What is sacroiliac joint dysfunction?
Sacroiliac joint dysfunction is a broadly defined condition that most commonly involves sensitised or painful sacroiliac joints (SIJ) and its surrounding musculature and ligaments. The SIJ connects the pelvis to the sacrum at the bottom of the spine and as such, is critical in transferring load between the spine and legs. It is an inherently stable joint as it needs to withstand large forces, but there are times when either excessive or reduced compression can occur in the region, leading to pain and dysfunction. SIJ pain can be quite disabling and reduce someone’s function and quality of life.
SIJ dysfunction commonly affects women during pregnancy but can be present in both women and men. Patients will often present with pain in the lower back/gluteal region, most commonly on one side, but there can be pain referred to other areas such as the thigh or lower leg. Common aggravating activities for SIJ dysfunction include:
- Weight bearing activities – i.e. running, walking and jumping
- Rolling over in bed
- Bending forwards
- May be aggravated by sitting with legs crossed or lying on your side
Although diagnosis of sacroiliac joint dysfunction is difficult as it has similar traits to lower back pain, combining several approaches can help differentiate the condition:
- a thorough history-taking by an experienced musculoskeletal physiotherapist
- clinical examination that includes locating pain around the SIJ ligaments on palpation, a set of pain provocation tests that reproduces the patient’s symptoms, active load transfer tests and the absence of other signs of involvement from the lumbar spine.
- X-rays or MRI have limited use, but ‘SPECT’ CT scans may be used in severe or chronic cases
Much like the diagnosis of sacroiliac dysfunction, treatment involves a combination of techniques to achieve best results. Management may include:
- Ice or anti-inflammatories to help settle inflammation if there is any present
- Manual therapy techniques to release tight musculature
- A progressive functional exercise program to build control and strength through the lower back and pelvis
- Compression gear such as a pelvic belt or contouring undergarments may help give support and relieve pain
Physiotherapy has positive outcomes for sacroiliac dysfunction to help relieve pain and improve function, but a continuation of functional rehabilitation is critical to prevent reoccurrence in the future. se