The sacroiliac joint is a joint between the sacrum and the ilium, or pelvic bone. The 2 sides of the sacroiliac joint normally work together. If 1 side becomes stiff, they will not move together and this causes pain or muscle stiffness in the area. Pain is often made worse with walking and bending activities. It is also possible that 1 side may become too loose (lax) as well, resulting in SIJ dysfunction. This may occur during the menstrual cycle or pregnancy due to hormonal changes that cause the ligaments to become more lax.
SIJ dysfunction can occur with injury, such as when a person falls and lands on 1 side of the body and alters the position of the joint, or when an athlete overtrains. Muscle imbalances and hip problems, such as hypermobility or dysplasia, may also lead to SIJ dysfunction. Sacroiliac pain is also related to some types of arthritis, such as ankylosing spondylitis, an inflammatory process most often affecting the lower back, which may cause the vertebrae to fuse.
People with SIJ dysfunction may experience:
- Pain that may be sharp, stabbing or dull, localised to 1 side of the pelvis/low back, groin, or tailbone.
- Pain that may radiate down to the knee.
- Pain with movements, such as standing up from a sitting position, turning in bed, or bending/twisting.
- Muscle tightness and tenderness in the hip/buttock region.
- Pain with walking, standing and prolonged sitting.
- Pain that is worse when standing and walking, and eases when sitting or lying down.
Alignment of the spine is dependent on the function of the SI joints. When an SI joint is improperly positioned, it is possible that the sacrum is also out of its normal position. When this happens, the lower lumbar vertebrae can subluxate, leading to a greater chance of an abnormal lumbar curve and appearing as conditions like mild scoliosis and hyper- or hypo-lordosis.
Treatment may comprise of:
Chiropractic Adjustments may be used to restore alignment and function.
Manual therapy Often, manual therapy includes soft tissue release or massage for tight and sore muscle groups. Manual therapy and muscle energy techniques are used to correct pelvic/SIJ alignment.
Flexibility exercises Stretching exercises may be prescribed to improve the flexibility of tight muscles. They may also help to improve movement in the spine and lower extremities and help decrease stress at the sacroiliac joint during daily activities.
Strengthening exercises Strengthening helps to improve the stability of the sacroiliac and spinal joints, which helps to reduce ligament strain and pain. These exercises are focused on weak muscles, including the lower abdominal, pelvic floor, and buttocks muscles.
Modalities Hot and cold treatments are often prescribed to loosen up tight muscles prior to treatment, or to alleviate pain following exercise.
Education How you move and use your body for daily work and other activities can contribute to your SIJ dysfunction and pain. Your Chiropractor will teach you how to improve your movements or body mechanics based on your specific daily activities. The Chiropractor may also make recommendations to improve activities, such as sitting, or lifting and carrying objects.
Bracing Your Chiropractor may also recommend wearing a sacroiliac belt, designed to provide support to the sacroiliac joints. It is used to provide stability during daily activities as your strength returns, and flexibility improves. This modality is especially helpful for pregnant women.
Activity modification advice A gradual return to activity program.
Sacroiliac joint dysfunction does have a tendency to return. The main reason it is thought to recur is due to insufficient rehabilitation. your chiropractor may recommend specific stretching or strengthening exercises, combined with regular chiropractic adjustments, to balance the alignment of your pelvis in the long term.