Sacroiliac SI Joint: Dysfunction, Pain, Treatment, and Therapy
There is a great deal of depth and nuance to the sport of running, despite its simple nature. Almost the entire body is involved when running; each bone, muscle, and joint are responsible for handling some aspect of the running process. Some provide the mechanical movements, some bear the weight of the body, and some absorb shock from impact. It is because of the complicated nature of this exercise that running has so many positive health benefits, but an unfortunate downside to this is that there is a constant risk of injury. If any part of this interconnected process is disrupted, major injury can occur that can prevent your ability to run.
Although running injuries can occur in your feet, shins, knees, and thighs, the focus of this article is on the damage running can do to your hips. In particular, the sacroiliac joint found on your pelvis can experience damage causing it to work improperly. SI joint pain can be debilitating, but if you are armed with the proper knowledge, you can recover quickly from injury and resume running normally. For tips on how to identify, treat, and prevent sacroiliac dysfunction, read below.
Sacroiliac SI joint dysfunction is a general term. It commonly refers to sacroiliac joint pain due to an abnormal excess of motion, or lack thereof, in the joint area. This typically results in inflammation, pain, reduced mobility, neurological disorders, and other potentially debilitating problems. Some other names for this condition include:
- sacroiliac syndrome
- sacroiliac dysfunction
- sacroiliac joint syndrome
- sacroiliac joint disease
- SI joint pain
- sacroiliac dysfunction and instability
The sacroiliac joint connects the pelvis (iliac crest) with the sacrum (the triangular bone at the bottom of the spine). This joint has the role of stabilizing, transferring, and absorbing the impact forces, protecting the spine. A network of ligaments and muscles keep them all together and allows a normal motion of the sacroiliac joint of around 2-4 mm in any direction. Such ligaments are more flexible in women because they need a greater level of flexibility in their hips so that they can give birth. As a result, women are at a higher risk of developing sacroiliac joint dysfunction. If the joint itself, the surrounding ligaments, or other proximal soft tissues become inflamed or damaged, then sacroiliac joint dysfunction occurs, reducing mobility and causing pain. The ligaments of the sacroiliac joint include:
- Anterior sacroiliac ligament
- Interosseous sacroiliac ligament
- Posterior sacroiliac ligament
- Sacrotuberous ligament
- Sacrospinous ligament
Fifty-eight percent of sacroiliac joint dysfunction cases resulted from a forceful torsion or high impacts incidents such as a car crash or hard fall. In more severe cases, the overly stretched ligaments will often result in an incongruent or asymmetrical locking/catching of the hip bones. In these cases, one bone may be tilted anteriorly while the other is tilted posteriorly, causing debilitating pain. Other potential causes for SI joint pain are:
- Hormone imbalances: Any kind of hormonal imbalance can cause ligamentous laxity, which can result in sacroiliac joint dysfunction by weakening the sacroiliac structure. Pregnancy, menopause, hormone replacement therapy (HRT), steroid cycles, and the like are some potential causes of hormone imbalances.
- Pregnancy: This is an especially important and high-risk period, as it affects the levels of the protein hormone relaxin. This is what allows the female pelvis to distend the birthing canal. Sometimes, after giving birth to a large baby or after extended labor, the stretched ligaments may not return completely to their initial tautness. This can cause chronic sacroiliac joint pain, instability, and sacroiliac joint dysfunction.
- Biomechanical factors: Bodily incongruencies such as bone or muscle length irregularities can favor the development of sacroiliac joint dysfunction. This is due to an altered gait pattern and increased force of stress on the SI joint and other associated structures. Consequently, leg or arm length inequality relating to the bones or muscles can seriously favor the development of sacroiliac syndrome.
- Bone disease: A history of bone-related diseases such as scoliosis, osteoarthritis, or polio can also trigger sacroiliac dysfunction.
