The sacro-illiac contributes to around 10-25 % of all cases of lower back pain that aren’t associated with disc pathology. (Simopoulos et al 2015) The sacro-iliac joint works in a similar way to the knee as it has two joint surfaces separated by synovial fluid. However it has some modifications to make it more stable and to reduce the amount of movement going through your lower back. (Forst et al 2006) Typically the movement through these join it’s around 4 degrees in rotation and only 2 in translation. The sacroiliac joints are significantly important in the transmission of forces from the lower extremity and into the lower back. Some of these modifications include an extra layer of cartilage, dips and ridges. The joint is also surrounded and supported by ligaments and muscles including the glutes and piriformis. The sacro-iliac joint also has a good nerve supply mainly of the L4 and L5 vertebra. (Hansen et al 2012) For more information about Lower back pain check out my complete guide, if you haven’t already.
- Pain into the Lower back/ buttock region
- Pain is often worse on moving from sitting to standing
- Pain is often on one side of the lower back
- You can get sharp pain into the buttock and lower back
- Stiffness or reduced movement in the lower back or hips
Who does it affect?
- Low BMI
- Leg length discrepancy
- Inflammatory joint conditions (AS, RA, psoriatic and reactive arthritis)
In some cases when the joint becomes inflamed it can irritate the surrounding nerve roots and cause you some pain down into your buttocks and or down into the leg. According to Chou et al(2004) in 44% the trigger of the injury can be linked to an uneven force going through your lower-back and pelvis such as a fall, running, miss timing the curb or stepping into a unexpected pot hole. Furthermore as uneven forces aggravate it while it is not uncommon to have one leg longer than the other a significant difference can also increase your cases and leave you more susceptible to developing SIJ inflammation. (Fortin, 1993) Other causes of SIJ pain can include degeneration with it often being strongly associated with osteoarthritis, you can find more information on osteoarthritis on my previous blog post.
This problem is often seen more in pregnant women this is due to several elements including hormonal changes and increases stress on the pelvis. During pregnancy the body will produce more of a hormone called relaxin, which allows for more movement in the ligament. Relaxin is essential for labour as it allows the safe passage of the baby through the pelvis. Due to the increase movement available at the joint along with the increased weight over the pelvis and the changes in gait and spinal curves as the foetus grows it increases the stress and risk of inflammation. To read more about pregnancy related problems look at the previous blog post: Osteopathy + pregnancy.
The diagnosis for sacro-illac pain is often similar to lower back pain and will often be given based on your symptoms and examinations. In the examination the practitioner will often have you lying on your side and press down onto the top of your pelvis to see if it recreates the pain you may be experiencing. Your GP may send you for imaging such as an X-ray or MRI to get a better idea of your symptom picture as well as to rule out any other. (DonTigny, 1985)
According to the guidelines for the international association of pain the treatments should be predominantly be managed with non surgical interventions due to the limited success from surgical inventions.
According to research by Visser et al 2013 manual therapy including the use of high velocity thrusts often performed by osteopaths helped to reduce the symptoms in 72% of patients examined, higher than both physio and injections. Manual therapy can work to help increase the movement in the joint as well as decrease and muscle spasm or tone that may develop. As well as treatment your practitioner should be able to give you exercises and stretches to help stabilise and strengthen the muscles around your pelvis. There is also evidence to show that other therapies such as acupuncture and massage can help reduce the symptoms.
While there are no specific guidelines for the rehabilitation of the SIJ, I have bases these articles on recommended strengthening exercises for SIJ degeneration and instability that is associated with it. Jellad et al (2009)
Lie down flat on the floor and slowly lift your hip in like with your knees and hold it for 15 secs before slowly lowering yourself down.
Place one foot in front of the other and go into a lunge position. Then slowly push your hips forwards and you should feel the stretch.
Start lying down on the floor, then bring yourself up so that your opposite elbow and knee touch then switch to the other side and touch the other elbow to the other knee and repeat 15 times.
Lie flat on you back and slowly bring both knee up so that you can bring your hand around them give them a hug. Hold this for 15 seconds.
Anti- inflammatory and RICE
Similar to most musculoskeletal based joint pathologies the use of NSAID (non-steroidal anti-inflammatories such as Ibuprofen are recommended. You can also be prescribed muscle relaxants such as Naproxen to help with any muscle spasm you may have as a result. Furthermore the use of ice over the area for 7 minutes is also recommended to reduce the initial inflammation that can occur.
There is some evidence to show that pelvic support belts can significantly improve the quality of life of patients with SIJ pain. The belt works by trying to provide support to the pelvis especially in activities such as walking and running. This maybe significantly beneficial if you are pregnant as it is will help to reduce and support the extra movement and pressure going through your pelvis. The serola belt has seen good results for this and is highly recommended.
You can be recommended to have corticosteroid injections for SIJ pain the success rate is normally around 50% in cases with leg symptoms. There is very limited research into the effectiveness of these injections especially in the long-term management of the pain.
- Simopoulos T.T., Manchikanti, L., Gupta, S., Aydin S.M., Kim, C.H., Solanki, D., Nampiaparampil D.E., Singh, V., Staats, P.S., Hirsch J.A.Systematic Review od the diagnostic accuracy and therapeutic effectiveness of sacroiliac joint interventions. Pain physician 2015
- Szadek KM, van der Wurff P, van Tulder MW, Zuurmond WW, Perez RSGM. Diagnostic validity of criteria for sacroiliac joint pain: a systematic review. The journal of pain: official journal of the American Pain Society. 2009;10(4):354–68.
- Forst SL, Wheeler MT, Fortin JD, Vilensky, J.A. The Sacroiliac joint: Anatomy, physiology and clinical significance. 2006 Pain physician
- Jellad A., Bouzaouache H., Salah, B.Z., Migaou. H., Sana. 2. 2009 Osteoarthritis of the sacroiliac joint complicating resection of the pubic symphysis. Interest of a rehabilitation programme. Annals of Physical and Rehabilitation Medicine 52 (2009) 510–517
- Fortin JD. The sacroiliac joint: A new perspective. Journal Back Muskuloskeletal Rehabilitaltion 1993; 3:31-43.
- Don Tigny, R.L.(1985) Function and Pathomechanics of the Sacroiliac Joint:A Review Journal of physical therapy 65:pp. 35-44
- Hansen, H., Manchikanti, L., Simopoulos, T.T., Christo, P.J., Gupta, S., Smith, H.S., Hameed, H., Cohen, S.P. (2012) A Systematic Evaluation of the Therapeutic Effectiveness of Sacroiliac Joint Interventions Pain Physician 2012; 15:E247-E278 • ISSN 2150-1149
- Chou LH, Slipman CW, Bhagia SM, Tsaur L, Bhat AL, Isaac Z, Gilchrist R, El Abd OH, Lenrow DA. Inciting events initiating injection-proven sacroiliac joint syndrome. Pain Med 2004; 5:26-32.
- Visser, L.H., Woudenberg N.P., De Bont, J., Van Eijis ,F., Verwer K., Jenniskens, H., Den Oudsten ,B.L. (2013) Treatment of the sacroilia joint in patients with leg pain: a randomised-controlled trial. European spine journal.