At the very base of the spine, several vertebrae fuse to form what is called the sacrum, or tailbone. Both sides of this triangular shaped bone connect to the back area of the pelvis known as the ilium, forming the sacroiliac or SI joints. These joints are supported by a system of muscles and ligaments that minimize uncontrolled motion during situations of physical stress or exertion, primarily the gluteal and deep abdominal muscles.
Walking upright relies on the ability of the sacroiliac joints to keep the center of gravity of the upper body located directly above the pelvis. They are crucial in assisting with the transference of weight between the upper and lower body, and must be relatively stiff and inflexible to avoid excessive strain. The normal range of motion is between two and four millimeters in any given direction. Compared to men, women have ligaments that are less rigid to allow childbirth.
The sacroiliac joints play a critical role in absorbing impact vibrations, preventing the shock of walking, running and jumping from being transferred into the spinal column. At the same time, these joints convert the torque from transverse rotations in the lower part of the body and allow them to move up through the spine, assisting with stability. The joints also have an effective locking mechanism for pushing off steadily as the body’s weight is shifted from one side to another when walking.
Under normal circumstances, the interlocking structure of the bones helps them maintain the proper positioning. What causes SI joint pain is sacroiliac joint dysfunction, which happens as a result of too little or too much mobility. When the movement becomes too restricted it is known as hypomobility and is usually associated with disorders that cause these joints to stiffen. These include progressive types of arthritis like Ankylosing Spondylitis, which involves persistent inflammation of joints along the spine.
Hypermobility is where the opposite situation occurs and there is an excessive degree of freedom, resulting in a lack of stability and poorly controlled movements that place too much stress on the joints. This is the most common cause of sacroiliac joint pain, but it also is more easily remediated. It is important in these cases to strengthen the abdominal and gluteal muscles that provide support to the surrounding connections and ligaments.
Hypermobility can be caused by a number of reasons, however, the injury is most common. Any impact or strain that is forceful enough can tear the ligaments connecting the joints. Injuries from automobile collisions or sports trauma are typically the kind that leads to hypermobility and sacroiliac joint pain. A solid, direct fall on the tailbone can also cause sufficient damage and become a chronic issue. Weakness in the surrounding support muscles increases the likelihood that such injuries will lead to SI joint pain.
Another factor associated with hypermobility is pregnancy. During this time, the female body produces a hormone that relaxes the connective tissues and causes the pelvis to expand. This gives the baby enough room to pass through the birth canal during labor, however, it also can make the joints become too relaxed. The odds of hypermobility and SI joint pain increase with every pregnancy and can be exacerbated by sleeping on the back. It most often manifests in the eighteenth week and is usually characterized by a focused pain that moves down the side of the back and through the buttocks. It will typically switch from one side to the other, growing in intensity throughout the remainder of the pregnancy. In some cases, the problem persists well after the delivery of the child and the ligaments may remain in a compromised state unless strengthened again.
Inherent attributes like differences in leg length or tilting of the pelvis can affect gait and place uneven strain on the sacroiliac joints. Improper footwear may alter the heavily repeated motions of walking enough to create problems. It also is not uncommon for people with polio, arthritic hips or scoliosis to have issues with hypermobility. The majority of lumbar spinal fusion patients are affected as well since the movement in their vertebrae is reduced and additional stress is placed on the sacroiliac joints.
Sometimes the reasons sacroiliac joint pain occurs is difficult to determine. It can flare up without provocation or warning and have no identifiable source. Healthcare professionals with knowledge, training, and experience in this area can provide a correct diagnosis and suggest an effective course of treatment.
SI joint dysfunction most often presents as a deep, sharp pain in the low back. It usually originates near the posterior superior iliac spine, or PSIS, and radiates from there into the areas like the hip, buttock, and groin. It can also cause sciatic pain and frequently mimic a variety of back and hip problems, which makes accurate diagnosis difficult in some circumstances.
Pain is most often brought on after spending long periods of time in sustained positions of standing or sitting. Lying down can be just as uncomfortable for some people although some get temporary relief when lying sideways with a pillow between the knees. Certain other postures like sitting cross legged are very painful for most sufferers since this position places excessive strain on the sacroiliac joints. The majority of those with SI joint dysfunction tend to change positions regularly to minimize discomfort.