- Improper footwear: Poor fitting or worn-out shoes can cause an array of health problems, including sacroiliac joint disease. Consider experimenting with low heel-to-drop or minimalistic/barefoot shoes. Give your feet some time to adapt to new footwear before participating in sports activity, as the foot will have to absorb a larger amount of shock in such shoes. This will eventually become beneficial in the long run. Contrary to popular belief, more cushioning is not always the best option for foot health or for general health.
- Past surgeries: A history of surgery or other invasive procedures regarding the spine, such as spinal fusions, can contribute to the formation of sacroiliac joint dysfunction. In fact, 75% of post-lumbar fusion patients exhibit SI joint degeneration within 5 years of surgery, making this an especially concerning risk factor.
Sacroiliac joint dysfunction cases
SI joint dysfunction can take a few different forms. These forms vary in terms of cause, levels of severity, and methods of treatment. When obtaining a diagnosis from a doctor or medical professional, they will determine which of these forms your injury has taken, if you are in fact dealing with sacroiliac joint syndrome.
Hypermobility (excess joint movement)
Sacroiliac joint dysfunction, instability or insufficiency refers to a condition where the lax ligaments are unable to support and sustain the joint. This can be due to weakness, injury, tearing or a sprained ligament tissue, resulting in joint hypermobility. As a result, this condition is categorized as an extra-articular dysfunction because the problem does not derive from the joint itself, but from the surrounding ligaments. Rarely does the joint indicate degenerative changes such as arthritis. In most cases, the sacroiliac joint appears to be healthy and normal until a considerable period of time has passed with the condition left untreated.
Hypomobility (insufficient joint mobility)
Hypomobility is closely related to hypermobility; often times, both conditions occur simultaneously. What this means is that the affected joint may exhibit excessive mobility in some directions, while being incapable of moving in other directions. In 2015, Dr. Jerry Hesch developed a treatment method and created a distinction between treatable and non-treatable hypomobility:
1. Non-treatable hypermobile joint (ankylosed)
The motion limitation is non-mutable despite rehabilitation program. Etiology indicates aging, disease, past trauma with intra-articular bleeding and recalcitrant scar tissue formation, and other similar conditions.
2. Treatable hypomobile joint
Such rigid hypomobility cases are clinically neglected to a degree but typically respond well to brief intervention, usually involving both a positional and a reflex muscular interplay.
This is a specific form of sacroiliac joint disease referring to an intra-articular disorder. It can appear due to age, degenerative joint disease, ankylosing spondylitis, rheumatoid arthritis, or an infection. This type of hypomobility is different from standard cases, as it is usually caused by other biomechanical factors as opposed to trauma. The distinction is due to the differences in treatment and prevention methods for the pathological variety over standard cases.
The following are symptoms commonly experienced when dealing with sacroiliac joint syndrome. If you experience one or more of these sensations, it is recommended that you visit a medical professional in order to obtain a proper diagnosis. Different forms of this injury will exhibit different symptoms, so it is possible that two individuals are experiencing SI joint disease while exhibiting completely different symptoms. It is also possible that some of these symptoms are indicative of other injuries, which is why obtaining a proper diagnosis from a qualified individual is important. For more information on potential injuries with similar symptoms, consult the False Positives section of this article.
- Acute or dull pain, especially with certain movements
- Pain in the buttocks, lower back (below L5), hip, groin, and legs
- Leg instability and balance issues
- Disturbed sitting and standing patterns
- Increased pain during menstruation
- Increased urinary frequency or blood in urine
- Numbness, tingling, “pins and needles” sensation
- Weakness and fatigue
- Insomnia and depression
One of the many reasons why it is recommended to obtain a thorough diagnostic from a medical professional is to determine the exact cause of your symptoms and to rule out any other conditions that could be causing them. Some conditions may take a form similar to SI joint dysfunction, but won’t respond to the same methods of treatment. The danger of falsely diagnosing these ailments is a waste of time and money, as well as potentially worsening the condition and causing permanent bodily damage. These false positives are injuries similar to sacroiliac joint syndrome that can be easily confused with it.
