Sacroiliac Joint Pain and Dysfunction

Relief from, and treatment for,
Sacroiliac Joint Pain and Dysfunction.

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The Sacroiliac (SI) joint connects the sacrum and the iliac crest to support the spine and hips. This joint is small and strong, and held together by tough fibrous ligaments. It is subjected to twisting and compression forces during normal activities. Pain in this joint may be the result of injury or inflammation. The pain is similar to sciatica and other back pain issues. It is sometimes difficult to pinpoint the cause of the lower back pain. Treatments for sacroiliac joint pain may also serve as diagnostic tools. Treatments range from very invasive surgeries to non-invasive anti-inflammatory medications and exercise.

What is Sacroiliac Joint Pain?
Sacroiliac pain is often described as pain that is focused in the lower portion of the back and hip. It may radiate out to the buttocks and lower back. In some cases it may travel down the legs or around to the front, in the groin area. Some males may feel pain in the testicles as well.

Pain in the sacroiliac joint may be a result of a subluxation of the joint. This is a partial dislocation. The bones are slightly displaced, which stresses the ligaments that hold it together. It also puts pressure on the surrounding structures.

Inflammation in the joint from trauma, chronic overuse, illness or infection may also cause SI joint pain. This inflammation can be in the ligaments or surrounding tissue. This will cause swelling and put pressure on the nerves. Degenerative arthritis is a common cause of inflammation in this joint.

Anatomy of the Sacroiliac Joint
The Sacroiliac joint is the connection of the lower part of the spine (the sacrum) and the pelvis (at the ilium.) The bones are held together by strong ligaments just like other joints. This is, generally considered, an immovable joint. It is subjected to twisting forces when the hips are moved or the spine twists. It is also under compressive forces when standing or walking, and extreme forces when landing during a jump. The hips are designed to absorb these forces of compression before they reach the spine. This joint is an integral part of this function.

The ligaments may become inflamed causing pain. The bones may be subject to stresses during athletic activities and could fracture, either from repetitive stress or acute trauma. Pressure, from swelling of the tissues in and around the joint, may cause pain impulses from the spinal nerves in the area. Nerves leave the spinal column and travel to the legs and outwardly to the muscles of the hips. If these nerves are compressed they will cause pain, and possible limitation of function. Pain is often felt in one side or the other, depending on which side is affected. It can affect both sides at once, although more commonly, it will affect one side first and then, due to compensation, the other side may become involved.

What causes Sacroiliac Joint Pain?
Sacroiliac Joint Pain may be the result of many injuries or disease processes. Arthritis, ankylosing spondylitis, postural problems, trauma to the hip, improper lifting, or chronic dynamic bending and twisting (such as those involved in sports activities,) are all possible causes of pain in this joint. Stress fractures from chronic overuse or dislocations from acute trauma, such as a car accident, may cause pain as well.

Research is still out on whether the pain comes from the joint surfaces or from the ligaments that hold the joint together. This area is rich in nerve endings, and therefore any inflammation or injury to this area results in pain. The pain may radiate because the nerves that travel through the joint area continue on to the legs and hips.

Signs and Symptoms
Pain in the lower back, often radiating out to the buttocks or back of the thigh, may be a sign of Sacroiliac joint involvement. The pain may increase during movement or weight bearing on the affected side. Sneezing, coughing, rolling over in bed and stooping may increase the pain. Pain may radiate to the groin area, sometimes resembling a groin strain or trauma to the testicles. A feeling that the leg, or hip, is rotated may also accompany this condition.

Inflammation in the joint will cause additional pain and inflammation, creating an unpleasant cycle. Numbness and a cold feeling may also accompany this condition. Stiffness in the lower back may be experienced as well. In severe cases, weakness and functional limitations may result, due to the nerve involvement. If a fracture is the cause of the pain a grinding sensation in the joint or a total inability to bear weight may be experienced.

Treatment
Initially, ice over the painful area and rest will help alleviate the pain. Non-steroidal anti-inflammatory medications will help as well. Later, as part of ongoing treatment, deep heat may provide temporary relief of pain. It may also serve to pre-warm the area before activities.

Sacroiliac joint injections are often used to treat pain in this area. The injection contains a pain relieving medication and can be used to rule out, or rule in, back pain from a sacroiliac joint condition. Cortisone injections may help reduce inflammation in the joint as well.

Bipolar Radiofrequency Neurotomy is another possible treatment for SI joint pain. This involves placing two needles into the joint area and, using an electrical current, creating a lesion in the pain transmitting nerves.

Both of these methods are invasive techniques. Many people prefer non-invasive treatments such as anti-inflammatory medications and rest. Chiropractic manipulation of the SI joint may help, especially when the pain is a result of the joint being displaced. Exercise, specifically stretching, can be used to manipulate this area and reduce pain and the underlying causes. Resting the joint and discontinuing activities that cause pain, until the inflammation and pain subsides will help prevent the development of chronic pain.

In very rare cases, surgical interventions may be needed to correct the underlying problems causing the pain.

Prevention
Prevention of sacroiliac joint pain should be the goal. Once the pain starts it requires intervention to reverse it.

• It is important to warm-up properly before beginning any activity. To prevent SI joint pain it is very important to warm-up the muscles surrounding the hips before weight bearing and high-impact activities. This will ensure adequate shock absorption and strong support for the joints.
• Identifying activities that cause pain will help in preventing future discomfort. Avoiding those activities that immediately cause pain, or eventually lead to pain, may also help identify the causes of the pain.
• Exercises that help strengthen the muscles around the hips will provide support for the sacroiliac joint. Stronger muscles, tendons and ligaments help hold a joint together and prevent subluxations and dislocations. Stronger muscles also provide additional shock absorption and transfer less of the impact to the spine.
• Stretching the muscles will also help prevent chronic overuse conditions from causing pain and inflammation in the joint. It will also prevent an uneven pull on the joint leading to additional complications. Stretches for the piriformis muscle, among others, will help prevent SI joint dysfunction.

Stretching is one of the most under-utilized techniques for improving athletic performance, preventing sports injury and properly rehabilitating sprain and strain injury. Don't make the mistake of thinking that something as simple as stretching won't be effective.

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• Allowing adequate rest to allow full recovery from the day to day damage this joint is subjected to, from simply walking or running, will help ensure the health of the joint. Avoid overtraining of the muscles in this area. Recovery and repair happens during rest times.
• Maintaining the proper posture will help ensure SI joint health. Stress on the muscles along the spine due to poor posture can lead to SI joint pain. Misalignment of the spine from poor posture may also cause pain in the sacroiliac region as well.
• Use proper lifting form to prevent injury to the muscles and intervertebral discs in the back. Injury to these structures increases the chance of developing pain in the sacroiliac joint.

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Article by Brad Walker. Brad is a leading stretching and
sports injury consultant with nearly 20 years experience
in the health and fitness industry. For more articles on
stretching, flexibility and sports injury, please visit
The Stretching Institute.
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Special Internet-Only Bonus! If yours is one of the next 200 orders placed through this website, we'll throw in a complete athletic preparation package, including a Special Bonus Stretching, Flexibility and Sports Injury Package worth over $300.00 for free when you order today!
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