What is the Sacroiliac Joint?
The sacroiliac (SI) joints are formed by the connection of the sacrum and the right and left iliac bones. The sacrum is the triangular-shaped bone in the lower portion of the spine, centrally located below the lumbar spine. While most of the bones (vertebrae) of the spine are mobile, the sacrum is made up of five vertebrae that are fused together and do not move. The iliac bones are the two large bones that make up the pelvis. As a result, the SI joints connect the spine to the pelvis. The sacrum and the iliac bones (ileum) are held together by a collection of strong ligaments.
What Causes Sacroiliac Joint (SIJ) Pain?
While it is not clear how the pain is caused, it is thought that an alteration in the normal joint motion may be the culprit that causes sacroiliac pain. This source of pain can be caused by either:
- Too much movement (hypermobility or instability): the pain is typically felt in the lower back and/or hip and may radiate into groin area.
- Too little movement (hypomobility or fixation): The pain is typically felt on one side of the low back or buttocks, and can radiate down the leg. The pain usually remains above the knee, but at times pain can extend to the ankle or foot. The pain is similar to sciatica, or pain that radiates down the sciatic nerve and is caused by a radiculopathy.
What are the Symptoms of Sacroiliac Joint Dysfunction?
- Sacroiliac joint dysfunction can mimic numerous other back and hip injuries.
- It can cause lower back, hip, groin, buttock and sciatic pain.
- Sacroiliac pain is typically worse with standing and walking and improved when lying down, but not always.
- It can sometimes be painful to sit cross legged and is normally painful to lie on your side for extend periods.
- Bending forward, stair climbing, hill climbing, and rising from a seated position can also provoke sacroiliac pain.
- Sacroiliac pain is sometimes reported to increase during sexual intercourse and menstruation in women.
What Does the Pain Feel Like?
It could be a dull or sharp. It starts at your SI joint, but it can move to your buttocks, thighs, groin, or upper back.
Sometimes standing up triggers the pain, and a lot of times you feel it only on one side of your lower back. You may notice that it bothers you more in the morning and gets better during the day.
Like most lower extremity joints, one of the SI joints’ function is shock absorption (depending on the amount of available motion at the sacroiliac joint) for the spine, along with the job of torque conversion allowing the transverse rotations that take place in the lower extremity to be transmitted up the spine. The SI joint, like all lower extremity joints, provides a “self-locking” mechanism that helps with stability during the push-off phase of walking. The joint locks on one side as weight is transferred from one leg to the other, and through the pelvis the body weight is transmitted from the sacrum to the hip bone.
The motions of the sacroiliac joint:
- Anterior innominate tilt of both hip bones on the sacrum (where the left and right move as a unit)
- Posterior innominate tilt of both hip bones on the sacrum (where the left and right move together as a unit)
- Anterior innominate tilt of one innominate bone while the opposite innominate bone tilts posteriorly on the sacrum (antagonistic innominate tilt) which occurs during gait
- Sacral flexion (or nutation Motions of the sacrum occur simultaneous with motion of the ilium so you must be careful in the description of these as isolated motions.
- Sacral extension (or counter-nutation)
Overcoming SIJ Dysfunction
There are obviously some initial remedies that can be implemented to help alleviate the immediate pain that can be caused by sharp SIJ pain, such as ice, heat and rest.
Initial treatment recommendations encourage the use of ice or cold packs, applied in 15 to 20 minute intervals as needed to reduce inflammation in the area, along with rest to reduce irritation. Depending on the duration of sharp, intense pain, ice can be continued anywhere between 2 days to 2 weeks. Once the inflammation is less, gradual return to normal activities may be advisable. Application of heat (such as a heat wrap or hot bath) may help the healing process, but not during the acute, high intense pain time frame.
The recovery time for sacroiliac joint dysfunction may vary from patient to patient depending on compliance with Osteopathic Care. With ideal treatment, patients may be pain free in as little as several days, although typically this may take 2 – 3 weeks. It is important to note, however, that injured tissue takes approximately six weeks to restore the majority of its strength in ideal healing conditions. Care must therefore be taken when returning to activity during this period.
What can an Osteopath do to help?
- Soft Tissue treatment which assists with Joint mobilisation
- Joint Manipulation
- Dry needling
- Various muscle energy techniques
- Speed up and assist with recovery
Further ongoing treatment of SIJ Dysfunction can include:
- Pain relief medication – it is best to consult your GP for best guidance.
- Complete a gradual return to activity and exercise program.
- Taping to restrict and control movement. See your Osteopath, Sports Therapist or Physiotherapist for help with showing you where and how to support the SIJ Joint best with Tape.
- Wearing a sacroiliac belt or lumbar brace.
- Implementing the use of a lumbar roll for sitting.
- Using a RADHelix or RADRoller to increase mobility and reduce pain.
- Taking part in regular Clinical Pilates classes.
- As your Osteopathy for some exercises that will help to improve flexibility, strength, posture and core stability.