Sacroiliac Joint Dysfunction
1. Introduction
The sacroiliac joint (SIJ) is a joint at the base of your back whereby the spine joins to the pelvis. There is a sacroiliac joint on each side of the sacrum where it joins onto the ilium (pelvis bone). It is thought to be a significant contributor to low back pain, particularly in the younger population.
The sacroiliac joint is heavily reliant on strong ligament structures to help support it. As with all soft tissue injuries, these can be overloaded and often produce a painful response. The common causes are during pregnancy when the extra load in front can overload these ligaments or cause trauma to this area (4).
There is very little movement in the sacroiliac joint; as we get older, the movement reduces to a point where the bones begin to fuse together and therefore no further movement comes from the joint. (6).
Frequently Asked Questions
- This refers to pain originating from the sacroiliac joint (a joint at the base of your back whereby the spine joins to the pelvis) commonly caused by abnormal motion (mainly stiffness) in the area.
- Sacroiliac joint dysfunction is a common source of lower back pain.
- It has been estimated that the sacroiliac joint can be responsible for 15% to 30% of low back pain cases (1).
- It is particularly common in pregnant women and those who have recently given birth (2).
- No.
- Sacroiliac joint dysfunction responds very well to physiotherapy treatment and exercise.
- It is not linked to any other serious conditions.
- People involved in asymmetrical sports such as hockey and tennis.
- Pregnant women experience joint laxity due to hormonal changes; this is when the sacroiliac joint is the most vulnerable (4).
- Low back pain.
- Buttock region pain.
- Stiffness.
- Pain can sometimes radiate to the hip, groin and/or upper thigh.
- Can be one or both sides (6).
- Education on posture.
- Advice on lifting techniques.
- Rehabilitation exercises.
- Stretching exercises.
- Over-the-counter medications such as pain relief or NSAIDs.
- The timeframe varies depending on treatment approaches. It can range from 1-2 rest days after injury, to 6-8 weeks conservative treatment (8).
We recommend consulting a musculoskeletal physiotherapist to ensure exercises are best suited to your recovery. If you are carrying out an exercise regime without consulting a healthcare professional, you do so at your own risk.
2. Signs and Symptoms
The main symptoms are usually:
- Pain in the low back / pelvic region; some hip or groin pain.
- Lower limb pain.
- Numbness and/or tingling.
- Instability of the leg(s), giving way.
- Unable to sit for long periods; unable to stand for long periods.
- Pain during the sit to stand phase.
- Disturbed sleep, struggling to get comfortable.
3. Causes
There are a number of reasons why this condition can occur, such as a fall typically onto the hip area or a collision in sport, but it can occur without clear reason, possibly due to a muscle imbalance. There is a close link between pregnancy and patients who are overweight. Smokers are also at risk of sacroiliac joint pain. The relationship between the sacroiliac joint and low back pain has been a topic of debate, with some believing that the sacroiliac joint does not contribute towards low back pain (3).
4. Risk Factors
This is not an exhaustive list. These factors could increase the likelihood of someone developing sacroiliac joint dysfunction. It does not mean everyone with these risk factors will develop symptoms.
- People involved in asymmetrical sports such as hockey and tennis.
- Pregnant women experience joint laxity due to hormonal changes; this is when the sacroiliac joint is the most vulnerable (4).
5. Prevalence
In the general population, sacroiliac joint dysfunction affects between 1% to 3% of people. In people who have already been diagnosed with back pain, it is believed to be a part of the problem 25% – 33% of the time.
6. Assessment & Diagnosis
If you experience the symptoms of sacroiliac joint pain then you should see your physiotherapist, take a complete background history, and offer an examination. During the examination, you will be asked to perform a few special tests to determine if the sacroiliac joint is involved or not. Different movements and positions can determine what elements are giving you your symptoms. Your physiotherapist may also check for any tenderness over the sacroiliac area.
Other tests such as X-ray, computer tomography (CT) or magnetic resonance imagery (MRI) scans are rarely used in the initial stages of the condition as we often find that these can be misleading and provide information that may not be linked to your symptoms. These investigations can be used if needed to differentiate between hip or serious lumbar spine problems, but only in severe cases or when treatment has been unsuccessful (2, 5).
7. Self-Management
As part of the sessions with your physiotherapist, they will help you to understand your condition and what you need to do to help you recover from your sacroiliac joint dysfunction. This may include reducing the amount or type of activity, as well as other advice aimed at reducing your pain. It is important that you try and complete the exercises you are provided as regularly as possible to help with your recovery. Rehabilitation exercises are not always a quick fix, but if done consistently over weeks and months then they will, in most cases, make a significant difference.
Self-help techniques include:
- Regular pain relief, such as over the counter paracetamol.
- Heat vs cold therapy.
- Adopting a good posture and use correct lifting techniques.
- Maintain a healthy lifestyle and regular fitness activities like stretches and strengthening techniques.
- Undertake in stress management if this is a factor. Use relaxation techniques or mindfulness.
- If your work is heavy, manual tasks, try to use suitable equipment and ask people to help to try and adapt to the workplace setting.
8. Rehabilitation
Below are three rehabilitation programmes created by our specialist physiotherapists targeted at addressing sacroiliac joint dysfunction. In some instances, a one-to-one assessment is appropriate to individually tailor targeted rehabilitation. However, these programmes provide an excellent starting point, as well as clearly highlighting exercise progression.
