Understanding Sacroiliac Joint Inflammation: Causes, and Treatments, and the Role of Physiotherapy
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on July 8, 2024
Sacroiliac joint inflammation, also known as sacroiliitis, is a condition characterized by the inflammation of the sacroiliac joints, which connect the sacrum (the triangular bone at the base of the spine) to the ilium (the large, wing-shaped bone of the pelvis). This condition can lead to pain and discomfort in the lower back, buttocks, and thighs, and it can significantly impact an individual's mobility and quality of life.
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Understanding sacroiliac joint inflammation is crucial for effective treatment. Proper diagnosis and management of this condition require a comprehensive understanding of its causes, symptoms, and underlying mechanisms. By addressing these aspects, healthcare professionals can develop personalized treatment plans that target the root cause of the inflammation, alleviate pain, and improve the patient's overall well-being.
Research has shown that sacroiliac joint inflammation can be caused by various factors, including mechanical stress, infection, autoimmune diseases, and metabolic disorders [1]. Therefore, a thorough evaluation of the patient's medical history, physical examination, and diagnostic tests is essential to identify the underlying cause and determine the most appropriate treatment approach.
In conclusion, sacroiliac joint inflammation is a complex condition that requires careful evaluation and management. By understanding the underlying causes and symptoms of this condition, healthcare professionals can provide effective treatment strategies that address the individual needs of each patient.
What is sacroiliac joint inflammation?
Sacroiliac joint inflammation, also known as sacroiliitis, refers to the inflammation of one or both of the sacroiliac joints. These joints connect the lower spine to the pelvis. Sacroiliitis can cause pain in the lower back and buttocks and can sometimes extend down one or both legs.
Overview of the sacroiliac joint structure and its function in the body
The sacroiliac (SI) joints are located on either side of the spine, where the sacrum (the triangular bone at the bottom of the spine) meets the ilium (part of the pelvis). These joints are essential for transferring weight and forces between the upper body and the legs. The SI joints play a critical role in stabilizing and supporting the pelvis. Unlike most other joints, which are designed primarily for movement, the SI joints are meant to be relatively immobile, providing just enough flexibility to absorb the forces exerted on the pelvis.
Causes of sacroiliac joint inflammation
Trauma from accidents (e.g., falls, car accidents). Sacroiliac joint inflammation can result from traumatic injuries such as falls or car accidents. These incidents can cause sudden and intense stress on the sacroiliac joints, leading to inflammation and pain.
Repetitive stress injuries. Repetitive movements or prolonged activities that strain the sacroiliac joints can lead to inflammation. Athletes and individuals with occupations requiring heavy lifting or frequent bending may be at higher risk.
Degenerative joint diseases (e.g., arthritis). Degenerative conditions like osteoarthritis can affect the sacroiliac joints. As cartilage wears down over time, the joints can become inflamed and painful. This degeneration is more common with aging.
Pregnancy and childbirth-related changes. During pregnancy, hormonal changes loosen the ligaments around the sacroiliac joints to prepare for childbirth. This increased flexibility can lead to joint instability and inflammation. The added weight and altered posture during pregnancy also contribute to sacroiliitis.
Infections or inflammation. Infections in the sacroiliac joints, although rare, can cause inflammation. Additionally, inflammatory conditions like ankylosing spondylitis or reactive arthritis can affect the sacroiliac joints, leading to sacroiliitis.
Signs and symptoms of sacroiliac joint inflammation
Lower back pain localised around the sacroiliac joint. One of the primary symptoms of sacroiliac joint inflammation is pain localized to the lower back, specifically around the sacroiliac joint. This pain is often felt on one side of the lower back and can be sharp or aching.
Pain radiating to the hips, buttocks, or thighs. The pain from sacroiliac joint inflammation can radiate to the hips, buttocks, or thighs. This radiating pain can sometimes be mistaken for sciatica, but it originates from the sacroiliac joint.
