Sacroiliac joint syndrome also known as sacroiliac syndrome and sacroiliac joint sprain, is a common cause of back pain and is regularly treated in Physical Therapist Clinics.
Even though the injury causes inflammation of the sacroiliac joint, it is not the same as sacroiliitis.
The sacroiliac (SI) joints are located on either side of the spine just below waist height. Looking from behind onto somebody's back you can see two dimples on either side just below the waist. That is where the SI joints are located.
The joints are between the two pelvic (iliac) bones, which join on to the sacrum, forming the two sacroiliac or SI joints.
Inside the joints is a system of ridges and grooves. The sacral side has a concave groove and the iliac side has a convex groove, which limit the movement. The joints also have a complex system of ligaments, which further strengthen the joints.
The main function of the sacroiliac joints is to transmit forces between the upper body and the lower limbs. They are designed to withstand large stresses.
Women tend to be affected more often than men since they tend to have more flexibility of their ligaments. The SI joints tend to lose their flexibility and we are less likely to sprain our SI joints as we get older.
Until recently the main anatomical textbook in medicine did not recognise that these joints moved. The Grey's Anatomy, since some years now, state that the sacroiliac joints do move, which has been a great help in making medical doctors accept that sacroiliac joints can benefit from chiropractic treatment.
How do the Sacroiliac joints get injured?
Sprains of the sacroiliac joints are caused by excessive movement; this can occur in a one off event such as a fall or car accident or more commonly developed over time due to repetitive micro-trauma.
Excessive stress on the joint capsule causes microscopic damage to the ligaments surrounding the joint. The joint then becomes inflamed and painful.
The body reacts to this by instructing the muscles to tighten up to prevent more damage but this muscle spasm tends to last for longer than it is useful, resulting in more pain.
It is common to get referred pain from the muscles that go into spasm. The most commonly involved are the piriformis, gluteal (buttock) and psoas muscles.
Causes of SI Sprain•
Repetitive micro-trauma: it means many small repetitive injuries, until the proverbial 'last straw'. That is why people often hurt themselves doing very trivial things such as bending to pick up a pen, and they hurt themselves before they even get to lift the pen. This can happen through fairly trivial activities. Maybe things that you have done a hundred times before.
•Muscular imbalance or weakness in the muscles surrounding the sacroiliac joints: these problems develop over a long period of time giving little or no symptoms until it is too late.
•Trauma such as a fall or road traffic accidents
•Prolonged bending or lifting
•Pregnancy: Hormones released in the last trimester to increase the laxity of the pelvic ligaments can make them more vulnerable to injury.
•Problems with the hip, knee and feet: can all put increased pressure on the sacroiliac joint, which can become painful over time due to repetitive strain.
Signs and Symptoms of SI Joint Sprain
•Pain on one or both sides over the joints and into the buttocks.
•Pain can also be felt into the back of the leg, the front of the thigh and groin.
•Pain is often after lifting or twisting; or can develop over a period of time.
•Pain is worse sitting and bending forward.
•Increased weight bearing such as standing on one leg increase the pain.
•Lying down eases pain.
•In most cases, there is no loss of strength, pins and needles or numbness.
An Osteopath, Chiropractor or other suitably qualified Physical Therapist is usually able to make a diagnosis based on the history and the signs and symptoms of the condition.
Sometimes, especially if the problem is long standing, if you have reached a certain age or if there is anything in your medical history to indicate it we may take an x-ray of the pelvis.
You cannot diagnose a sacroiliac joint sprain on an x-ray, CT or MRI scans alone. The diagnosis is made on the clinical findings - but the x-ray may help to rule out other causes and in some cases help the physical therapist determine which type of treatment is most appropriate. It can help to rule out underlying inflammatory conditions, sacroiliitis, such as Ankylosing spondylitis.
Treatment of a Sacroiliac Sprain
The healing time for a damaged ligament is between 4-6 weeks. Physical Therapy will normally help you get comfortable quicker, but it is important to remember that the ligaments might not be fully healed even though the pain has subsided.
The Chiro Approach:
The Initial Stage of Chiropractic treatment
•The aim is to reduce inflammation and improve mobility The treatment frequency is in most cases 3 times over 10 days or until the pain and inflammation begins to subside. The acute pain tends to settle down within 3-6 treatments.
In the early part it can be very useful to use a sacroiliac belt to support the pelvis, especially if the sacroiliac joint is severely inflamed and unstable.
Ice packs are used regularly to reduce the pain, joint inflammation and muscle spasm.
Spinal manipulation or adjustments are used to areas of the spine with restricted movement, to increase mobility and reduce pain.
Massage, soft tissue therapy, ultrasound and interferential therapy may also be used.
