SI Joint Pain

Sacroiliac joint (SIJ) dysfunction is a lower back/pelvic condition that can result from joint stiffness (hypomobility) or slackness (hypermobility) at the sacroiliac joints in the pelvis. The condition can affect both men and women of all ages, but is more common in females. Symptoms typically are present on 1 side of the back, and affect 10% to 25% of patients with complaints of low back pain. Physical therapists design individualized treatment programs to address SIJ dysfunction based on the specific cause of each person’s condition, and treatment goals.

What is Sacroiliac or SI Joint Pain?

The sacroiliac joint is a joint between the sacrum and the ilium, or pelvic bone. The 2 sides of the sacroiliac joint normally work together. If 1 side becomes stiff, they will not move together and this causes pain or muscle stiffness in the area. Pain is often made worse with walking and bending activities. It is also possible that 1 side may become too loose (lax) as well, resulting in SIJ dysfunction. This may occur during the menstrual cycle or pregnancy due to hormonal changes that cause the ligaments to become more lax. SIJ dysfunction can occur with injury, such as when a person falls and lands on 1 side of the body and alters the position of the joint, or when an athlete overtrains. Muscle imbalances and hip problems, such as hypermobility or dysplasia, may also lead to SIJ dysfunction. Sacroiliac pain is also related to some types of arthritis, such as ankylosingspondylitis, an inflammatory process most often affecting the lower back, which may cause the vertebrae to fuse.

How Does SI Joint Pain Feel?

People with SIJ dysfunction may experience:

  • Pain that may be sharp, stabbing or dull, localized to 1 side of the pelvis/low back, groin, or tailbone.
  • Pain that may radiate down to the knee.
  • Pain with movements, such as standing up from a sitting position, turning in bed, or bending/twisting.
  • Muscle tightness and tenderness in the hip/buttock region.
  • Pain with walking, standing, and prolonged sitting.
  • Pain that is worse when standing and walking, and eases when sitting or lying down.

How Is SI Joint Pain Diagnosed?

When you see your physical therapist, the therapist will ask you questions about your current condition, such as:

  • When did the pain start?
  • What happened to cause the pain to start?
  • Did you experience a fall or injury?
  • Have you experienced similar symptoms in the past?
  • Where is the pain located?
  • What specific movements/activities cause your pain?
  • Are you pregnant, or have you recently given birth?

Your physical therapist will then conduct a physical evaluation. Your therapist may examine the position of your spine, conduct strength tests of the hip, pelvic, and lower extremity muscles, and gently perform movement tests to assess your mobility and flexibility. Specialized tests will be performed to rule out any problems that may require other medical intervention. If further medical intervention is required, your physical therapist may refer you to a physician who specializes in SIJ dysfunction or other conditions that may be causing your symptoms.

Once SIJ dysfunction has been confirmed, your physical therapist will work with you to determine your personalized treatment program.

How Can a Physical Therapist Help Treat My SI Joint Pain?

Your physical therapist will design a targeted treatment program based on your evaluation and your goals for a safe return to sport or daily activities. Treatment may include:

  • Manual therapy. Often, manual therapy for SIJ dysfunction includes soft tissue release or massage for tight and sore muscle groups. Manual therapy and muscle energy techniques (MET) are used to correct pelvic/SIJ alignment. MET uses your own muscle contractions to realign the position of the pelvis, and can be a source of pain relief. Joint mobilizations/manual therapy uses gentle movements to improve mobility of the hip, SIJ, and low back.
  • Flexibility exercises. Stretching exercises may be prescribed to improve the flexibility of tight muscles. They may also help to improve movement in the spine and lower extremities, and help decrease stress at the sacroiliac joint during daily activities.
  • Strengthening exercises. Strengthening helps to improve the stability of the sacroiliac and spinal joints, which helps to reduce ligament strain and pain.These exercises are focused on weak muscles, including the lower abdominal, pelvic floor, and buttocks muscles.
  • Body mechanics. How you move and use your body for daily work and other activities can contribute to your SIJ dysfunction and pain. Your physical therapist will teach you how to improve your movements or body mechanics based on your specific daily activities. The physical therapist may also make recommendations to improve activities, such as sitting, or lifting and carrying objects.
  • Modalities. Hot and cold treatments are often prescribed to loosen up tight muscles prior to treatment, or to alleviate pain following exercise. Electrical stimulation uses electricity to target nerve fibers that send pain signals to the brain, and may also be used in conjunction with ice to provide pain relief.
  • Braces. Your physical therapist may also recommend wearing a sacroiliac belt, designed to provide support to the sacroiliac joints. It is used to provide stability during daily activities as your strength returns, and flexibility improves. This modality is especially helpful for pregnant women.

All treatments prescribed by the physical therapist will be based on your specific case.

Can SI Joint Pain be Prevented?

Fall prevention, the use of proper body mechanics (such as correcting your posture), and maintaining healthy activity levels are all ways that SIJ dysfunction may be prevented. Adhering to appropriate strength and flexibility programs can maintain muscle mobility and strength to keep the area stable when joint hypermobility is present. Your physical therapist can work with you to strengthen and stretch your joints and muscles to prevent conditions like SIJ dysfunction from occurring.To prevent a recurrence of SIJ dysfunction after physical therapy treatment is completed, you will need to continue performing your home-exercise program. It is imperative that you do this to maintain your strength and flexibility. Improving and maintaining muscle strength will continue to provide stability for the sacroiliac joint and low-back ligaments after an injury.
References:
http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=dc362d89-aa6d-4cb7-af04-d9e31f654d08#.VW8-bc_BzGc