- Tailbone injury: The tailbone or coccyx is a part of the pelvis, located on the lower back. Injuries sustained to this part of your hips can cause dull pain when standing or sitting, difficulty urinating, and fatigue. These shared symptoms are due to the fact that coccyx injury affects your pelvis in a similar manner to sacroiliac joint pain. If your hip pain came as a result of sustaining trauma on your lower back or butt, you may be dealing with a tailbone injury instead of SI joint syndrome.
- Groin strain: Your pelvic area is made up of many bones, joints, and cartilage. This means that pain in that general area, as well as other symptoms such as imbalances, numbness or fatigue, can be caused by muscle strain as well as joint dysfunction. Something that differentiates a strain in your groin muscles from sacroiliac joint discrepancies is how you can relieve the pain: muscle strain can be relieved with massage and TENS therapy, whereas joint pain will require chiropractic treatment or injections.
- Hip fracture: While it is possible to experience strain or dysfunction in your hip joints, there is also the possibility that pain in the exact same area is caused by a fracture in the bones connected by the joint instead. A stress fracture in your hip bones could occur in an identical position and present similar symptoms such as instability, pain, weakness, and nerve damage. However, stress fractures will often require much more intensive treatment methods, such as surgery.
- Hip bursitis: If you are experiencing stiffness and limited mobility in your hip, coupled with weakness and flares of pain, the possible culprit may be bursitis. This is a condition that can affect any joint in your body that contains bursa, a fluid used to reduce friction during movement. If it occurs in your hip joints, you will experience similar symptoms to sacroiliac joint dysfunction. However, this condition can be differentiated based on the spot where pain and stiffness are felt; bursitis affects the outside of the hip, whereas SI joint dysfunction affects the inner pelvis.
In the event that you fail to properly treat sacroiliac joint disease, more serious injuries may occur. It is precisely due to the risk of developing these conditions that you should obtain a proper diagnosis from a medical professional as soon as possible. These conditions can be very debilitating: painful at best, and permanently damaging to your body at worst.
- Sacroiliitis: The inflammation of the sacroiliac joint itself, known as sacroiliitis, may or may not be a consequence of sacroiliac joint dysfunction. In theory, this often false-positive disease is less severe than sacroiliac joint dysfunction and may be easier to treat. However, the possibility is still present for this injury to come about from failure to properly treat SI joint injury. Symptoms of Sacroiliitis include pain in the upper leg and lower back, buttock and hip pain, fever, swelling, and stiffness.
- Pelvic floor dysfunction: This condition occurs whenever there’s an impairment to the sacroiliac joint, hip joints, lower back or coccyx. It also occurs whenever the pelvic floor descends under the pubococcygeal line. The injury affects up to 50% of women, with obesity, menopause, pregnancy, and childbirth as risk factors. Symptoms include pelvic pain, stiffness, dyspareunia, bladder/bowel incontinence, and gross organ protrusion.
- Pelvic floor muscle disorder: With this disease, the pelvic floor muscles remain contracted, tense, or clenched involuntarily. The specific biological pathways for this malady aren’t well known, but it’s commonly accepted that it’s a result of a natural inclination or learned behavior to stress, pain, trauma, or any combination of these. Chronic pain from sacroiliac joint disorder can train your body to exhibit these behaviors, potentially causing this condition.
- Psoriatic arthritis: This form of arthritis is a chronic inflammatory condition which afflicts people with psoriasis, an autoimmune disease. Genetic predisposition plays a huge factor in the development of this injury alongside obesity and lifestyle. Psoriatic arthritis occurs in roughly 30% of people with psoriasis. Heredity plays a part in the development of this disease as well, with the HLA-B27 genotype found in 40-50% of individuals with psoriatic arthritis. Symptoms include the extreme swelling of extremities, nails changing shape or falling, and color or texture changes to the skin (e.g. red itchy scaly plaques).
