Sacroiliac joint dysfunction, also known as SI joint pain or SI joint dysfunction, refers to a condition characterized by pain and discomfort in the sacroiliac joints. The sacroiliac joints are located in the lower part of the back, where the sacrum (the triangular bone at the base of the spine) connects with the iliac bones (the large bones of the pelvis).
The primary function of the sacroiliac joints is to provide stability and transmit forces between the upper body and the lower body during activities such as walking, running, and lifting. However, when these joints become dysfunctional or injured, it can lead to pain and limited mobility.
Causes of Sacroiliac joint dysfunction
Trauma:
Injuries such as falls, motor vehicle accidents, or sports-related impacts can disrupt the normal function of the pelvic joints.
Pregnancy:
Hormonal changes and increased joint mobility during pregnancy can lead to sacroiliac joint dysfunction and pain.
Arthritis:
Inflammatory conditions like ankylosing spondylitis or osteoarthritis can affect the pelvic joints and can cause sacroiliac joint dysfunction and pain.
Degenerative joint disease:
The gradual wear and tear of the joint cartilage over time can contribute to sacroiliac joint pain and dysfunction. Degenerative sacroiliitis can
Common symptoms of Sacroiliac joint dysfunction
Pain:
Typically, sacroiliac pain is felt on one side of the lower back or buttocks, which may radiate down the leg. The SI joint pain intensity can vary from mild to severe.
Difficulty in moving the lower back or hips, especially after prolonged periods of inactivity or rest. This can be associated with disturbed sleeping patterns, problems standing particularly on the affected side, altered shock absorption, leg instability, potentially leading to chronic SI joint pain.
Instability:
A sensation of the joint “giving way” or feeling unstable, affecting walking or weight-bearing activities.
Stiffness and restricted range of motion:
Difficulty in bending forward, twisting, or performing activities that involve the lower back and hips.
If you suspect you have SI joint dysfunction, it is recommended to consult with a healthcare professional, such as a primary care physician, orthopaedic specialist, or physiotherapist. They can perform a physical examination, review your medical history, and order diagnostic tests (such as X-rays, MRI, or CT scans) to determine the underlying cause of your pain.
Anatomy of the Sacroiliac joint
The sacroiliac (SI) joint is located in the pelvis and is formed by the connection between the sacrum and the ilium, which are two bones on either side. Here is an overview of the anatomy of the sacroiliac joint:
Sacrum: The sacrum is a triangular bone located at the base of the spine, between the fifth lumbar vertebra (L5) and the coccyx (tailbone). It consists of five fused vertebrae and serves as a foundation for the spine. The top part of the sacrum, called the base, articulates with the fifth lumbar vertebra, while the bottom part, called the apex, connects to the coccyx.
Ilium: The ilium is one of the three bones that make up the hip bone or pelvic girdle. It is the largest and uppermost portion of the hip bone. The ilium forms the superior and posterior parts of the pelvis and contributes to the formation of the acetabulum, which is the socket where the femur (thigh bone) connects.
Articular surfaces: The sacroiliac joint is formed by the articulation of the auricular surfaces of the sacrum and the ilium. The auricular surfaces are large and irregularly shaped, with a rough texture that helps provide stability to the joint.
Ligaments: The sacroiliac joint is supported by several ligaments that provide stability and limit excessive movement. The major ligaments associated with the sacroiliac joint include:
Sacroiliac ligaments: These ligaments reinforce the joint on the anterior (front) and posterior (back) sides. The anterior sacroiliac ligaments include the anterior sacroiliac ligament and the interosseous sacroiliac ligament. The posterior sacroiliac ligaments include the posterior sacroiliac ligament, the sacrotuberous ligament, and the sacrospinous ligament.
Interosseous ligament: This ligament is located within the joint itself, connecting the tuberosities of the sacrum and the ilium. It provides additional stability to the joint.
Muscles: Various muscles surround and attach to the sacroiliac joint, contributing to its stability and movement. These muscles include the gluteal muscles (such as the gluteus maximus and gluteus medius), the deep muscles of the back (such as the erector spinae), and the muscles of the pelvic floor.
The sacroiliac joint plays a crucial role in transferring forces between the upper body and the lower body during activities such as walking, running, and lifting. Its stability is essential for maintaining proper posture and facilitating efficient movement.
What is sacroiliac joint pain?
Sacroiliac joint pain refers to the discomfort or pain experienced in the sacroiliac joints, which are located in the lower part of the back where the sacrum (the triangular bone at the base of the spine) connects with the iliac bones (the large bones of the pelvis). Sacroiliac joint pain is also known as SI joint pain or sacroiliitis.
The pain associated with sacroiliac joint dysfunction can vary in intensity and location. It is commonly felt in the lower back, buttocks, hips, and may radiate down the leg. The pain can be sharp, stabbing, dull, or achy, and it may worsen with certain activities or positions such as standing, walking, climbing stairs, or prolonged sitting or lying down.
Diagnosing sacroiliac joint pain can be challenging because the symptoms can overlap with other conditions affecting the lower back and hips. A healthcare professional, such as a primary care physician, orthopaedic specialist, or physiotherapist, may perform an examination, review medical history, and order diagnostic tests, including X-rays, MRI, or CT scans, to assess the joints and rule out other possible causes of pain.
What treatments are available?
Following a thorough physical exam, treatment for sacroiliac joint pain often involves a combination of conservative measures, such as:
Rest and activity modification: Avoiding activities that exacerbate the pain and modifying daily activities to reduce stress on the joints, will be an important component of managing SI joint syndrome.
Pain medication: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) or prescription pain medications can help alleviate pain and reduce inflammation.
Physical therapy: Specific exercises and stretches prescribed by a physical therapist can help improve joint stability, strengthen surrounding muscles, and increase flexibility. Regular exercise can also help to maintain or build strong ligaments across the two joints and reduce low back pain and/or buttock pain.
Pelvic belt or brace: This can provide pain relief and support if there is too much movement or uneven movement through the SI joints and/or sacroiliac ligaments causing abnormal motion.
Joint injections: Corticosteroid injections into the sacroiliac joint can provide pain relief and reduce inflammation.
In cases where conservative treatments do not provide sufficient relief, more invasive interventions such as radiofrequency ablation (nerve ablation) or sacroiliac joint fusion surgery may be considered.
It is important to consult with a healthcare professional for an accurate diagnosis and appropriate treatment plan tailored to your specific condition.
Physiotherapy management of Sacroiliac disorders
Physical therapy: Specific exercises and stretches to improve joint stability, strengthen supporting muscles, and enhance flexibility.
Joint injections: Targeted injections of anaesthetic or corticosteroids into the affected joint for pain relief and inflammation reduction.
Bracing or belts: Wearing a sacroiliac belt or brace to provide external support and stability to the joint.
In some cases, if conservative treatments fail to provide relief, surgical interventions such as sacroiliac joint fusion may be considered. Joint fusion may help stop stress and inflammation at the involved SI joint. However, surgery is usually considered a last resort and is only recommended for severe cases that have not responded to other treatments.
It’s important to remember that this information is not a substitute for professional medical advice. If you are experiencing symptoms of SI joint dysfunction or any other health concerns, please consult with a qualified healthcare provider for an accurate diagnosis and appropriate treatment options.
