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Sacroilliac Joint Dysfunction

What is the Sacroilliac Joint?

The Sacroilliac joint is the joint which connects the Illiac bones of the pelvis and the sacrum (Triangular bone which becomes the tail bone). The sacrum sits directly below the lumbar spine and the sacroiliac joints are to the right and left of the lumbar spine.

Statistically 85% of the population will suffer from low back/pelvic pain at some stage in their life and 18-30% of chronic low back pain has the sacroiliac joint as the pain generator.

How does the Sacroiliac Joint get injured?

  1. Pregnancy related injuries

  2. Fall directly onto the coccyx (Tail bone)

  3. Fall onto one knee

  4. Traction injuries E.g one leg pulled by leg rope while surfing

  5. Repetitive trauma E.g excessive pelvic tilting motions in sports

What are the common symptoms associated with Sacroilliac Joint Dysfunction?

  1. Pain over the sacroiliac joint

  2. Pain with prolonged sitting or standing

  3. Buttocks pain

  4. Coccyx pain (Tail bone)

  5. Neural symptoms down the back or side of the leg – This may be very similar to disc related symptoms

  6. Pain and aching in the surrounding muscles – The gluteals, legs, hips, low back and ribs

  7. Pain at the front of the hip

Following an injury the body starts to respond with compensatory strategies

After an acute injury the body goes into protective mode and stiffens up in attempt to protect the injury. Within 3 days the core stabilisers (Transverse abdominus and Lumbar Multifidus) are inhibited and stop working effectively. If this is addressed quickly, you should return to a “normal” movement pattern as the acute pain settles back down.

If this isn’t addressed early or a significant injury is sustained and takes much longer to settle down the body starts to compensate for this by overusing the surrounding muscles. The muscles that are often overused are the gluteals, legs, hips and back leading to overuse and altered movement patterns.

How can Sacroilliac Joint injuries be diagnosed?

Sacroilliac Joint dysfunction can be difficult to diagnose and is often misdiagnosed. Statistically it takes 2 years to be diagnosed after the initial injury as the body generally can compensate well using the surrounding muscles for approximately 2 years, until the pain starts to present more specifically around the sacroiliac joint.

Sacroilliac Joint Dysfunction is difficult to identify on scans. MRI and CT scans may detect irritation or inflammation around the Sacroiliac Joint however cannot determine dysfunction. The diagnosed is made based on a series of clinical tests.

If the pain is not coming from the Sacroilliac joint, what else could it be?

  1. Referred pain from the lumbar spine

  2. Pelvic pain due to issues with the internal organs such as the bladder, bowel or intestines

How can physiotherapy help Sacroilliac Joint Dysfunction?

Physiotherapy can help in identifying the abnormal compensation strategies you are using and help re-train lumbopelvic control to ensure you are using the correct stabiliser muscles and not overusing the surrounding muscles.

Physiotherapy treatment can help ease the symptoms through various treatments such as:

  1. Soft tissue release

  2. Taping or sacroiliac joint belts (if appropriate)

  3. Dry needling

  4. Muscle energy techniques

  5. Specific exercises

More importantly the physiotherapist will work towards underlying cause of the pain through identifying incorrect movement patterns, muscle imbalances or activities that may be contributing to the pain. The physiotherapist will work with you in addressing these issues and treating the source of the pain as well as the symptoms.

Example of some exercises to help re-train lumbopelvic control

Written by Ashley Holliday

Physiotherapist

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