Sacroiliac joint dysfunction can be difficult to correctly diagnose because the symptoms mimic other common bone conditions. This is why it is so important to obtain a proper diagnosis if you suspect that you are injured in this way. The first few steps when diagnosing this condition include studying the patient’s medical history through an interview, coupled with a hands-on physical examination.
After assessing the patient through palpation, a series of provocative tests are performed for further confirmation. As a rule of thumb, at least 3 out of 5 tests should be positive in order to confirm the presence of SI joint syndrome. These tests may also be performed after an injection, as mentioned in the next section.
- Distraction: In this test, a tensile force is being applied to the anterior aspect of the sacroiliac joint. The patient lies supine with their forearm under their lower back to maintain lordosis. A pillow is put under the patient’s knees. Then, the examiner places his hands on the anterior and medial parts of the patient’s left and right anterior superior iliac spine and pushes downwards. The examiner may cross his hands for a better downward push.
- Thigh Thrust: Anteroposterior stress is applied to the SI joint during this next test. The patient lies supine with the flexed leg of the affected hip side planted on the mat while forming a 90-degree angle between his torso and thigh. The examiner stabilizes the pelvis at the opposite anterior superior iliac spine with his hand. Then, they generate increasing force through the axis of the femur.
- FABER: An acronym for Flexion, ABduction, and External Rotation, Faber involves tensile force being applied to the anterior part of the SI joint. The patient lies supine with the affected side leg crossed over the opposite thigh. The examiner then stabilizes the pelvis at the opposite anterior superior iliac spine with his hand. Then, they apply gentle downward force on the knee of the crossed leg while amplifying the flexion, abduction, and external rotation of the hip.
- Compression: Compression force is applied to the SI joints for this test. The patient lays sideways on the affected side, with a pillow placed between their knees while they face away from the examiner. The examiner then applies a gradual downward force on the anterior aspect of the lateral ilium, just between the iliac crest and greater trochanter.
- Gaenslen’s: For this test, a torsional force is applied to the SI joints. The patient lies supine close to the edge of the table while letting his non-affected leg hang off the table from the knee. The other leg is flexed with the foot planted on the table. The examiner stabilizes the leg by placing a hand on the flexed knee, thus keeping the ilium in a slightly posterior position throughout the maneuver.
- Fortin finger test: This test involves the patient indicating twice the painful region on their body. It can be performed both while sitting or standing. The patient will use their finger to localize the exact location of the pain. If the patient identifies twice the pain region within 1 cm (0.4 in.) of the inferomedial posterior superior iliac spine, then the test results positive for sacroiliac joint dysfunction.
After these initial steps, more comprehensive tests may be required. One such procedure is an injection of a numbing agent into the patient’s sacroiliac joint, which can serve two purposes: diagnosing the source of pain, and providing temporary relief to the patient. When diagnosing through injection, another physical examination is performed while their joint is numbed. If the patient no longer feels pain when performing the same physical movements that caused pain before the injection, then it is decided that they are in fact experiencing sacroiliac joint disease.
After the interview, physical examination, and injection stages of a diagnosis, your doctor may decide to perform imaging scans of your hip. This can be used to rule out any other conditions or to determine how severe your injury is. Some common imaging technology used to perform these scans include:
- X-rays: Radiographs, also known as X-rays, involve bombarding the body with electromagnetic high energy waves that have very short wavelengths. This allows the waves to pass through skin and tissue, forming a photographic image of what’s inside the body. X-rays are able to capture details about the bones of a specific area, but the technology isn’t advanced enough to catch much more detail.
- CT scan: A Computed Tomography or Computer Assisted Tomography scan is a cross-sectional image captured from different angles using multiple X-rays. It allows a better image to be shown of the scanned body part and can capture more detail than ordinary X-ray scans.
