The sacroiliac joint is the joint connecting the sacrum of the spine to either the right or left iliac bone. These iliac bones are the large ones that form your pelvis. The sacrum is the triangular bone structure located at the lower part of the spine just above the tailbone.
These sacroiliac joints are impressive when you consider what they can handle; they support the weight of your entire upper body when you are upright and help you balance as you walk, as well as absorbing shock to the spine. These joints are relatively immobile, typically allowing for just a few degrees of rotation, however there is potential for unwanted movement.
Some things that can irritate the sacroiliac joint and result in lower back pain and discomfort would include: the wear and tear of ageing, injury of the joint due to a fall or severe impact, an abnormal gait (how you walk), certain medical conditions, or loosening ligaments due to hormone changes during pregnancy. (Women are 8-10 times more likely to have sacroiliac joint pain than men, due to the structural and hormonal differences between the sexes.)
What are sacroiliac joint dysfunction symptoms?
The most common symptom of sacroiliac joint (SIJ) dysfunction is sacroiliac joint pain. Patients often experience pain in the lower back or the back of the hips. Pain may also be present in the groin and thighs. The pain is typically worse with standing and walking and improved when lying down.
In many cases, it can be difficult to determine the exact source of the pain. If you experience any of these symptoms, a visit to a physiotherapist, sports therapist or Chiropractor is advisable. They may perform specific tests to help isolate the source of the pain.
Inflammation and arthritis in the SI joint can also cause stiffness and a burning sensation in the pelvis.
Hypo- and Hypermobolity of the SIJ
SIJ dysfunction can also often result from joint stiffness (hypomobility) or slackness (hypermobility) at the sacroiliac joints in the pelvis.
Although it might seem counterintuitive, a lack of mobility (hypomobility) is often caused by some initial hypermobility, or excessive mobility and instability.
How can that be?
Hypermobility in the surrounding ligaments can open up the normal gliding pattern of the pelvis and allow the bones to move out of alignment.
When there is enough space, your bones can actually move away from their normal, custom-fit grooves, and get wedged into a new position that doesn’t quite fit.
It’s when this happens that your SI joint can become “locked.”
Treatment of Sacroiliac Joint Pain
PHASE I: Management of Pain
Managing your sacroiliac pain is the main reason that you seek treatment for sacroiliac joint dysfunction, but will likely be the final symptom experienced as a result of other biomechanical dysfunctions.
Your therapist should perform postural and dynamic assessments, as well as active, passive and resisted range of movement ROM tests, and specific tests to identify any areas of imbalance and weakness or restriction, and potential causes the altered sacroiliac loading.
The source of pain is inflammation within the SI joint. Sacroiliac joint inflammation is best eased via ice therapy and manual techniques to ease tight supporting muscles or exercises that unload the inflamed structures and support the pelvis.
PHASE II - Restoring Normal ROM via Strength
As your pain and inflammation settles, your physiotherapist will turn their attention to restoring your normal pelvic alignment and sacroiliac joint range of motion, muscle length and resting tension, muscle strength and endurance, proprioception, balance and gait (walking pattern).
A series of stretching and strengthening exercises should be prescribed to help reduce sacroiliac joint pain.
These exercises are designed to restore natural movement of the joint, by:
Relaxing tense muscles and ligaments that limit natural motion at the joint
Conditioning the surrounding muscles and ligaments to better support the joint
Because a range of muscles support the SI joint, exercises may target the pelvis as well as the lower back, groin, hamstring and thigh, and/or abdominal muscles.
Exercises will target lower abdominal and hip core stability to facilitate the muscles that dynamically control and stabilise your sacroiliac joints.
Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for you specific to your needs. An individual plan can then be devised to rehabilitate your sacroiliac joint function to enable you to achieve your own functional goals.
However the image below includes some general exercises that may be initiated in the early stages of SI joint rehabilitation by everyone.
PHASE III - Restoring Full Function
As your sacroiliac joint dynamic control improves, your physiotherapist will turn their attention to restoring your normal pelvic alignment and sacroiliac joint range of motion during more stressful positions and postures plus work on your muscle power, proprioception, balance and gait (walking pattern).
Depending on your chosen sport or activities of daily living, your therapist will aim to restore your SIJ function to safely allow you to return to your desired activities.
