Sacroiliac joint pain aka SI joint pain is a frequent cause of pain or dysfunction in the low back pain or pelvis. Most disorders of the Sacroilliac joint are functional in nature. Arthritis or true instability requiring surgical intervention is very rare.
The SI joint is an integral part of lumbopelvic-hip complex which is considered a functional unit responsible for movement of the lower quarter of the human body. The SI joint is a biomechanical hub of lumbopelvic hip complex . Even though, the degree of movement in the SI joint is minimal the consequences of its loss or misalignment could be of primary importance for sitting and walking.
The function of SI joint is ensured by two complimenting mechanisms. The form closure is an anatomical congruency of opposing SI joint surfaces responsible for self locking and stability of the sacrum between the pelvic bones. The force closure is a precise coordination of lumbopelvic hip musculature in order to actively control the movement and stability of SI joint.
Pain from SI joint can be a result of functional instability (unlocking ) or joint movement restriction.
Loss of motor control in the lumbopelvic hip area Pelvic misalignment Pelvic trunk uncoupling Hypermobility or ligamentous laxity Trauma Poor function of core musculature Pelvic floor dysfunction.
SI joint pain may mimic pain from herniated disc , sciatica or piriformis syndrome or myofascial syndrome of gluteal muscles
The SIJ forms the juncture of the sacrum and the ilium. Both bones have rough surfaces that interlock to restrict extraneous movement. The processes where the bones meet to form the SIJ are covered with smooth cartilage, with a space between the bones filled with synovial fluid to reduce friction and allow for smooth but limited movement. The surrounding fibrous joint capsule helps to stabilize the pelvis.
Upper body force loads are transferred from the spine through the SIJ to the lower extremities during movement, making joint positioning a critical factor. The SIJ’s articular cartilage serves as a shock absorber between the spine and the pelvis, and SIJ movement facilitates hip joint range of motion.
SIJ dysfunction is most prevalent in young and middle-aged females. Pregnant women or those who have recently given birth are more likely to complain of SIJ pain. During pregnancy and childbirth, the ligaments that support the SIJ soften in response to an increase in the hormone relaxin. Lax ligaments enable the pelvis to expand and open, to allow the fetus to descend through the birth canal. However, ligament laxity can contribute to SIJ dysfunction.
Symptoms of SIJ dysfunction are often similar to those of other abnormalities, and accurate diagnosis is foundational to effective treatment. Symptoms include:
Pain from SIJ dysfunction stems from either too much movement in the joint (hypermobility), or too little movement (hypomobility).
Causes of SIJ dysfunction include:
SIJ pain may mimic herniated disc pain, sciatica, piriformis syndrome, or gluteal myofascial syndrome, making accurate diagnosis a key factor in providing effective treatment. Imaging from CT scan, MRI or X-ray provides little information. A battery of clinical tests have been developed that help provide a reliable diagnosis of SIJ dysfunction. Lidocaine injections guided by diagnostic ultrasonography may be used to confirm diagnosis.
The SIJ plays a central role in maintaining spinal and pelvic stability during walking, running and other physical activities. Two components of SIJ stability include structural stability which relies on the two joint surfaces being tightly linked and held in place by ligaments; and functional stability, which relies on motor control. Both aspects must be considered when devising a treatment plan.
The SIJ is an integral component of the entire lumbopelvic-hip complex, and cannot be treated as a stand-alone structure. In addition to the SIJ, the pelvic ring includes the pubic symphsis and the lubrosacral articulations, and dysfunction or pain in any one of these joints has a direct affect on the others. Moreover, pain in the SIJ may originate from movement dysfunction elsewhere along the kinetic chain, anywhere from the rib cage to the foot.
Normal gait and hip function are pivotal to SIJ function. Over time, a dysfunctional SIJ may become a weak link in the kinetic chain, causing pain and dysfunction elsewhere in the body.
Treatment options at NYDNR include:
Dr. Kalika has participated in multiple interdisciplinary conferences on pelvic pain. He has had the privilege of meeting Diane Lee, a foremost leader and evidence based researcher on the diagnosis and treatment of SIJ pain. Dr. Kalika is a certified practitioner of ISM (integrated systems model approach), a comprehensive and evidence based method for diagnosis and treatment of pelvic pain.