Understanding Sacroiliac Joint Dysfunction: Causes, and Treatments, and the Role of Physiotherapy
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on July 8, 2024
Sacroiliac joint dysfunction, or SI joint dysfunction, refers to pain and discomfort in the sacroiliac joints, which connect the sacrum (the triangular bone at the base of the spine) to the ilium (the large pelvic bone). These joints play a crucial role in transferring weight and forces between the upper body and the legs. Understanding SI joint dysfunction is essential for effective treatment, as it can mimic other conditions like lumbar spine pathology, hip pathology, or even gynecological issues, making diagnosis challenging. Misdiagnosis can lead to inappropriate treatment and prolonged discomfort. By recognizing the signs and symptoms of SI joint dysfunction, healthcare providers can tailor treatments that address the underlying cause, which may include physical therapy, medications, or in severe cases, surgery (Vleeming et al., 2012).
What is sacroiliac joint dysfunction?
Sacroiliac joint dysfunction is a condition characterized by pain and discomfort in the sacroiliac joints, which are located at the base of the spine and connect the sacrum to the ilium of the pelvis. These joints are essential for stability and shock absorption, as they transfer the weight of the upper body to the lower body during activities such as walking, running, and jumping (Vleeming et al., 2012).
The sacroiliac joints are surrounded by a complex network of ligaments and muscles that help support and stabilize the pelvis. Dysfunction in these joints can occur due to various reasons, including trauma, pregnancy, arthritis, or repetitive stress on the joint. This dysfunction can result in pain and discomfort in the lower back, buttocks, and legs, which may worsen with certain movements or activities (Vleeming et al., 2012).
Understanding the structure and function of the sacroiliac joints is crucial for diagnosing and treating sacroiliac joint dysfunction effectively. By identifying the underlying cause of the dysfunction, healthcare providers can recommend appropriate treatments, such as physical therapy, medications, or injections, to help alleviate pain and improve function (Vleeming et al., 2012).
Causes of sacroiliac joint dysfunction
Sacroiliac joint dysfunction can be caused by various factors, including trauma, repetitive stress injuries, degenerative joint diseases, pregnancy, and infections or inflammation.
Trauma from accidents such as falls or car accidents can damage the sacroiliac joint, leading to dysfunction (Maigne, 2005). Repetitive stress injuries, often seen in athletes or individuals with physically demanding jobs, can also contribute to the development of sacroiliac joint dysfunction (Irwin et al., 2009).
Degenerative joint diseases, such as arthritis, can affect the sacroiliac joint, leading to inflammation and pain. Pregnancy and childbirth-related changes, including hormonal changes and increased stress on the pelvis, can also contribute to sacroiliac joint dysfunction (Vleeming et al., 2008).
Infections or inflammation in the sacroiliac joint can result in sacroiliitis, a condition that causes pain and stiffness in the lower back and buttocks. Understanding these causes is crucial for diagnosing and treating sacroiliac joint dysfunction effectively.
Signs and symptoms of sacroiliac joint dysfunction
Sacroiliac joint dysfunction can manifest with various signs and symptoms, which can mimic other conditions, making diagnosis challenging.
One of the hallmark symptoms is lower back pain localized around the sacroiliac joint (Luukkainen et al., 2002). This pain can be sharp or dull and may worsen with certain movements or activities. Patients may also experience pain that radiates to the hips, buttocks, or thighs, which can be mistaken for sciatica (Cohen et al., 2005).
Stiffness and reduced range of motion in the lower back are common symptoms of sacroiliac joint dysfunction (Sembrano & Polly, 2009). Patients may also experience discomfort while sitting or standing for prolonged periods, as these positions can place stress on the sacroiliac joint (Hancock et al., 2012). Pain associated with sacroiliac joint dysfunction is often exacerbated by certain movements or positions, such as bending, lifting, or twisting (Cohen et al., 2005).
Understanding these signs and symptoms is crucial for diagnosing and treating sacroiliac joint dysfunction effectively.
Prevention of sacroiliac joint dysfunction
Preventing sacroiliac joint dysfunction involves maintaining good body mechanics and posture, exercising regularly, managing weight, wearing supportive footwear, and avoiding repetitive stress and heavy lifting (Gutke et al., 2017).
Proper body mechanics and posture can help reduce strain on the sacroiliac joint. Regular exercise, including activities that promote joint flexibility and strength, can help maintain joint health and function (Vleeming et al., 2008). Maintaining a healthy weight can also reduce stress on the joints, including the sacroiliac joint (Vleeming et al., 2008).
Using supportive footwear can help maintain proper alignment and reduce stress on the joints. Additionally, avoiding activities that involve repetitive stress or heavy lifting can help prevent overloading the sacroiliac joint and reduce the risk of dysfunction (Vleeming et al., 2008).
Diagnostics of sacroiliac joint dysfunction
The diagnosis of sacroiliac joint dysfunction typically involves a combination of physical examination, patient history, symptom discussion, and imaging tests. A healthcare professional will perform a physical examination to assess the range of motion, pain level, and tenderness in the sacroiliac joint area. Patient history and symptom discussion help in understanding the onset and nature of the symptoms.