Patients are advised to take ‘active rest’, which means to avoid activities which the patients find aggravating but to keep moving around regularly. Prolonged bed rest has been shown to actually prolong back pain. It is best to alternate rest with walking around.
The chiropractor will also give advice on how to get comfortable, how to move, and taught which exercises to do to get comfortable and help you to get on with your life as comfortably as possible.
The Stabilisation Stage of Chiropractic treatment
•The aim is to normalise function and improve strength
As the pain starts to subside, treatments will be gradually spaced out to once a week, once every two weeks etc and you will be given more exercises to do at home.
Specific chiropractic manipulation and soft tissue techniques will be targeted at areas of restricted movement in the low back and surrounding joints, to increase the mobility and optimise spinal function.
Core muscle exercises will gradually be introduced to create better spinal control and stability, which is one way of preventing the injury from coming back.
You will also be giving postural and ergonomic advice to help you reducing the risk of injury.
Doing your exercises long term will be extremely important to create more support and stability for the spine. In some cases ‘curing’ the problem might not be possible, but the goal of the treatment will be to make sure the problem stays manageable, allowing you to do your normal daily activities.
Click Below:
*Consult Your Therapist Before Undertaking Any Exercise Programme!
SI Exercises:
If you are looking to do exercises for sacroiliac joint pain then your first focus should be to stabilize the pelvis including the sacrum in proper alignment.
DO NOT do SI joint exercises in poor pelvic alignment, you will only stabilize the faulty alignment and cause more problems!
FIRST
Learn neutral spine: Neutral Spine is the healthiest and most stable position for the spine and pelvis taking in to account the natural curvature of the spine. Standing: Back up against a wall with your buttocks and shoulder blades leaning into the wall. Notice whether your lower back is against the wall or if there is an excessive arch there. The latter is more common.
To achieve neutral keep the buttocks and shoulders against the wall and then draw the middle part of your back into the wall. You should feel the abdominal muscles engage and/or the ribs drawing in.
•Lying: Lying on a mat with your knees bent and feet hip width apart, arms at your side.
Begin by releasing your tailbone down creating an arc in the lower back, move up into the mid back and draw it down without flattening the spine. The shoulder blades are down and heavy and the back of the neck is long, do this by drawing your chin down towards your chest leaving the size of a fist space there.
•Sitting: When sitting in a chair press your bottom right up against the back of the chair then stack the rest of the spine over it. Your collarbone is over your hip bones and your breastbone is right above the pubic bone. Navel drawn in gently.
Proper posture is the best way to reduce tension from sitting at work all day, on computers, driving, etc.
SECOND
Pelvic Stabilization Exercises for Sacroiliac Joint Pain:
Wall squats
Position: Standing in neutral against the wall with your feet the length of your thighs away from the wall.
Action: Bend your knees no lower than a 90 degree angle keeping your weight in the heels evenly for both feet. Kneecaps should line up with the second toe in each foot. Repeat for 8-12 repetitions. Do 2-3 sets every other day.
Cues: Place hands on hip bones and make sure they stay level as you bend and lift, also keep the buttocks, shoulder blades, and mid part of the back against the wall throughout the exercise.
Pelvic clocks
Position: Lying on the floor with neutral spine and knees bent.
Action: Imagine your pelvis as a clock. 12 o'clock is at your navel, 6 is at your pubic or tailbone, 3 and 9 are the hip bones. Now imagine there is water in that clock or bowl and you are going to empty from 12 o'clock around clockwise and then counter clockwise feeling each number on the clock working.
Cues: Keep the knees still you are just mobilizing the pelvis.
Diaphragmatic Breathing
Position: Lying in neutral spine.
Action: Without changing the position of your spine inhale deeply through the nose filling up or expanding into the ribs and upper back, then exhale through your mouth expelling the air again without changing the spine. On the exhale feel all the air leave your body feeling the muscles tighten around the waist as your abdomen flattens.
THIRD
Strengthening Exercises for Sacroiliac Joint Pain: Once you have a stable and aligned pelvis you can begin mobilizing exercises to continue strengthening.
Leg Circles
Position: Lying on the floor with one leg extended along the mat and the other at a 90 degree angle to the floor and a neutral spine.
Action: Keeping the pelvis still circle the thigh (leg) in the hip socket 6 times each direction. Switch legs.
Cues: Focus on keeping the torso and leg on the mat very still as you freely circle the leg in the air.
Bridges
Position: Lying in neutral with knees bent arms at your side.
Action: Inhale to prepare and exhale as you press into your heels lifting the pelvis up in neutral until weight is between shoulder blades not in the neck. Inhale hold then exhale to bring the tailbone and ribs down all at one time.
Cues: Focus on the navel drawn in to lift the pubic bone up to the ceiling. Weight even in the feet.
Rotation and side bending exercises can be added as you are symptom free in neutral spine.
