Sports Medicine
Sports Injury Prevention & Rehabilitation

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SI Joint Dysfunction

(Also known as Sacroiliac Joint Pain, Sacroiliac Joint Sprain, SIJ Dysfunction, Sacroiliac Joint Inflammation, Sacroiliac Joint Injury, Sacroiliac Joint Disorder, Sacroiliitis, Sacroiliacitis)
What is sacroiliac joint dysfunction?
The sacroiliac joint is located in the lower part of the back and joins the tail bone (sacrum) to one of the pelvic bones (ilium). There are two sacroiliac joints – one on either side of the spine. The sacroiliac joints act to transfer weight from the spine to the pelvis and allow a small amount of movement to occur.
During certain movements of the spine and hips, stretching or compressive forces are placed on the sacroiliac joints and surrounding ligaments. If these forces are excessive and beyond what the sacroiliac joint can withstand, injury to the sacroiliac joint may occur. This is known as sacroiliac joint dysfunction.

Causes of sacroiliac joint dysfunction
Sacroiliac joint dysfunction may occur from excessive forces being applied to the sacroiliac joint. This can be from bending, sitting, lifting, arching or twisting movements of the spine, or, from weight bearing forces associated with running or jumping. Injury to the sacroiliac joint may occur traumatically or due to repetitive or prolonged forces over time.

Signs and symptoms of sacroiliac joint dysfunction

Patients with this condition usually experience one sided low back pain around the top of the buttock with symptoms sometimes referring into the lower buttock, groin or thigh. In rare cases, pain may be felt on both sides of the lower back. Symptoms are generally exacerbated with activities that involve lower back or hip movements.
Often patients will experience pain upon rolling over in bed, putting on or taking off their shoes and socks, walking up and down stairs, or with running. Tenderness is usually felt on firm palpation of the sacroiliac joint. Sacroiliac joint dysfunction may also be associated with asymmetry of the pelvis due to muscle tightness, joint stiffness, or joint laxity associated with pregnancy.

Diagnosis of sacroiliac joint dysfunction
A thorough subjective and objective examination from a physician is usually sufficient to diagnose sacroiliac joint dysfunction. Investigations such as an X-ray, MRI, bone scan or CT scan may be used to assist with diagnosis.

Treatment for sacroiliac joint dysfunction
Most patients with sacroiliac joint dysfunction heal well with appropriate physical therapy. The success rate of treatment is largely dictated by patient compliance. One of the key components of treatment is that the patient rests sufficiently from ANY activity that increases their pain until they are symptom free. This allows the body to begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms.
  • Generally, sitting for prolonged periods should be avoided. However, if inevitable, optimal sitting posture is important to minimize stress on the sacroiliac joint. If you sit slouched, your lower back goes into its maximal bend (similar to standing and touching your toes) this may aggravate the sacroiliac joint. Optimal sitting posture can be obtained by sitting tall on an appropriate chair, with your bottom in the back of the chair and a lumbar support (or a pillow / rolled up towel) in the small of your back. Your shoulders should be back and your chin should be tucked in slightly.
  • Patients should follow RICE in the initial phase of injury. RICE is beneficial in the first 72 hours following injury or when inflammatory signs are present (i.e. morning pain or pain with rest). RICE for sacroiliac joint dysfunction primarily involves resting from aggravating activities (this may include the use of a protective brace) and regular icing. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation.
  • Patients with this condition should perform early movement and strength exercises to prevent stiffness and weakness from developing and to ensure the sacroiliac joint is functioning correctly. The treating physical therapist can advise which exercises are most appropriate for the patient and when they should be commenced.

Prognosis of sacroiliac joint dysfunction
The recovery time for sacroiliac joint dysfunction may vary from patient to patient depending on compliance with physical therapy. With ideal treatment, patients may be pain free in as little as several days, although typically this may take 2 – 3 weeks. It is important to note, however, that injured tissue takes approximately six weeks to restore the majority of its strength in ideal healing conditions. Care must therefore be taken when returning to activity during this period.

Physical therapy for sacroiliac joint dysfunction
Physical therapy treatment for sacroiliac joint dysfunction can hasten healing, ensure an optimal outcome and reduce the likelihood of future recurrence. Treatment may comprise:
  • soft tissue massage
  • mobilization
  • manipulation
  • electrotherapy (e.g. ultrasound)
  • taping
  • bracing
  • the use of a lumbar roll for sitting
  • correction of any leg length discrepancy
  • dry needling
  • muscle energy techniques
  • education
  • activity modification advice
  • biomechanical correction
  • ergonomic advice
  • clinical Pilates
  • hydrotherapy
  • exercises to improve flexibility, strength, posture and core stability
  • a gradual return to activity program

Contributing factors to the development of sacroiliac joint dysfunction
There are several factors that may contribute to the development of sacroiliac joint dysfunction. These factors need to be assessed and corrected with direction from a physical therapist and may include:
  • muscle imbalances
  • leg length differences
  • muscle weakness or tightness
  • biomechanical abnormalities
  • poor posture
  • lumbar spine stiffness
  • a sedentary lifestyle
  • poor core stability
  • inappropriate lifting technique
  • being overweight
  • a lifestyle involving large amounts of sitting, bending or lifting
  • The pelvic girdle changes associated with pregnancy may also contribute to the development of sacroiliac joint pain.

Other intervention for sacroiliac joint dysfunction

Despite appropriate physical therapy management, a small percentage of patients with sacroiliac joint dysfunction fail to improve and may require other intervention. This may include pharmaceutical intervention, investigations such as an X-ray, bone scan, CT scan or MRI, blood tests or assessment from a specialist. A corticosteroid injection into the sacroiliac joint may sometimes be used to help alleviate symptoms. The treating physical therapist can advise on appropriate management and can refer to the appropriate medical authority if it is warranted clinically.