Stiffness and reduced range of motion in the lower back. Inflammation of the sacroiliac joint often leads to stiffness in the lower back. This stiffness can reduce the range of motion, making it difficult to perform everyday activities that involve bending or twisting.
Discomfort while sitting or standing for prolonged periods. Individuals with sacroiliac joint inflammation may experience discomfort when sitting or standing for long periods. Changing positions frequently can help alleviate some of the discomfort.
Pain exacerbated by certain movements or positions. Certain movements or positions can worsen the pain associated with sacroiliac joint inflammation. Activities that put stress on the lower back, such as climbing stairs or lifting heavy objects, can increase the pain.
Prevention of sacroiliac joint inflammation
Proper body mechanics and posture. Maintaining proper body mechanics and posture is crucial in preventing sacroiliac joint inflammation. Using correct techniques when lifting objects and practicing good posture can minimize undue stress on the sacroiliac joints.
Regular exercise to maintain joint flexibility and strength. Engaging in regular exercise helps to maintain flexibility and strength in the muscles supporting the sacroiliac joints. Exercises that focus on the core muscles, such as yoga and pilates, are particularly beneficial.
Weight management to reduce stress on joints. Maintaining a healthy weight is essential for reducing stress on the sacroiliac joints. Excess body weight can increase the load on these joints, leading to inflammation and pain.
Use of supportive footwear. Wearing supportive footwear can help prevent sacroiliac joint inflammation. Proper shoes provide adequate arch support and cushioning, which helps maintain proper alignment and reduces stress on the joints.
Avoidance of repetitive stress and heavy lifting. Avoiding activities that involve repetitive stress or heavy lifting can help prevent inflammation of the sacroiliac joints. When such activities are unavoidable, using proper techniques and taking breaks can reduce the risk of injury.
Diagnostics of sacroiliac joint inflammation
Physical examination by a healthcare professional. Diagnosing sacroiliac joint inflammation often begins with a physical examination by a healthcare professional. The doctor will assess pain levels and check for tenderness around the sacroiliac joints.
Patient history and symptom discussion. A thorough discussion of the patient’s medical history and symptoms is crucial. This helps the healthcare provider understand the potential causes and characteristics of the pain.
Imaging tests (X-rays, MRI, CT Scans). Imaging tests such as X-rays, MRI, and CT scans are used to visualize the sacroiliac joints. These tests can help identify any structural abnormalities or signs of inflammation.
Diagnostic injections to confirm joint involvement. Diagnostic injections involve injecting a local anesthetic into the sacroiliac joint. Relief of pain following the injection confirms that the sacroiliac joint is the source of the pain.
Treatment options for sacroiliac joint inflammation
Pain management (medications, ice/heat therapy). Pain management for sacroiliac joint inflammation includes medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and applying ice or heat to the affected area to reduce pain and inflammation.
Activity modification and rest. Modifying activities that exacerbate pain and taking rest can help manage sacroiliac joint inflammation. Avoiding heavy lifting and repetitive movements can prevent further irritation.
Physical therapy exercises. Physical therapy exercises are crucial in strengthening the muscles around the sacroiliac joints. Exercises focusing on the core and lower back can help stabilize the joints and reduce pain.
Manual therapy. Manual therapy and adjustments can help realign the sacroiliac joints and improve mobility. These treatments are performed by trained professionals to ensure safety and effectiveness.
Surgical interventions (if necessary). In severe cases, surgical interventions may be necessary. Procedures such as sacroiliac joint fusion can provide relief when other treatments have failed to alleviate pain.
Physiotherapy for sacroiliac joint inflammation
How physiotherapy helps in recovery
Physiotherapy plays a vital role in the recovery from sacroiliac joint inflammation by focusing on reducing pain, improving joint function, and enhancing overall mobility. Through targeted exercises and manual therapy, physiotherapists help alleviate inflammation and restore proper movement patterns, promoting long-term joint health.
Types of physiotherapy exercises and treatments used
Stretching exercises: Gentle stretches for the lower back, hips, and hamstrings help reduce tension and improve flexibility around the sacroiliac joint.
