Sacroiliac Joint Dysfunction

The sacroiliac joint (SIJ) is a joint at the base of your back whereby the spine joins to the pelvis. There is a sacroiliac joint on each side of the sacrum where it joins onto the ilium (pelvis bone). It is thought to be a significant contributor to low back pain, particularly in the younger population.

The sacroiliac joint is heavily reliant on strong ligament structures to help support it. As with all soft tissue injuries, these can be overloaded and often produce a painful response. The common causes are during pregnancy when the extra load in front can overload these ligaments or cause trauma to this area ⁽⁴⁾.

There is very little movement in the sacroiliac joint; as we get older, the movement reduces to a point where the bones begin to fuse together and therefore no further movement comes from the joint. ⁽⁶⁾.

There are a number of reasons why this condition can occur, such as a fall typically onto the hip area or a collision in sport, but it can occur without clear reason, possibly due to a muscle imbalance. There is a close link between pregnancy and patients who are overweight. Smokers are also at risk of sacroiliac joint pain. The relationship between the sacroiliac joint and low back pain has been a topic of debate, with some believing that the sacroiliac joint does not contribute towards low back pain ⁽³⁾.

In the general population, sacroiliac joint dysfunction affects between 1% to 3% of people. In people who have already been diagnosed with back pain, it is believed to be a part of the problem 25% – 33% of the time.

If you experience the symptoms of sacroiliac joint pain then you should see your physiotherapist take a complete background history and offer an examination. During the examination, you will be asked to perform a few special tests to determine if the sacroiliac joint is involved or not. Different movements and positions can determine what elements are giving you your symptoms. Your physiotherapist may also check for any tenderness over the sacroiliac area.

Other tests such as X-ray, computer tomography (CT) or magnetic resonance imagery (MRI) scans are rarely used in the initial stages of the condition as we often find that these can be misleading and provide information that may not be linked to your symptoms. These investigations can be used if needed to differentiate between hip or serious lumbar spine problems, but only in severe cases or when treatment has been unsuccessful ^{(2, 5)}.

As part of the sessions with your physiotherapist, they will help you to understand your condition and what you need to do to help you recover from your sacroiliac joint dysfunction. This may include reducing the amount or type of activity, as well as other advice aimed at reducing your pain. It is important that you try and complete the exercises you are provided as regularly as possible to help with your recovery. Rehabilitation exercises are not always a quick fix, but if done consistently over weeks and months then they will, in most cases, make a significant difference.

Self-help techniques include:

• Regular pain relief, such as over the counter paracetamol.
•  Heat vs cold therapy.
• Adopting a good posture and use correct lifting techniques.
• Maintain a healthy lifestyle and regular fitness activities like stretches and strengthening techniques.
• Undertake in stress management if this is a factor. Use relaxation techniques or mindfulness.
• If your work is heavy, manual tasks, try to use suitable equipment and ask people to help to try and adapt to the workplace setting.

For patients wanting to achieve a high level of function or return to sport we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage. Before returning to sport a rehabilitation program should incorporate plyometric based exercises this might include things like bounding, cutting, and sprinting exercises (5,7).

As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain reliving treatments to support symptom relief and recovery. Whilst recovering you might benefit from further assessment to ensure you are making progress and establish appropriate progression of treatment.  Ongoing support and advice will allow you to self-manage and prevent future re-occurrence.

• Joint injections where a corticosteroid is used can settle inflammation and swelling of the nerves; they are often used with an analgesic numbing agent. Although it may be a temporary measure, people can have up to 3 injections a year ⁽⁵⁾.
• Use of gels or pain relief patches to help. Your GP is the best person to see to discuss this further.

https://www.physio-pedia.com/Sacroiliac_Joint_Syndrome 

https://www.arthritis-health.com/types/general/possible-causes-sacroiliitis-and-si-joint-pain

https://pubmed.ncbi.nlm.nih.gov/28932014/