Sacroiliac joint dysfunction

What is sacroiliac joint dysfunction?

The sacroiliac joint (SIJ) is the joint that links your pelvis to your spine. The SIJ has little movement, which decreases further with age and sometimes becomes lost entirely as the joints eventually fuse. Muscles (glutes and piriformis) and ligaments strongly contribute to the stability of the posterior aspect of the joint; as such, compromise to these structures will also affect the SIJ.

SIJ dysfunction can arise from different sources, and it is crucial to establish the cause before continuing with care. SIJ pain can be secondary to severe pathologies, which need early detection to provide the patient with adequate treatment. For example, fractures, infection, inflammation secondary to spondyloarthropathies and arthritis. However, the majority of cases are due to ligament and muscle injuries. These can arise due to trauma or repetitive loading of the joint. Pregnancy also predisposes women to SIJ pain, with weight gain, increased ligamental laxity and increased low back curvature (lordosis).

What are the signs of SIJ dysfunction?

Pain from the SIJ is generally on one side and localised to the buttock area. Pain is also often felt in the lower back and may radiate down the back of the leg, usually not passed the knee. In some cases, it is also painful through the groin region.

Symptoms are often triggered when rising from a seated position, walking or sitting on a hard surface. The pain may be sharp or stabbing or could feel like a pinching sensation.

Diagnosis

Diagnosing SIJ dysfunction can be tricky and requires a combination of findings. Clinically, several orthopaedic tests must be positive to warrant the diagnosis of SIJ dysfunction.

No imaging is required, as X-rays are a poor screening test for SIJ-mediated pain. The chosen method for diagnosing is the diagnostic block, an anaesthetic injection into the joint used to determine if the SIJ is the source of the pain.

Prognosis

Each patient responds differently, and it is impossible to give an exact timeline for all SIJ dysfunction recoveries. Recovery usually occurs within 4 to 12 weeks of injury, depending on the injury's severity and patient-specific characteristics, such as age and build.

Treatment recommendations

If the dysfunction is judged purely musculoskeletal (related to the muscles and ligaments of the joint), we will proceed with treatment. However, a referral recommending cortisone will be organised if further investigation is required.

Phase 1: Acute care

In the acute stages of injury, the focus is to reduce swelling, inflammation, and pain. A combination of manual adjustment and soft tissue therapies increases movement, reduces muscle tightness and relieves pain. In addition, pelvic blocks are commonly placed under the hips to unload the joint under the force of gravity while maintaining some level of comfort.

Phase 2: Stabilisation

The second phase of care aims to stabilise the area and increase joint stability by adding rehabilitation exercises.

Phase 3: STRStrengthening and maintenance

Finally, maintenance care aims to monitor progression and increase strength in the area to prevent reoccurrences and reach optimal function.

In more severe cases or if there is little to no relief through conservative care, intraarticular steroid injections may be recommended as pain relief, with effects lasting from 6 months to a year. Finally, surgery is the last resort and often consists of joint fusion.

Home advice

An SIJ belt can be worn in the acute stages to support and stabilise the joint. Maintaining as much movement as possible and going for regular walks are also recommended. Stretching the muscles involved will help with pain management. Other home advice includes applying heat to the area, avoiding sitting cross-legged and sleeping with a pillow between the legs.

As we progress to the stabilisation phase, the introduction of strengthening exercises will aid in increasing joint stability.

Dr Elsa de Froberville

BscAnat., BscChiro., BChiro.

Chiropractor | Spine & Sports Centre

References

Cohen SP. Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment. Anesth Analg. 2005 Nov;101(5):1440-1453. doi: 10.1213/01.ANE.0000180831.60169.EA. PMID: 16244008.

Ou-Yang DC, York PJ, Kleck CJ, Patel VV. Diagnosis and Management of Sacroiliac Joint Dysfunction. J Bone Joint Surg Am. 2017 Dec 6;99(23):2027-2036. doi: 10.2106/JBJS.17.00245. PMID: 29206793