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Common Conditions

Sacroiliac Joint (SIJ) Dysfunction

25/09/2020

Sacroiliac Joint (SIJ) Dysfunction occurs when the sacroiliac joints of the pelvis become stiff or weak. The condition can develop at any age. SIJ dysfunction is found in 25% of people who complain of low back pain. It is most often diagnosed in females.

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. There is relatively little motion at the SI joints specifically less than 4 degrees of rotation and 2 mm of translation at these joints. Most of the motion in the area of the pelvis occurs either at the hips or the lumbar spine. These joints do need to support the entire weight of the upper body when one is erect, which places a large amount of stress across them. This can lead to wearing of the cartilage of the SI joints and arthritis.

As with most other joints in the body, the SI joints have a cartilage layer covering the bone. The cartilage allows for some movement and acts as a shock absorber between the bones. When this cartilage is damaged or worn away, the bones begin to rub on each other, and degenerative arthritis (Osteoarthritis) occurs. This is the most common cause of SI joint dysfunction. Degenerative arthritis occurs commonly in the SI joints, just like other weight-bearing joints of the body. Another common cause of SI joint dysfunction is pregnancy. During pregnancy, hormones called relaxin are released in the woman’s body that allow ligaments to relax. This prepares the body for childbirth. Relaxation of the ligaments holding the SI joints together allows for increased motion in the joints and can lead to increased stresses and abnormal wear. The additional weight and walking pattern (altered gait) associated with pregnancy also place additional stress on the SI joints. Any condition that alters the normal walking pattern places increased stress on the SI joints and is a risk factor for SI joint dysfunction. This could include a leg length discrepancy (one leg longer than the other), or pain in the hip, knee, ankle, or foot.

The signs and symptoms of SI pain start in the lower back and buttock, and may radiate to the lower hip, groin or upper thigh. While the pain is usually one-sided, it can also occur on both sides. Numbness or tingling in the leg or a feeling of weakness in the leg may also be experienced. Symptoms may worsen with sitting, standing, sleeping, walking or climbing stairs. Often the SI joint is painful sitting or sleeping on the affected side. Some also may have difficulty riding in a car or standing, sitting or walking too long. Pain can be worse with transitional movements (going from sit to stand), standing on one leg or climbing stairs.

Physical therapy can help with SIJ dysfunction. A physical therapist will help identify and change any outside factors causing your pain. Pain management solutions such as therapeutic ultrasound therapy, electro-stimulation therapy may help control the pain. Physical therapists are experts in prescribing pain-management techniques that reduce or eliminate the need for medicine. A physical therapist may also recommend the use of a brace, such as a sacroiliac belt. The belt provides stability during daily activities as strength returns and flexibility improves. Ways to improve body mechanics will also be taught. Additionally, manual therapy such as massage will be used to help correct SIJ dysfunction. Stretching exercises to improve muscle flexibility and movement as well as strengthening exercises improve the stability of the sacroiliac and spinal joints will be prescribed. Once pain, strength and motion improve, functional training will be introduced. If in doubt, seek professional advice.