Motions, like standing up, climbing stairs, and leaning or bending forward, are common triggers of sacroiliac joint pain, but sometimes simply walking is enough to cause aggravation for some. Activities such as intercourse can worsen the pain for some women, while others report escalated pain during menstruation or when urinating, however, these are rarer and only occur with about a tenth of SI joint dysfunction cases.
Arriving at a correct diagnosis for sacroiliac joint dysfunction requires knowledge and experience to differentiate it from a variety of other disorders that can present similar symptoms. The difficulty is increased because it typically is not detectable by X-rays, CT scan or MRI. It is possible to make a diagnostic injection, however, the depth of the joint necessitates the process be guided with a fluoroscope or X-ray. The joint is then injected with steroids and drugs to numb the area. A sudden and significant improvement in pain levels could indicate that the joint is the source of the pain. In the majority of cases, the condition is determined through a physical examination and the information reported by the patient, so many health care professionals have problems evaluating these cases consistently.
Besides the other conditions which this type of joint pain can mimic, there are a few that are typically associated with sacroiliac joint dysfunction. In facet joint syndrome, the twisting motion bends the facets in the direction of rotation, compressing and crushing their articulated surface on that side, while tearing occurs on the opposite side. Another condition that arises from this is called nerve root, and involves the stretching of the nerves on the opposite side of rotation until they are deformed, which can lead to bilateral entrapment of the nerve roots. Torsion can also result in an annular bulge of the nucleolus purposes, which is the outer ring of the vertebral disc. L4 bulges are fairly common among those suffering from chronic sacroiliac joint dysfunction because of the tension in the attached iliolumbar ligament.
The long-term effects of sacroiliac joint instability have on muscles is very uneven. Muscles involved in posture are strengthened while phasic muscles are inhibited and weakened by the cumulative effect of the dysfunction. These changes can become permanent if the condition persists for long enough. Other muscles like the iliopsoas, adductors, gluteus and hamstrings are also negatively affected. Spams produced in the pelvic wall can result in pelvic floor dysfunction as well. Nerves do not fare much better that muscles and those with long histories of chronic spasms or alterations in the position of the pelvis can suffer damage to the lateral femoral cutaneous nerve, the pudendal nerve, and the sciatic nerve.
These conditions that arise in association with or as a result of chronic and prolonged instances of SI joint dysfunction stress the importance of not putting off treatment. Since some of these conditions cannot be corrected once the damage has been done and can cascade into still further complications.
Effective treatment for SI joint dysfunction cannot be rushed. A lasting recovery requires a graduated approach, where the goals of each phase of healing and recuperation must be attained before moving on to the next step. It can be easy to think that the body will repair itself more quickly if it is worked harder since this is the basis of countless fitness and bodybuilding routines. In instances of injury, however, there is a minimum amount of time required for proper healing to occur. Younger people will generally recover more quickly than older people, however, the process does require patience. Attempting to accelerate the natural process of mending and regaining strength can result in prolonged recovery periods or further injury. It is important to follow through each of these steps fully before advancing to the next phase of recovery.
There are several strategies for SI joint pain relief, though most involve managing the symptoms and issues that are the source the discomfort. Medication that targets pain only works for as long as it is being taken and can result in aggravating the problem further since is easier to overexert without realizing it. As any physical therapist can verify, rehabilitation is never pain-free.
The key to getting the issue under control is reducing the amount of inflammation in the affected area. Physicians may suggest ibuprofen or other anti-inflammatory drugs to alleviate swelling and improve mobility. These may not entirely block out the pain, however, they will usually provide enough relief to resume day to day routines. More intense activity should be avoided until all swelling has subsided. Icing the area down is another effective means of relieving pain and suppressing the body’s inflammatory response, and may be preferred by those who have gastrointestinal sensitivities to such medications. Sports creams and other topical pain ointments are also an effective way to target the source of the discomfort.
