Stubborn SIJ: a potential cause of your back pain
You’ve probably heard about the SIJ before. But did you know the SIJ, or sacroiliac joint, could be part of the cause behind your back pain?
What is the SIJ?
The SIJ provides the connection between the spine and the lower limbs. Our bodies have two SIJ’s, both attaching the left or right ilia (part of the hip) to the left or right sacrum (tailbone) respectively [1,2]. Primarily these joints play an integral role in transmitting force between the upper and lower body during movements such as walking, running, bending and jumping [1].
What is SIJ Dysfunction?
Pain and irritation of the SIJ is commonly referred to as sacroiliac dysfunction [3]. The SIJ’s are a primary cause of back pain in up to 30% of back pain presentations [1]. Due to the joint’s role in lumbopelvic stability, SIJ dysfunction can refer pain into the groin, buttock and thigh region [2,4].
Presentation
Pain below the level of L5 (bottom of the lumbar spine) [1,2]
Tenderness in the PSIS region [2,4,5]
Pain when rising from a chair [6]
Problems rolling in bed [1]
Difficulty with stairs [1]
Potential relief when lying supine [6]
Aetiology
Mechanical imbalance between the muscles that bring the thigh forward (hip flexors) and the muscles that bring the thigh backwards (hip extensors) [2]
Mechanical imbalance between the muscles that rotate the thigh inwards in the hip socket (internal rotators) and outwards (external rotators) [2]
Leg length discrepancies [2,4]
Abnormalities in gait and movement patterns [2,4]
Scoliosis [4]
Heavy Physical Exertion [4]
Trauma to the hip or low back region [4]
Recent pregnancy [4]
How Can Physiotherapy Help?
The first step will be for the physio to conduct an appropriate assessment to determine where the pain is derived from [2,3].If it is indeed SIJ related several treatment options may be utilised to help reduce pain, disability and improve stability around the pelvic region [5]. Potential treatment options include but are not limited to;
1.Exercise Therapy
Exercise therapy is an integral component of recovery from SIJ dysfunction. This consists of both strengthening and stretching various muscle groups. Your physio will provide exercises to help strengthen weak muscles and address any muscle imbalances [2,5]. This plays a crucial role in restoring correct movement mechanics and aids in your body’s efficiency in transferring force through the hip and spine [2]. A primary focus of this treatment is to work on strengthening the core, gluteal and hip muscles whilst stretching muscles that have become tight and sore from overuse or guarding [2,4,5,7].
2.Manual Therapy
Manual therapy is an umbrella term for any hands-on treatment such as joint manipulations, mobilisations and soft tissue massage [2]. Stiffness and decreased joint range of motion, whether it be from your joints or surrounding musculature, can impair the ability to transmit force between the upper and lower body [2,5]. Altered or impaired force transmission can place increased strain on certain structures like your SIJ. Therefore, overall these therapies help address these movement limitations to play a role in decreasing the strain on your SIJ; to decrease your pain and improve your function [2,5].
3.Motor Control Retraining
Motor control refers to the ability to recruit muscles to effectively coordinate movement. This is specifically the case around the lumbopelvic (core) muscles, which are responsible for the control and coordination of movement between the spine and pelvis [2]. After an injury to the SIJ or low back, the recruitment of lumbopelvic muscles becomes impaired [7]. Consequently, we lose the stability between the spine and the pelvis thus placing more stress on the SIJ joint [7]. Therefore, not only is it important to strengthen these muscles but it is equally important to retrain the body’s ability to synchronise correct movement patterns [7]. Various techniques can be used to achieve this such as training lumbopelvic stability [2,5] and taping to help provide feedback for correcting movement patterns [4].
If you have any questions regarding SIJ or back pain, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.
References
Chien GCC, Grandhe RP, Fortin JD. Sacroiliac Joint Dysfunction. In: Treatment of Chronic Pain Conditions. New York, NY: Springer New York; 2017:177-181. doi:10.1007/978-1-4939-6976-0_49
Brukner P. Brukner and Kahn’s Clinical Sports Medicine. 4th editio. McGraw-Hill Australia; 2012.
Polly DW, Swofford J, Whang PG, et al. Two-Year Outcomes from a Randomized Controlled Trial of Minimally Invasive Sacroiliac Joint Fusion vs. Non-Surgical Management for Sacroiliac Joint Dysfunction. Int J Spine Surg. 2016;10:28. doi:10.14444/3028
Al-subahi M, Alayat M, Alshehri MA, et al. The effectiveness of physiotherapy interventions for sacroiliac joint dysfunction: a systematic review. J Phys Ther Sci. 2017;29(9):1689-1694. doi:10.1589/jpts.29.168
Nejati P, Safarcherati A, Karimi F. Effectiveness of Exercise Therapy and Manipulation on Sacroiliac Joint Dysfunction: A Randomized Controlled Trial. Pain Physician. 2019;22(1):53-61. http://www.ncbi.nlm.nih.gov/pubmed/30700068. Accessed February 10, 2019.
Ou-Yang DC, York PJ, Kleck CJ, Patel V V. Diagnosis and Management of Sacroiliac Joint Dysfunction. J Bone Jt Surg. 2017;99(23):2027-2036. doi:10.2106/JBJS.17.00245
Vleeming A, Schuenke MD, Masi AT, Carreiro JE, Danneels L, Willard FH. The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat. 2012;221(6):537-567. doi:10.1111/j.1469-7580.2012.01564.x