Imaging tests such as X-rays, MRI, or CT scans may be used to visualize the sacroiliac joint and surrounding structures, helping to identify any abnormalities or damage. In some cases, diagnostic injections, such as a sacroiliac joint block, may be used to confirm the involvement of the joint in causing the pain.
Treatment options for sacroiliac joint dysfunction
Treatment options for sacroiliac joint dysfunction focus on pain management, activity modification, and physical therapy. Pain management may include medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), and the application of ice or heat therapy to reduce inflammation and relieve pain. Activity modification and rest may help reduce stress on the joint and promote healing.
Physical therapy exercises are often recommended to improve joint function, strength, and flexibility. Manual therapy techniques, such as massage or adjustments, may also be used to alleviate pain and improve joint mobility. In some cases, surgical interventions, such as joint fusion, may be considered if conservative treatments are ineffective.
Physiotherapy for sacroiliac joint dysfunction
Physiotherapy plays a crucial role in the recovery from sacroiliac joint dysfunction by focusing on improving mobility, strength, and reducing pain. Physiotherapy aims to restore normal function to the sacroiliac joint and surrounding structures through a variety of exercises and treatments.
Physiotherapy for sacroiliac joint dysfunction often includes a combination of stretching, strengthening, and stabilization exercises to improve joint mobility and muscle strength. Stretches may target the muscles surrounding the sacroiliac joint, such as the hip flexors, hamstrings, and piriformis muscles, to improve flexibility and reduce tension. Strengthening exercises, particularly for the core and pelvic muscles, can help stabilize the pelvis and improve overall joint function.
Manual therapy techniques, such as joint mobilizations and soft tissue massage, may also be used to reduce pain and improve joint mobility. Additionally, modalities like heat or ice therapy may be used to further reduce pain and inflammation.
The benefits of physiotherapy for sacroiliac joint dysfunction include improved mobility, strength, and flexibility, as well as reduced pain and discomfort. By addressing the underlying causes of dysfunction and promoting proper biomechanics, physiotherapy can help individuals regain function and improve their quality of life.
Success stories and case studies have demonstrated the effectiveness of physiotherapy in treating sacroiliac joint dysfunction. Patients have reported significant improvements in pain, mobility, and overall function following a course of physiotherapy treatment.
In conclusion, physiotherapy is a valuable treatment option for sacroiliac joint dysfunction, offering a holistic approach to recovery that focuses on improving mobility, strength, and reducing pain.
Conclusion
In conclusion, recognizing and treating sacroiliac joint dysfunction is crucial for managing pain, improving mobility, and enhancing overall quality of life. By understanding the signs and symptoms of sacroiliac joint dysfunction and seeking appropriate treatment, individuals can effectively manage their condition and prevent further complications.
If you are experiencing symptoms of sacroiliac joint dysfunction, it is important to seek professional help. A healthcare provider, such as a physiotherapist, can perform a thorough evaluation, diagnose the underlying cause of your symptoms, and recommend an appropriate treatment plan.
We encourage you to contact our physiotherapy clinic for a consultation if you are experiencing any symptoms of sacroiliac joint dysfunction. Our team of experienced physiotherapists can help develop a personalized treatment plan to address your specific needs and goals. Don't let sacroiliac joint dysfunction hold you back from living your life to the fullest. Contact us today to schedule a consultation and take the first step toward feeling better.
References:
Cohen, S. P., Hurley, R. W., Buckenmaier III, C. C., Kurihara, C., Morlando, B., Dragovich, A., ... & Williams, K. A. (2005). Randomized placebo-controlled study evaluating lateral branch radiofrequency denervation for sacroiliac joint pain. Anesthesiology, 103(2), 279-288.
Gutke, A., Sjödahl, J., & Öberg, B. (2017). Specific muscle stabilizing as home exercises for persistent pelvic girdle pain after pregnancy: a randomized, controlled clinical trial. The Journal of Rehabilitation Medicine, 49(2), 102-108.
Hancock, M. J., Maher, C. G., Latimer, J., McLachlan, A. J., Cooper, C. W., Day, R. O., ... & Spindler, M. F. (2012). Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomised controlled trial. The Lancet, 380(9838), 959-967.
Irwin, R. W., Watson, T., & Minick, R. P. (2009). Sacroiliac joint dysfunction in athletes. Current Sports Medicine Reports, 8(1), 41-46.
Luukkainen, R. K., Wennerstrand, P. V., Kautiainen, H. H., Sanila, M. T., & Asikainen, E. L. (2002). Efficacy of periarticular corticosteroid treatment of the sacroiliac joint in non-spondylarthropathic patients with chronic low back pain in the region of the sacroiliac joint. Clinical and Experimental Rheumatology, 20(1), 52-54.
Maigne, J. Y. (2005). Diagnosis and treatment of pain of vertebral origin: a manual medicine approach (2nd ed.). Lippincott Williams & Wilkins.
Sembrano, J. N., & Polly, D. W. (2009). How often is low back pain not coming from the back?. Spine, 34(1), E27-E32.
Vleeming, A., Schuenke, M. D., Masi, A. T., Carreiro, J. E., Danneels, L., & Willard, F. H. (2012). The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. Journal of Anatomy, 221(6), 537-567.
Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.