Sacroiliac Joint Pain

What is Sacroiliac joint pain?

The Sacroiliac joints (SIJ) are located at the very bottom of the back, one either side of the spine. They help make up the rear part of the pelvic girdle. They join the sacrum and the Ilia.

SIJ dysfunction is a term that 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.

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 described as a band of pain across the lower back.
• Pain ranges from a dull ache to a sharp pain that restricts movement.
• Symptoms may radiate into your buttocks, 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.
• Tenderness on palpating (pressing in on) the ligaments which surround the joint.

What causes Sacroiliac joint pain?

There are four categories of Sacroiliac joint pain; traumatic, biomechanical, hormonal, and inflammatory joint disease.

Traumatic

Sudden impact or trauma which ‘jolts’ the joint causes traumatic injuries. For instance, 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

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.

How is SI Joint Pain traditionally treated?

Typical treatments for SI Joint Pain include: at-home exercises, rest, ice/heat, and stretching to help reduce the pain in your low back. Sacroiliac support belt: Wearing a sacroiliac support belt helps 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. Physical therapy, Cortisone injections, and RF Nerve Ablation are other traditional treatments for SI Joint Pain. Surgery is typically not recommended for this type of pain.

Many people with SI joint pain choose to undergo joint manipulation/adjustment by a chiropractor, PT, or DO. If the dysfunction is caused by hypermobility (the joint moving too much), then this manipulation can and will cause increased inflammation, pain, and muscle spasm.