9. Sacroiliac Joint Dysfunction
Rehabilitation Plans
Our team of expert musculoskeletal physiotherapist have created rehabilitation plans to enable people to manage their condition. If you have any questions or concerns about a condition, we recommend you book an consultation with one of our clinicians.
What Is the Pain Scale?
The pain scale or what some physios would call the Visual Analogue Scale (VAS), is a scale that is used to try and understand the level of pain that someone is in. The scale is intended as something that you would rate yourself on a scale of 0-10 with 0 = no pain, 10 = worst pain imaginable. You can learn more about what is pain and the pain scale here.
Exercises at this stage aim to reduce the stress on the joint, increase muscle flexibility and movement around the area. This should not exceed any more than 4/10 on your perceived pain scale.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
At this stage the emphasis changes to include more focus on increasing the stability and strength around the hips and pelvis. This should not exceed any more than 4/10 on your perceived pain scale.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
The advanced stage aims to further increase stability and core strength to ensure a full return to normal daily activities and reduce the risk of recurrence of the problem. This should not exceed any more than 4/10 on your perceived pain scale.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
10. Return to Sport / Normal life
For patients wanting to achieve a high level of function or return to sport we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage. Before returning to sport a rehabilitation program should incorporate plyometric based exercises this might include things like bounding, cutting, and sprinting exercises (5,7).
As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain reliving treatments to support symptom relief and recovery. Whilst recovering you might benefit from further assessment to ensure you are making progress and establish appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future re-occurrence.
11. Other Treatment Options
- Joint injections where a corticosteroid is used can settle inflammation and swelling of the nerves; they are often used with an analgesic numbing agent. Although it may be a temporary measure, people can have up to 3 injections a year (5).
- Use of gels or pain relief patches to help. Your GP is the best person to see to discuss this further.
References
- Cohen SP, Chen Y, Neufeld NJ. (2013). Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis, and treatment. Expert Rev Neurotherapy. 13, 99-116.
- Evidence-Based Diagnosis and Treatment of the Painful Sacroiliac Joint. Mark Laslett. (2008). FNZCP, PhD, Dip MT, Dip MDT. J Man Manipulation Therapy. 10.1179/jmt.2008.16.3.142. 16, 142–152.
- Anterior dysfunction of the sacroiliac joint as a major factor in the etiology of idiopathic low back pain syndrome. DonTigny RLPhys Ther. (1990). 70, 250-65; 262-5.
- Sacroiliac Joint Injury. Alexander M. Dydyk; Stephen D. Forro; Andrew Hanna. (2020).
- Chronic low back pain in older adults: prevalence, reliability, and validity of physical examination findings. Weiner DK, Sakamoto S, Perera S, Breuer P. J Am Geriatr Soc. (2006). 54, 11-20.
- Sacroiliac joint pain. Marc Orlando, (2019). MD, William Tobler, MD.
- Evaluation of Efficacy of Bone Scan With SPECT/CT in the Management of Low Back Pain. A Study Supported by Differential Diagnostic Local Anesthetic. Jain, Anuj MD; Jain, Suruchi MD; Agarwal, Anil MD; Gambhir, Sanjay MD; Shamshery, Chetna MD; Agarwal, Amita MDS. (2015). The Clinical Journal of Pain: 31, 1054-1059.
- Postoperative complications in patients undergoing minimally invasive sacroiliac fusion. Spine. Schoell K, Buser Z, Jakoi A, Pham M, Patel NN, Hsieh PC, Liu JC, Wang JC. (2016). 16, 1324-1332.
Other Conditions in
Lower Back, Hips & Pelvis
Spondylolysis
An injury due to a stress fracture through part of a vertebra known as the pars interarticularis of the lumbar vertebrae (lower back).
Spondylolisthesis
A term to describe a slight change in position (usually further forward) of one vertebra relative to the vertebrae below.
Mechanical Back Pain
Lower back pain caused by structures in the back, such as joints, bones and soft tissues.
Lumbar Spinal Stenosis
Narrowing of the spaces though which lower back spinal nerves travel which can result in weakness, pain and reduced function.
Lumbar Disc Injury
Lumbar discs sit between each of the bones of the spine. Problems can occur when these discs become irritated.
Low Back Pain and Sciatica
Sciatica is a symptom describing pain and/or pins and needles down the back of the leg.
Greater Trochanteric Pain Syndrome
A condition affecting the tendons that insert into outside of the hip. A common cause of pain felt around the hip and pelvis.
Femoroacetabular Impingement
A condition that results in pain in the groin, hip and down the front of the thigh.
Femoral Nerve Radiculopathy
This is where the nerve that supplies the front of the leg is irritated and causes pain/numbess.
Deep Gluteal/Piriformis Syndrome
A presentation where the sciatic nerve is irritated in the buttock and can cause sciatica symptoms in the leg.
Cauda Equina Syndrome
A rare but serious condition as a result of compression of the nerves at the base of your spine.
Benign Joint Hypermobility Syndrome
Common age related changes to the structure of the knee joint which may be associated with pain, stiffness and loss of function.
Ankylosing Spondylitis
A rare condition that can cause joint stiffness and pain, often worse at night and when resting.