Everyone has different demands for their sacroiliac joints that will determine what specific treatment goals you need to achieve. For some it may be simply a walk around the block. Others may wish to run a marathon.
PHASE IV - Preventing a Recurrence
Sacroiliac joint dysfunction does have a tendency to return. The main reason it is thought to recur is due to insufficient rehabilitation. In particular, poor compliance with deep abdominal and hip core muscle exercises. You should continue a version of these exercises routinely a few times per week.
Your therapist will assist you in identifying the best exercises for you to continue indefinitely.
CORE STRENGTH & STABILITY
FORTIFYING ONE’S MID-SECTION = POWER & INJURY PREVENTION TO OTHER AREAS
By initiating the contraction of the core muscles prior to any movement of any other limb, the body is kept centered and the core rigid during all movement. If the core muscles fail to contract prior to movement, the spine is vulnerable to injury.
Recent evidence has found that in people with low back pain the CORE muscles fail to contract before limb movement. Thus retraining these muscles to contract at the right time is the fundamental theory of core stability.
So, having good core strength and stability allows us to have;
1. Greater control of our motions and activities,
2. Improved balance
3. Greater control over injury prevention.
Engaging the core muscles
Developing control over the abdominal muscles begins with learning where the deeper muscles are and how to engage them.
Either in a sitting upright position or lying on your back with your knees bent and feet flat on the floor, place two fingers on the bones at the front of you’re hips (ASIS). Move your fingers one inch in towards the midline of your body and another inch down towards your toes. You should now be directly over your transverse abdominis. When you contract your core, you should feel a gentle tightening beneath your fingers as though your belt has been tightened slightly.
It is important to learn to engage your core in a variety of positions, to enable its correct initiation during functional activities to prevent injury.
There are many exercises that one might try to strengthen and stabilise the core and gluteal muscles, and in turn the pelvis. Below are a variety that are excellent to begin with, many of which may be progressed and control and strength gains are felt.
Helpful Core Exercises
The Plank
Draw your shoulders back and down & try to keep the upper back flat, maintaining a straight line down through your hips to your feet.
Brace your core by pulling belly button back to spine & drawing your pelvic floor up - imagine you are having to stop your self from urinating mid flow!
Look just ahead of your hands so your spine is neutral.
BREATHE GENTLY in through nose & out through mouth.
Aim to keep your hips level and core braced at all times, with very little movement up & down.
If this feels a little too challenging to begin with, or if any pain is experienced in the back, start by placing one knee down for support, but be careful that this doesn't create a twist at the pelvis. You must always ensure that the spine is in a straight (neutral) line.
Start by holding the position for 20 seconds and build up.
The Supported Side Plank
It is important to brace the core muscles in and have straight line from your knees through your hips and up to your shoulders for this. Ensure elbows are underneath shoulders and your hips are raised to create the straight line.
This may be performed with one or both knees bent to begin with, and progressed to one or both legs extended.
Attempt 15 secs to begin with, and increase the time as your strength improves.
The Bridge
This is the easiest way to get your glutes firing as well as activating your core. The movement is small and targeted, so go slowly and you will feel your glutes "waking up."
Lie on your back, bending your knees and placing a folded towel between them.
Place your feet flat on the floor.
Make sure your feet are under your knees, and tighten your abdominal and buttock muscles.
Raise your hips up to create a straight line from your knees to your shoulders.
Squeeze your core and try to pull your belly button back toward your spine.
The goal is to maintain a straight line from your shoulders to your knees and hold for 20 to 30 seconds.
If your hips sag or drop, lower yourself back on the floor.
Be sure to contract the glutes hard and keep the hamstrings relaxed.
You may need to begin by holding the bridge position for a few seconds as you build your strength. It's better to hold the correct position for a shorter time than to go longer in the incorrect position.
The Future : What is Your Prognosis for Sacroiliac Joint Pain?
In addition to prescribing exercises for muscle control, your therapist should reassess your SIJ, spine, hip and lower limb biomechanics, as you progress through the weeks of rehabilitative exercises, to identify changes and hopefully corrections.
Fine tuning and maintenance of your sacroiliac joint stability and function is best achieved by addressing any core stability and/or biomechanic dysfunctions. This is likely to be an ongoing programme of exercise and self-management techniques.
The success of sacroiliac joint pain treatment via pelvic joint re-alignment and subsequent dynamic stabilisation via a deep abdominal and hip core stability control programs is very good.