There are a variety of therapies that may be employed to help with the pain such as soft tissue massages, acupuncture, electrotherapy and others. Other methods involve reducing the load borne by the joints so they are protected from strain until strength and normal functioning has returned. A cane or crutch can be use on the affected side to improve mobility. Taping or SIJ belts can provide additional support and help minimize hypermobility. One can also relieve the stress on the joints by taking Epsom salt baths. The added buoyancy provided by the hypersalinated water can allow the joints to relax and resume a less strained position.
After the pain and inflammation are under control, the task of building enough strength move without pain begins. It can take some time to restore the muscles to their previous condition. Exercises do tend to emphasize strength but also flexibility, endurance, and balance. Areas of focus are the lower abdominal muscles and the hips, both of which are the main stabilizers of the sacroiliac joints. Strength should be increased initially in the deepest layers of muscle, providing a stable core to build around. Once this has been done, the intermediate muscles are next, followed by the uppermost layers. If this process is done correctly and there are no additional complications, the pain will have ceased by this point.
Needs will vary from one person to another, depending on individual physiological factors and the nature of the injury. Consulting with a physical therapist is advised so they may assess the situation and determine the best course of action for the situation. Once a proper course has been established the journey towards normal functioning can begin. It is important to maintain patience and perseverance in equal measure for an optimal recovery.
As the functioning of the sacroiliac joint gets better, focus shifts more towards the restoration of normal range of motion. Again, the needs of different people will vary, with some aiming for optimal performance and others that would be satisfied enough with returning to daily activities free from pain.
A therapist can best determine how the desired goals of a particular person may be met, and customize the rehabilitation program accordingly. As long as the expectations are not too unreasonable or physically demanding to the point hazard, a suitably challenging routine will help toughen the injured area and reduce the chances of getting hurt again in the future.
It is important to have patience, but if the desired result are not being achieved then some modification of the course of treatment may be necessary. Goals may also shift as the recovery progresses, and what was previously considered to be normal functioning may have to be adapted to a new set of expectations. In any case, this will most likely be the longest phase in the process of healing. For many, it will be a project of a lifetime. Rather than an obvious transition, the movement into the final stage occurs so slowly and gradually, that this third step is never entirely complete.
Once the problem has healed and the work of recovery is complete, it must be stressed that this last step is one that is never truly finished. SI joint dysfunction has a high chance of returning since in most cases the preconditions that led to the issue still exist and cannot be fixed in any permanent sense.
Whether the cause stemmed from an injury or genetic predispositions, the best and most effective treatments involve some sort program or routine that will maintain the strength of the supporting muscles throughout life. This will help minimize issues that can arise as age advances, reducing the need to spend more money on doctors and medications in the future.
As the previous steps just illustrated, the most effective way to treat sacroiliac joint dysfunction and achieve lasting SI joint pain relief is consistent exercise, targeted to strengthen the areas that can offer the most stability and support for the joints. If levels of pain are high and mobility is discouraged, one can begin exercising the muscle groups that are not bearing any weight. Once these are sufficiently strong the progression can be made, slowly and carefully, to weight bearing exercises. The degree of soreness brought on by the exercises can serve as a guide in this process. The incorporation of wider ranges and types of motion should continue as treatment progress.
Some of the other therapies like deep tissue massage may provide temporary relief for sacroiliac joint dysfunction, but the pain inevitable returns as the tension do. Also, because of the strength and stability of the sacroiliac joint, the hands are not powerful enough to affect any structural alterations of any kind. The joint is not going to be moved, adjusted or altered in position in any way by manual therapy. There is an argument for the relief manual therapy can provide since even temporary relief is welcome is situations of chronic pain. In the long term, however, the cumulative expense can make it difficult to justify the lack of lasting positive results.
Those who are suffering from SI joint pain will be happy to know that despite the seemingly unceasing discomfort, the prognosis is generally very good. Most of those who are correctly diagnosed have very little standing between them and SI joint pain relief as well as their full recovery of movement and functionality. The pain can be tough to work around initially, but this is why allowing each phase of the healing process to finish is essential. The rest is simple, and just requires a little bit of good professional assistance, time and commitment to the challenge of regaining what was lost. Recovering from an injury is hard work, and there aren’t really any other choice except to do it. If one can continue to stay engaged in maintaining fitness and strength, especially after coming back from injuries and pain such as this, problems with the SI joint need never be an issue again.
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