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
There has been much controversy in the medical science about sacroiliac join pain. However, in the past decade researchers (Sniders, Vleeming, Lee at al…) have finally provided the clarity on this issue.
The following consensus has been reached. Yes the sacroiliac joint (SIJ) moves and its articulation is very important for function of lumbopelvic-hip complex. The receptors in the joint could become irritated and produce pain which can mimic variety of other conditions such as: low back pain, herniated disc, sciatica, groin pain, hip pain, piriformis syndrome and more…
The SIJ pain most commonly feels like low back and buttock pain. However, it could mimic variety of other conditions. The pain may affect one or both SI joints. The pain may radiate down the leg or in the groin. Occasionally it radiates down the leg and as far as into the foot and May mimic bulged or herniated disc in the lumbar spine. May There is always muscle spasm in one or both buttocks and / or hip muscles.
Problems with the SI joint may make sitting difficult. Pain in one SI joint may cause a person to sit with that buttock tilted up. It is usually uncomfortable to sit flat in a chair.
The SIJ is an anatomical hub of the lumbopelvic complex. It is an important joint with major role in maintaining stability of the spine and pelvis during gait and running as well as many other movements. The stability of this joint is divided in two components structural and functional. The structural stability is based on form closure mechanism. This is when two joint surfaces are tightly fitted and reinforced by the ligaments. The functional stability is called force closure and is based on muscular control of the joint. Both are important in healthy function of lumbopelvic-hip complex movement. It is a cross road of muscles and ligaments connecting the pelvis to the leg as well as hip and pelvic floor from below and spine and ribcage from above. It is also an integral biomechanical and neuromuscular connection of hip movement on the pelvis during swing phase of gait and pelvis movement on the hip during stance. The sacroiliac joints however cannot be considered as stand-alone structures as their participation in movement is integrated into the movement of the whole lumbopelvic-hip complex. The SIJ movement inside the pelvic ring is all inclusive of the pubic symphysis articulation, hip and lumbosacral articulations, which together form functional unit called lumbopelvic-hip complex. The movement dysfunction or pain in one of these articulations has direct influence on others. Therefore clinician familiar with biomechanics of the locomotor system should always interpret the movement dysfunction in SIJ as a sign of malfunction of the whole lumbopelvic-unit rather then its constituents alone. The pain from SIJ can be coming from an SIJ which is a source of a problem or the SIJ which is hurting because of movement dysfunction elsewhere in the whole locomotor system as there are muscular connection to the SIJ from the ribcage to the foot.
What type of movement dysfunction can cause in SI joint pain. The old Osteopathic and Chiropractic theories considered that it is a blocked movement in SIJ, which causes pain. Therefore manipulation would bring relief. Nowadays we know that even thou this type of pain can present itself as an acute condition it are not as common and not as serious as excessive movement in SIJ. The even more serious condition is when SIJ is hypermobile and structural integrity is lost due to damage to the ligaments around it. This could potentially become a very painful disabling and chronic condition.
The most common cause of low back pain in pregnant women is due to SIJ sprain. Hormonal changes during pregnancy stretch out pelvic ligaments and any awkward movement could potentially lead to unlocking of sacroiliac joints beyond physiological barrier causing sprain.
There are multiple, multiple reasons beyond possible to explore in this summary, however few characteristic examples could be expressed. A possible scenario is loss of force closure (muscular support mechanism) due to muscle imbalance of the pelvio-femoral muscle or inhibition phenomena to the same pelvic-hip muscles due to a pinched nerve or a herniated disc. When the disc pain is gone and disc tear is no longer an active source of pain the time during which the body adjusted its movement to protect irritating the nerve by the torn disc has created a movement stereotype in which shorter steps are necessary and the hip muscles were shut off either by pain or by new protective and compensatory stereotype. Thus without proper attention to restoration of normal gait and hip function SIJ can become a weak link in the system whether eventually becoming a source of pain or a driver for dysfunction and pain elsewhere in kinetic chain.
Radiological modalities such as CT scan, MRI or X-ray provide little information of function and dysfunction of SIJ. The diagnosis is based on battery of clinical tests. Seven SIJ specific tests have been proven reliable by research studies on clinical diagnosis of SIJ pain. Lidocane injection may be used occasionally for diagnostic purposes.
Treatment options include specialized physical therapy, chiropractic and osteopathy. Guided steroid injection may be used to shut down the inflammation in order to insure the rehabilitation process.
Surgical treatment is only necessary in less then 1 percent of patients with SI joint pain.
Dr.Kalika has been a participant of all world interdisciplinary congresses on pelvic pain.
While at the congress he met Diane Lee (one of the leaders in SI joint pain research evidence base diagnosis and treatment) who is been at the forefront of research of SIJ pain. Dr.Kalika is certified in ISM (integrated system model approach) – a most comprehensive and evidence based method in diagnosis and treatment of pelvic pain
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