Sacroiliac joint pain refers to discomfort or inflammation in the sacroiliac joint, which is located between the sacrum (the triangular bone at the base of the spine) and the ilium (the pelvic bone). It is a common cause of low back pain and affects both men and women. The exact pathology of the sacroiliac joint pain can vary, but it is often related to issues such as degeneration, inflammation, ligaments sprains, or abnormal joint movement. Certain factors, such as pregnancy, previous lumbar fusion surgery, trauma, or conditions like arthritis, can increase the risk of developing sacroiliac joint pain Although the prevalence of sacroiliac joint pain can vary, studies suggest that it may account for approximately 15-30% of cases of chronic low back pain.
Anatomy
The sacroiliac joints are located on each side of the spine between the two pelvic bones, which attach to the sacrum. The main function within the pelvic girdle is to provide shock absorption for the spine and to transmit forces between the upper body and the lower limbs. The SI joint experiences forces of shearing, torsion, rotation, and tension. Ambulation is heavily impacted by the SI joint, as this is the only orthopaedic joint connecting the upper body to our lower body. The joint is a relatively stiff synovial joint filled with synovial fluid. The bones of the sacrum and ilium are coated in hyaline cartilage at their articular surfaces with dense fibrous tissue connecting the ilium and the sacrum. SI joints typically only have a few degrees of motion.
Symptoms
Some common sacroiliac joint pain symptoms are as follows:
- Lower back pain,
- Hip pain,
- Pain that radiates down the leg
- Feeling weakness in the leg
Causes
Predisposing factors for SIJ pain include:
- Apparent leg length discrepancy
- Older age
- Inflammatory arthritis
- Previous spine surgery
- Pregnancy and trauma
Diagnosis
The diagnostic process collects medical history, including information on current pain and symptoms. Additionally, a medical history includes information on diet, sleep, and activity habits, as well as any recent or past injuries that may contribute to the cause of SI joint pain.
Some of orthopaedic provocation tests can rule out or identify the sacroiliac joint as the pain source, including:
- Sacral thrust test
- Distraction test
- FABER test
- Palpation tests
Treatment
Treatment for Sacroiliac Joint Pain typically involves a combination of physical therapy, exercises, and medication. The specific treatment plan will depend on the causes and severity of the pain.
- Physical therapy is often recommended as the first line of treatment for SI joint pain. A physical therapist can teach exercises to help strengthen the muscles that support the joint and improve flexibility in the hip and lower back. These may include exercises to strengthen the glutes, hamstrings, and core muscles, as well as stretching exercises for the hip and lower back.
- Medications: over the counter pain relievers, such as ibuprofen or naproxen, may be used to manage pain and inflammation. If these are not effective, your doctor may prescribe stronger medications such as muscle relaxants or tricyclic antidepressants.
- Injections of corticosteroids or hyaluronic acid into the joint may be used to reduce inflammation and pain.
- Surgery is typically only considered for severe cases of SI joint pain that do not respond to other treatments. Surgery to stabilize the joint may be done, but it should be considered as a last resort.
- Chiropractic care can also provide manual adjustments to the joint, which can help to reduce inflammation, improve range of motion, and relieve pain
Exercises
Here are some exercises that can help alleviate SI joint pain:
1. Pelvic Tilts
- Purpose: Mobilise and strengthen the lower back and pelvic muscles, helping to alleviate stiffness and pain around the SI joint.
- How to Perform:
- Lie on your back with your knees bent and feet flat on the floor.
- Gently flatten your lower back against the floor by tilting your pelvis upward, engaging your abdominal muscles.
- Hold the position for a few seconds, then relax and return to the neutral position.
- Repeat for the desired number of repetitions.
2. Clamshells
- Purpose: Strengthen the gluteus medius and other hip muscles, which help stabilise the pelvis and SI joint.
- How to Perform:
- Lie on your side with your legs stacked and knees bent at 90 degrees.
- Keep your feet together as you lift your top knee, opening your legs like a clam shell while keeping your hips stable.
- Lower your knee back down and repeat before switching to the other side.
3. Bridging
- Purpose: Strengthen the glutes and lower back muscles, providing better support and stability to the SI joint.
- How to Perform:
- Lie on your back with your knees bent and feet flat on the floor, hip-width apart.
- Lift your hips toward the ceiling, squeezing your glutes and keeping your body in a straight line from shoulders to knees.
- Hold for a few seconds at the top, then slowly lower your hips back down.
4. Lying Leg Abduction
- Purpose: Strengthen the hip abductors, particularly the gluteus medius, which helps stabilise the pelvis and reduce SI joint stress.
- How to Perform:
- Lie on your side with your legs straight and stacked.
- Lift your top leg upward, keeping it straight and in line with your body.
- Slowly lower the leg back down and repeat before switching sides.
5. Fire Hydrants
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- Purpose: Strengthen the gluteus medius and hip muscles, improving pelvic stability and reducing SI joint pain.
- How to Perform:
- Start on all fours with your hands under your shoulders and knees under your hips.
- Keeping your knee bent, lift one leg out to the side, like a dog at a fire hydrant, while keeping your hips level.
- Lower the leg back down and repeat before switching to the other side.
Prevention
Preventing sacroiliac joint pain involves maintaining prohttps://youtu.be/3J1d1jJQ1-Eper alignment and stability of the joint, as well as reducing the stress placed on it.
- Maintain good posture
- Strengthen your core
- Stretch your hip muscles
- Avoid high impact activities
- Use a proper form when lifting weights
- Wear shoes with good arch
- Maintain a healthy weight
