint where your sacrum and ilium meet. It’s like a sturdy hinge that allows a tiny bit of movement, helping absorb shock and keep your body balanced when you walk, run, or jump. If you put your hands on your hips, just below your waist, you’re right above your SI joints.

Stability and Support:

The sacroiliac joint acts as a sturdy anchor, connecting your spine to your pelvis. It provides a stable base for your upper body and helps distribute the weight of your body to your legs. This joint is supported by a network of strong ligaments and muscles that add extra stability and prevent excessive movement.

Body Movement:

Without your sacroiliac joint, you wouldn’t be able to twist your body to look behind you or bend over to tie your shoelaces. The muscles around the sacroiliac joint, like the gluteus maximus and piriformis, assist in movements such as walking, running, and lifting your legs.

Teamwork:

The sacroiliac joint doesn’t work in isolation. It collaborates with other parts of your pelvis and spine to support your body and enable movement. So, whether you’re kicking a soccer ball or dancing to your favorite song, it’s this teamwork that allows for smooth and coordinated motion.

Shock Absorber:

Just like the cushions in your shoes that soften each step, the sacroiliac joint helps absorb the impacts and stresses your body experiences during activities like jumping or running. This protective role is crucial for preventing injuries and ensuring the longevity of your joints.

The Big Fall

Imagine you’re walking and suddenly slip or trip. Instinctively, you twist your body to try to catch yourself. When you land awkwardly, a lot of force travels through your pelvis and spine. Or maybe you took a direct hit to your lower back while playing soccer. Either way, this force can jolt your sacroiliac joint out of its usual position, leading to a sacroiliac joint dysfunction.

The Support System

Our pelvis has a bunch of soft tissues, like ligaments, that act like strong bands holding the bones together. When there’s a dysfunction or injury, these “bands” can get stretched or torn. It’s like when a belt gets too worn out and can’t keep your pants up properly.

What Happens at the Injury Site

With sacroiliac joint dysfunction, many changes occur in your body physiologically, and these are the factors causing the pain and discomfort experienced.

• Inflammation: Just like when you sprain your ankle and notice redness and swelling around it, that’s what’s happening to the tissues around your sacroiliac joint. Inflammation is one of the ways your body starts healing, though it also makes the area stiff, swollen, and more painful.
• Muscle Spasm: Contraction of the muscles in and around the injury can be due to a spasm. It’s your body’s involuntary response to protect the injury, but spasm can create significant pain and affect your ability to move.
• Ligament Sprain/Tear: The ligaments, which are like strong cords, could be overstretched or even torn. This is quite similar to when a rubber band is stretched too far and loses its shape or snaps. A torn ligament might not be able to hold the bones in position, causing instability and pain.

• Falls: Falling directly onto your buttocks or landing awkwardly after a jump can jolt the SI joint, leading to pain or dysfunction.

• Repetitive Stress

  : Activities like long-distance running, cycling, or certain sports can put repeated strain on the SI joint, leading to discomfort or pain over time.

• Pregnancy: While not all pregnant women experience SIJ pain, pregnancy is a risk factor due to the increased weight and altered posture, as well as hormonal changes that can loosen the ligaments supporting the joint.
• Lifting and Bending: Improper lifting techniques or bending awkwardly can strain the SI joint, especially if you’re lifting heavy objects or twisting your body.
• Arthritis: Degenerative changes in the SI joint, such as osteoarthritis, can cause pain and stiffness, making movement more difficult.
• Previous Injuries: A history of lower back injuries or pelvic trauma can lead to SI joint dysfunction and pain.

Mild Strain

In this stage, the ligaments supporting the sacroiliac joint are slightly stretched but not torn. You might feel a dull ache or tenderness in your lower back or buttocks, particularly after sitting for a long time or when bending over. The pain is usually mild and doesn’t significantly limit your movement, but activities like jogging or lifting light objects might be uncomfortable.

Moderate Strain

The ligaments are more significantly stretched, and there might be minor tears. This leads to more noticeable pain that can spread to your thigh or groin. Activities such as climbing stairs, getting in and out of a car, or carrying moderate weights can cause discomfort. You might also experience sharp pain during sudden movements or when changing positions.

Severe Strain

In this stage, the ligaments are severely torn or completely ruptured, leading to instability in the sacroiliac joint. The pain is intense and can severely limit your mobility. Simple tasks like walking, sitting, or bending can be extremely painful. The joint may feel unstable, and you might need assistance or a walking aid to move around.

