Sacroiliac joint pain

Sacroiliac joint pain

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.

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Pain from SI joint can be a result of functional instability (unlocking ) or joint movement restriction.


Muscle imbalance.

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.


Purely clinical


SI joint pain may mimic pain from herniated disc , sciatica or piriformis syndrome or myofascial syndrome of gluteal muscles


Treatment of SI joint pain is based on distinguishing which mechanism is causing irritation of the capsule of the SI joint. In case of altered force closure ( most common) treatment should be directed of restoration of pelvic alignment and function of muscles responsible for dynamic control of force closure.There is a direct anatomical connection of deep spinal musculature lumbodorsal fascia and the Sacroilliac joint. SI Joint fixation is a very simple articular dysfunction which requires specific mobilization or manipulation of SI joint. However, the blockage may be a self guarding mechanism to protect existing instability.

When the ligamentous integrity of SI joint is lost prolo therapy could become a viable option. However, loss of structural integrity is very rare and usually follows a significant trauma to the pelvis.

Treatment of sacroiliac joint


Sacroilliac Joint Pain Treatment NYC
The sacroiliac joint (SIJ) is a synovial planar joint located in the pelvis. It plays an important role in load transfer during physical activity, and helps to mediate the transfer of forces from the upper to the lower body. Dysfunction of the SIJ can cause pain in the low back and legs, which is sometimes mistaken for sciatic nerve pain.

Anatomy and Function of the SIJ

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.

Incidence of SIJ Dysfunction

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

Symptoms of SIJ dysfunction are often similar to those of other abnormalities, and accurate diagnosis is foundational to effective treatment. Symptoms include:

  • Low back pain ranging from mild to severe
  • Pain spreading to the buttocks, hips or groin
  • Pain in the upper back and along the side of the thigh

Causes of SIJ Dysfunction

Pain from SIJ dysfunction stems from either too much movement in the joint (hypermobility), or too little movement (hypomobility).

Causes of SIJ dysfunction include:

  • Muscle imbalances that alter SIJ position
  • Poor lumbopelvic motor control
  • Pelvic misalignment
  • SIJ uncoupling
  • Ligament laxity
  • Trauma
  • Weakened core muscles
  • Pelvic floor dysfunction

Diagnosis of SIJ Dysfunction

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.

Treatment for SIJ Dysfunction

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:

  • Gait retraining
  • Specialized physical therapy
  • Chiropractic treatment
  • DNS (Dynamic Muscular Stabilization)
  • Other innovative treatment methods

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.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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