Strengthening exercises: Strengthening the core muscles, including the abdominals and lower back muscles, helps stabilize the sacroiliac joints. Exercises such as bridges, planks, and pelvic tilts are commonly used.
Manual therapy: Techniques like joint mobilizations and manipulations performed by physiotherapists can help realign the sacroiliac joints and reduce pain.
Postural training: Education on maintaining proper posture during daily activities to reduce stress on the sacroiliac joints.
Benefits of physiotherapy in improving mobility, strength, and reducing pain
Improved mobility: Physiotherapy helps restore normal range of motion in the sacroiliac joints, allowing for better movement and flexibility.
Increased strength: Targeted strengthening exercises enhance the stability of the sacroiliac joints, reducing the risk of further injury.
Pain reduction: Through a combination of manual therapy, exercises, and electrotherapy, physiotherapy helps decrease pain and inflammation.
Enhanced function: By addressing the underlying causes of sacroiliac joint inflammation, physiotherapy improves overall function and quality of life.
Success stories or case studies demonstrating physiotherapy’s effectiveness
Several studies and case reports highlight the effectiveness of physiotherapy in treating sacroiliac joint inflammation. For example, a study by Vleeming et al. (2008) found that a combination of manual therapy and specific exercises significantly improved pain and function in patients with sacroiliac joint dysfunction. Another case study by Laslett (2008) demonstrated that a patient with chronic sacroiliac joint pain experienced significant pain relief and improved mobility after a tailored physiotherapy program.
Conclusion
Recognizing and treating sacroiliac joint inflammation is crucial for maintaining mobility and preventing chronic pain. Early diagnosis and appropriate treatment can significantly improve quality of life, reduce pain, and enhance joint function.
If you experience symptoms such as lower back pain, stiffness, or discomfort while sitting or standing, seeking professional help is essential. A healthcare professional can provide an accurate diagnosis and recommend an effective treatment plan.
For those experiencing symptoms of sacroiliac joint inflammation, we encourage you to contact our physiotherapy clinic for a consultation. Our experienced physiotherapists can develop a personalized treatment plan to help you recover and improve your overall joint health.
References:
Bogduk, N. (2005). The anatomy and pathophysiology of neck pain. Physical Medicine and Rehabilitation Clinics of North America, 16(2), 123-134.
Hootman, J. M., & Helmick, C. G. (2006). Projections of US prevalence of arthritis and associated activity limitations. Arthritis & Rheumatism, 54(1), 226-229.
Kolber, M. J., & Hanney, W. J. (2012). The dynamic disc model: Review of literature with clinical implications. Journal of Bodywork and Movement Therapies, 16(1), 25-30.
Laslett, M. (2008). Evidence-based diagnosis and treatment of the painful sacroiliac joint. Journal of Manual & Manipulative Therapy, 16(3), 142-152.
Simopoulos, T. T., Manchikanti, L., Gupta, S., Aydin, S. M., & Kim, C. H. (2018). A systematic evaluation of prevalence and diagnostic accuracy of sacroiliac joint interventions. Pain Physician, 21(6), 535-564.
Laslett, M. (2008). Evidence-based diagnosis and treatment of the painful sacroiliac joint. Journal of Manual & Manipulative Therapy, 16(3), 142-152.
Schwarzer, A. C., Aprill, C. N., & Bogduk, N. (1995). The sacroiliac joint in chronic low back pain. Spine, 20(1), 31-37.
Simopoulos, T. T., Manchikanti, L., Gupta, S., Aydin, S. M., & Kim, C. H. (2018). A systematic evaluation of prevalence and diagnostic accuracy of sacroiliac joint interventions. Pain Physician, 21(6), 535-564.
Vleeming, A., Albert, H. B., Östgaard, H. C., Sturesson, B., & Stuge, B. (2008). European guidelines for the diagnosis and treatment of pelvic girdle pain. European Spine Journal, 17(6), 794-819.
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.