As experienced physiotherapists, we are dedicated to using a comprehensive and methodical approach to diagnose your sacroiliac joint (SIJ) pain. Our objective is to precisely pinpoint the source of your lower back or pelvic pain and develop a customized treatment plan that fits your lifestyle.

The diagnostic process begins with a detailed exploration of your symptoms, including their onset, intensity, and factors that worsen or alleviate them. Following this, we conduct a thorough physical examination of your lower back and pelvis, which includes:

• Palpation: We carefully examine the area around your SIJ for tenderness, swelling, or warmth, aiding in the differentiation between inflammatory pain, muscle pain, or joint pain.
• Range of Motion Assessment: We assess the mobility of your lower back, hips, and pelvis, along with the flexibility of the surrounding muscles, to identify any limitations or asymmetries.
• Strength Testing: We evaluate the strength of your lower back, pelvic, and hip muscles to detect any imbalances that could contribute to SIJ dysfunction.
• Special Tests: We employ specific clinical tests designed to elicit your symptoms, assisting in the confirmation of SIJ dysfunction and distinguishing it from other conditions. These tests include the FABER test, the Gaenslen’s test, and the Thigh Thrust test.

Based on the findings, your physiotherapist will discuss with you the most suitable treatment plan to effectively address your sacroiliac joint pain. At Well Health Pro, we are committed to supporting you on your journey to recovery and helping you return to a pain-free daily life.

X rays are generally not the choice, for diagnosing sacroiliac SIJ) pain because they may not clearly display early signs of inflammation or soft tissue issues. However X rays can be useful in ruling out sources of pain such as fractures or degenerative changes in the spine and pelvis. For a diagnosis of SIJ pain healthcare providers often lean towards other imaging methods, like MRI.

Your physiotherapist can refer you to get x-rays taken if necessary.

CT scans are valuable tools for assessing sacroiliac joint pain, providing detailed images of bones and soft tissues like ligaments and muscles. In a CT scan, we focus on key areas such as joint alignment, checking for misalignment that could indicate dysfunction. We also examine the condition of the bones for signs of erosion or thickening, which can point to degenerative changes. The joint space is assessed to see if it’s widened or narrowed, suggesting inflammation or degeneration

If you need an ultrasound, your physio will refer you.

MRI is commonly seen as the best way to diagnose sacroiliac joint (SIJ) pain because it offers detailed images of both bones and soft tissues, allowing for a thorough evaluation of the joint. By detecting early signs of inflammation, edema and other issues that might not be apparent on X rays or ultrasound, MRI proves to be valuable in identifying conditions such as sacroiliitis, a frequent source of SIJ pain.

If your physiotherapist suspects anything more than just a muscle spasm, you will be referred to the right specialist.

Improper Healing and Chronic Inflammation:

The sacroiliac joint area may not have fully healed, leading to continued discomfort. If the injury does not heal properly and is repeatedly aggravated, it can lead to chronic inflammation. This inflammation can result in the formation of scar tissue, which can limit movement and cause discomfort in the pelvic region.

Complications and Muscle Imbalances:

Other injuries or conditions, such as nerve impingement or arthritis, might have developed due to the sacroiliac joint dysfunction. This can occur if the supporting muscles of the pelvis and lower back were not strong enough to stabilize the joint, increasing the risk of developing other painful conditions in the area such as a disc injury.

Improper Treatment and Underlying Conditions:

The initial treatment might not have addressed the root cause or severity of the sacroiliac joint dysfunction. Inadequate treatment can affect the recovery process, and there may also be other factors that have not been considered, such as diabetes, osteoporosis, or rheumatoid arthritis, which can exacerbate the condition.

Waiting Too Long:

Delaying treatment for sacroiliac joint pain can worsen inflammation and pain, leading to a more difficult recovery. Over time, the pain can spread to other areas, causing them to become sore and overworked due to compensatory movements.

Inadequate Use of Supportive Devices:

Using supportive devices like a sacroiliac belt for either too short or too long can hinder healing. Incorrect use may result in inadequate support, leading to further instability or dependence on the device for pain relief.

Misdiagnosis or Incomplete Treatment:

Starting with an incorrect diagnosis can delay appropriate treatment for sacroiliac joint pain. It’s crucial to identify the root cause accurately. Often, patients may try various treatments without completing them, which undermines the recovery process.

Over-reliance on Rest and Medication:

While rest and pain medication can provide temporary relief, they don’t address the underlying cause of sacroiliac joint pain. Excessive stretching can exacerbate the issue. Both excessive rest and insufficient rest can be harmful; too much rest leads to weakness and stiffness, while too little rest prolongs inflammation.

