Sacroiliac Joint Pain

Sacroiliac joint pain is a very common cause of low back pain, and sometimes also leg pain and is often misdiagnosed as a problem with the discs in the spine, or the spine itself. Sacroiliac joint (SIJ) pain can affect one or both sides of your lower back and the pain can travel from the sacroiliac joint into the buttocks, hips and even the groin area. The pain may also have a dramatic impact on your daily activities as well as your ability to work and exercise.

WHAT ARE MY SACROILIAC JOINTS?

You have two sacroiliac joints in your body. They are located on either side of the sacrum at the bottom of your spine, where it connects to your pelvis. They are essentially the joints connecting your upper body and trunk to your legs. The SIJs act as a shock absorber for your spine and provide stability for your body as you run, walk, or jump.
The SI joint is held together by several large, very strong ligaments.
Because your pelvis is a ring, these ligaments work like the hoops
that hold a barrel together. If these ligaments are torn or become
overstretched, you can develop SIJ pain. The muscles of the back and
pelvis are crucial to provide strength and support to the ligaments of
your SIJ. If they are weak or unbalanced they can give rise to uneven
movement, and pain can develop. Everyday wear and tear, work injury
(repetitive strain), car accident, pregnancy and childbirth, arthritis, or a
single injury like a fall can damage your joints, changing their normal
movement and creating pain.
In more severe cases the pain caused by the sacroiliac joint can
travel down your legs and cause numbness and tingling which can be
very limiting. You may have difficulty sitting or lying on one side, climbing
stairs, pain trying to get in or out of your car, possibly even buckling
of your leg on the painful side. Chronic lower back pain can be very
debilitating affecting not only yourself, but also the people around you.
Because of the impact of chronic pain on your daily life it can even lead
to depression.

HOW IS A DIAGNOSIS MADE?

A physical therapist can help determine whether your SIJ is the source of your pain. Your therapist will consider all the information you provide, including any history of an injury, as well as the exact location and nature of your pain. There’s a range of things therapist can do to help diagnose the source of your pain. These will include muscle tests, asking you to carry out certain movements or assume a specific position, and feeling for tenderness around the joints. Each of these will help the therapist diagnose the cause of your pain. An X-ray, CT, or MRI, may be ordered to help in the diagnosis and rule out other spine and hip-related problems.

WHAT TREATMENTS ARE AVAILABLE FOR SIJ PAIN?

Thorough treatment for SIJ pain is essential to hasten the healing process and ensure the best outcome with the least likelihood of the pain recurring.
Physical therapy and massage therapy will be beneficial in relieving pain and releasing tight stiff muscles. Treatment may include mobilising or manipulating the joints of your lower back and SIJ to ensure good alignment. Taping or strapping your lower back can also be helpful in reducing pain. Your therapist may include ultrasound, heat or ice therapy in treatment and may even use dry needling to promote healing and relieve pain.

You are an essential member of the rehabilitation team! Your SIJ needs the support of the muscles around your lower back, buttocks and stomach to withstand the loads from your spine and exercises may be prescribed by your therapist to strengthen weak muscles, commonly weak core and buttock muscles.

Stretching is often advised to relieve stiff tight structures of the lower back and buttocks. Your therapist will assess your daily activities and advise on any postural problems that could be contributing to your pain. A difference in leg lengths is relatively common and frequently associated with SIJ pain. You may be assessed for this and a small insole may be necessary to correct the difference.

There are other medical treatments available such as steroid injections, nerve blocks and even surgery which you can discuss with your physical therapist or doctor, but hopefully you won’t need these if your physical therapy treatment succeeds. A positive attitude, regular activity, and a prompt return to work or sport are all very important elements of recovery from SIJ pain. With the correct diagnosis, and treatment as well as advice you can be pain-free.