Treatment of Sacroiliac Joint dysfunction

Article by Graceville Physiotherapist Molly Cartledge

The sacroiliac joint or SIJ is a common complaint of patients presenting to physiotherapy [1]. The SIJ is a joint that sits between the sacrum at the bottom of the spine, and the pelvis. This joint only allows small amounts of movement but is important for force transmission between the trunk and lower limbs. The joint surface, ligaments and muscles surrounding the joint all contribute to both movement and stability of the joint. Issues or dysfunctions with the SIJ can be painful and debilitating. SIJ dysfunctions tend to present as either tight, catching joints or loose, unstable joints.

Patients with SIJ dysfunction can present with a range of symptoms. Pain can be dull or very sharp [5] but usually presents unilaterally [6]. The most prevalent area of complaint is pain in the buttock [6]. Other areas of pain can include the hip and groin, and even into the leg and foot [5,6]. Main aggravators of SIJ pain include repeated or sustained movements, especially if asymmetrical such as single leg weight bearing [3]. Sitting, rising from a chair and climbing stairs are other common complaints [4].

Resolution of pain includes addressing aggravating activities, suboptimal postures and poor body mechanics. It is also important to address muscle imbalances, tightness, spasm and weakness. There are many muscle groups that contribute to SIJ issues and need addressing in regaining function. Many muscles in the buttock overlie the joint and spasm can contribute to pain and catching [6]. Weakness in the glutes is also a common finding in patients with SIJ dysfunction and this has also been shown to present with hamstring shortness [2]. Other muscles of the thigh as well as muscles in the trunk also act on the joint and contribute to problems.

Initial treatment focuses on relieving pain, catching and stiffness, which usually requires muscle release. Dry needling or acupuncture can help facilitate this. Patients are given self-release techniques and stretches to help with self-maintenance. Taping and bracing can be beneficial to provide good short-term relief and can be used long term during activities that are known to be aggravating. The longer term focus is addressing muscular weakness and imbalances and improving postures and activities that have contributed to the dysfunction.

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References:

1. Hodge JC, Bessette B. The incidence of sacroiliac joint disease in patients with low-back pain. Can Assoc Radiol J. 1999;50[5]:321–3.

2. Massoud Arab A, Reza Nourbakhsh M, Mohammadifar A. The relationship between hamstring length and gluteal muscle strength in individuals with sacroiliac joint dysfunction. J Man Manip Ther. 2011;19[1]:5–10.

3. Prather H, Hunt D. Conservative management of low back pain, part I. Sacroiliac joint pain. Dis Mon. 2004;50[12]:670–83.

4. Schwarzer AC, April CN, Bogduk N. The sacroiliac joint in chronic low back pain. Spine. 1995;20[1]:31–7.

5. Sims Vicki, PT. The secret cause of low back pain: how to end your suffering; 2004: pp. 11–12.

6. Slipman CW, Jackson HB, Lipetz JS, et al. Sacroiliac joint pain referral zones. Arch Phys Med Rehabil. 2000;81:334–8. This study assessed the common referral patterns for patients with sacroiliac joint pain. It determined that patients with sacroiliac joint pain may have pain patterns in the buttock, low back, and lower extremity pain.