As experienced physiotherapists, we understand that your SIJ is painful and that it is frustrating to recover from. We want to assure you that together, we can create a treatment plan to guide you through recovery. It will include a combination of techniques designed to reduce your pain and inflammation, and to improve your lower back and hip’s mobility and strength.

• Manual therapy: Hands-on techniques, like soft tissue mobilization and joint mobilization, to decrease your pain and increase your range of motion especially in tasks that involve bending over.
• Therapeutic exercises: We’ll work together on targeted exercises to strengthen and stretch the muscles around your lower back.
• Activity modification: Initially, we guide you to modify your daily activities and exercise to minimize stress on your lower back.
• Pain management and Education: Giving you the information you need to understand your pain, helps with long-term pain relief. We can advise you on different pain-relief strategies.
• Other effective modalities: We will also use pain management techniques such as Dry Needling and Electrotherapy that has been proven to manage pain. Strapping can also be used to protect the injured area so that the joint may heal properly.

The goal is to help you get back to your daily life and exercise routine as soon as possible, while minimizing the chances of recurring sacroiliac joint pain.

You’ve just started your physiotherapy for your sacroiliac joint pain and you’re probably thinking, “how long will it take for me to start feeling better?” While the timeline varies for each individual, here’s what you can anticipate:

Initial Phase: Bi-weekly Sessions Over Two Weeks

Consider this as the groundwork for your recovery. During these appointments, we will concentrate on:

• Alleviating pain and reducing inflammation: This may involve manual therapy techniques, specific exercises and treatments like ultrasound or electrical stimulation.
• Enhancing mobility and flexibility: Gentle stretches and exercises will aid in restoring movement in your sacroiliac joint and its surrounding regions.
• Strengthening and stabilizing: As your discomfort subsides, targeted exercises will help reinforce the muscles around your core and pelvis to offer better support for your SI joint.

Moving Forward: Customizing Your Care Plan

Following the initial two weeks, the frequency of your physiotherapy sessions is likely to decrease. However, this doesn’t mean you’re left to navigate it alone! Your physiotherapist will craft a personalized regimen that you can follow at home to sustain progress and prevent any setbacks.

Keep in mind; Recovery is a process, not a sprint. It may take a few weeks to see some progress, but it could be several months before you fully recover and can get back to playing sports. Stay patient, keep up with your exercises regularly and pay attention to how your body is healing!

• Taking pain relief medication can help ease your symptoms, but it’s important to be mindful as they could potentially mask the true seriousness of your injury if not coupled with a proper diagnosis. While medication is significant for the recovery process, it’s crucial to seek advice on its usage.

• Injections like

  cortisone

  , which are corticosteroids, can temporarily reduce inflammation, swelling and pain. However, using them frequently might weaken your joints and ligaments over time.

• Home remedies such as ice and heat therapy are effective in relieving pain and swelling on a temporary basis. It’s advisable to include them in a complete treatment regimen for the best outcomes.
• Using supportive devices like a sacroiliac belt for either too short or too long can hinder healing and may not address the underlying muscles imbalances such as weakness of the gluteal muscles.
• Getting guidance from a biokineticist for rehabilitation can be advantageous, especially when working towards safely resuming your exercise routine or sports activities.
• Trying to adjust your sacroiliac joint without professional help from a chiropractor is not recommended. There could be underlying sprains or injuries that may worsen with improper manipulation.

When conservative treatments are ineffective in alleviating sacroiliac joint (SIJ) pain, surgery becomes a viable option. The goal of SIJ fusion surgery is to stabilize the joint, alleviating pain and enhancing functionality. After surgery, undergoing physiotherapy plays a crucial role in achieving a successful recovery. It aids in rebuilding strength, flexibility and movement, ensuring optimal results and lowering the chances of future complications. A personalized physiotherapy regimen can assist patients in their rehabilitation journey, fostering healing and facilitating a return to regular activities.

• Lumbar Disc Injury: Radiating leg pain (sciatica) is more common in disc injuries, while SIJ pain typically remains in the lower back and buttocks.
• Hip Osteoarthritis: Groin pain is more characteristic of hip issues, whereas SIJ pain is felt in the lower back and buttocks.
• Piriformis Syndrome: Pain with sitting and radiating down the leg, differentiating it from the localized pain of SIJ.
• Ankylosing Spondylitis: Morning stiffness and systemic symptoms like fatigue, which are not typical of SIJ pain.
• Pelvic Floor Dysfunction: Symptoms related to urinary or bowel function, unlike localized pain to the SI Joint.

• Sacroiliitis

• SI joint dysfunction
• SI joint syndrome
• Pelvic girdle pain
• Sacroiliac joint inflammation