Sacroiliac problems



What is sacroiliac joint dysfunction?

During normal movement of the spine and hips, stretching or compressive forces are put through the sacroiliac joints and surrounding ligaments. When these forces are sudden, repetitive or excessive, injury to the sacroiliac joint may result.

Sacroiliac joint dysfunction refers to pain in the sacroiliac joint caused by abnormal motion of the sacroiliac joint, either too much motion (hypermobility) or too little motion (hypomobility). This typically results in inflammation of the sacroiliac joint.

Causes of sacroiliac joint dysfunction

Common causes and contributory factors of SI joint dysfunction include:

  • Repetitive micro-trauma: low level trauma over a period of time can cause damage that can often build up without being noticed. Pain can then be triggered by fairly innocuous activities such as bending to pick something off the floor.
  • Muscular imbalances, weakness (poor core strength) or tightness around the lumbar spine and pelvis: This can develop from not only from sedentary activities, such as sitting in the office or at home watching the TV, but also from repetitive and excessive movements that are experienced during sport or even gardening develop over a long period of time giving little or no symptoms until it is too late.
  • Trauma such as a falls or road traffic accidents
  • Prolonged sitting, bending, twisting or lifting
  • Pregnancy: Hormones released during pregnancy, such as Relaxin, increases the laxity of the pelvic ligaments can make them more vulnerable to injury.
  • Problems with the lower limb: biomechanical abnormalities, such as flat feet or leg length differences, can increase pressure on the SI joint, which can cause repetitive strain to the SI ligaments.
  • Poor posture
  • Obesity
  • Excessive or repetitive forces associated with impact sports: examples include running, rugby and golf.

Signs and symptoms of sacroiliac joint dysfunction:

  • Pain and tenderness is usually felt on one side of the low back over top of the buttock. Rarely is it felt on both sides.
  • Pain can sometimes refer into the buttock back of the leg, front of the thigh and groin.
  • Pain can come on suddenly or develop gradually over a period of time.
  • Pain is worsened by sitting, bending (e.g. putting on shoes and socks), lifting or twisting.
  • Increased weight bearing such as standing on one leg can increase the pain e.g. with walking up and down stairs
  • Lying down usually eases the pain.

Diagnosis of sacroiliac joint dysfunction

SI joint dysfunction is a major source of low back pain. Pain from the SI joint is often under-diagnosed, under-appreciated, and misunderstood. The clinical presentation together with a thorough examination by an Osteopath is usually sufficient to diagnose sacroiliac joint dysfunction. Very occasionally you may need to be referred for further investigations such as an X-ray, MRI, bone scan or CT scan so aid in the diagnosis.

Osteopathic Treatment for sacroiliac joint dysfunction

Osteopathic treatment aims to assist in the bodies natural healing process, speeding up the recovery, and reducing the likelihood of future recurrence.

In the acute phase (when the injury has just happened), Osteopaths will aim to reduce the pain and inflammation. They will also aim to improve the function of other parts of the musculo-skeletal system to reduce the stress on the injured area. Ice-packs can also help within the first 48-72 hours.

After the acute phase, treatment is focused on improving the stability of the area by introducing rehabilitation exercises and lifestyle modifications.

Treatment methods used may include:

  • soft tissue massage & stretching
  • joint mobilisation & manipulation
  • medical acupuncture
  • taping
  • the use of a sacroiliac or lumbar support belts
  • correction of any leg length discrepancy
  • activity modification advice
  • ergonomics advice (your working environment)
  • exercises to improve flexibility, strength, posture and core stability

Prognosis of sacroiliac joint dysfunction

Patients can get dramatic pain relief from Osteopathic manipulation, but typically this relief may take 3-6 weeks. The recovery time will vary depending on individual and compliance with advice and exercises.