- Magnetic resonance imaging (MRI): This is a complex imaging technique in which radio waves, field gradients, and strong magnetic fields combine to create a detailed anatomic photo of the examined body part. The images created by MRI scans are highly detailed, providing a 360-degree view of the body and capturing the detail of the bone and tissue in a way that can’t be done with X-rays or CT scans.
These are some more complex and less conventional methods of scanning your body during a diagnosis. It is less common for a medical professional to perform these scans, but they may be necessary in particular cases.
- Fluoroscopy: Also commonly referred to as a nuclear bone scan, this is a more invasive imaging procedure than standard X-rays due to its use of needles. During fluoroscopy, an injection containing a nuclear tracer is made into the patient’s veins. This tracer travels through the bloodstream and eventually into the bones, which then makes it easier to see detailed images of these body parts during a normal X-ray scan. Fluoroscopy is also sometimes used when injecting a numbing agent during previous stages of a diagnosis.
- SPECT: If the aforementioned imaging tests do not reveal sufficient information, then a more complex nuclear-based imaging technique will be deployed. Short for single-photon emission computed tomography, SPECT is a nuclear tomographic imaging method which uses gamma rays. A solution of gamma-emitting radioisotope known as a radionuclide is delivered intravenously, which then binds to specific tissues and delivers true 3D cross-sectional images.
Generally, the treatment stretches and exercises consist of increasing hypomobility while reducing the motion in the hypermobile direction. In short terms, a compensatory strengthening program of the joint and ligaments for improving stability.
In the case of a sacroiliac joint dysfunction crisis, the P.R.I.C.E. method is suitable for immediate pain relief. This is a common procedure that can be performed immediately after being injured and can provide quick relief to a wide range of running injuries.
- Protection: This means refraining from strenuous physical activities and protecting the affected region from additional trauma. Immediately stop all activity in order to avoid causing further damage to the affected joint. Always keep this principle in mind when planning your behavioral guided program. Pay attention to the way you sleep, walk, drive etc.
- Rest: This is fairly self-explanatory. Getting 7-8 hours of sleep every day is the bare minimum and will allow your body to focus and heal the affected area. It’s a general principle in which the patient seeks to better his lifestyle towards a more efficient recuperation.
- Ice: The proper usage of ice can be a very useful and fast method of relieving pain, lack of mobility, and general discomfort. Applying an ice pack to the painful area for approximately 20 minutes every hour can help by both reducing the inflammation and numbing the pain nerves. If you don’t have access to a medical ice pack, some alternatives include a bag of frozen vegetables or wrap a dozen ice cubes in a towel.
- Compression: Using some form of compression can be very helpful in stabilizing the hip area, keeping inflammation down, and relieving stress from pressure. Search for supports, braces, belts and other types of orthopedic devices that could benefit you greatly. An alternative to these devices is compression tape, also commonly known as KT tape.
- Elevation: Symptoms may be reduced when the patient sits or lays in convenient positions, elevating the affected body part. Speak to a doctor or chiropractor about your specific condition and try out a few different resting positions until you find a couple of comfortable ones that will allow you to continue your day-to-day life.
In conjunction with PRICE, the next most effective course of action when treating SI joint dysfunction is medicine. Many milder forms of medicine will ease the symptoms, allowing your body to recover naturally. However, in the event that your joint injury is more severe and requires more intensive treatment, there are stronger medications you can administer that will aid in your recovery.
This is an acronym that stands for Non-Steroidal Anti-Inflammatory Drugs. They are over-the-counter anti-inflammatory medications which can relieve many minor symptoms, such as pain and swelling. Popular NSAIDs include:
- Ibuprofen: This is one of the most popular forms of NSAIDs. These drugs should be taken after a fiber-rich meal so as to avoid fairly rare side-effects such as gastrointestinal bleeding. Furthermore, carefully read the package insert if any other special instructions need to be followed. Refrain from taking it if you’re suffering from asthma, heart conditions, kidney damage, or liver damage. It is commonly found under the brand names of Nurofen, Advil, Brufen, and Motrin.
- Naproxen: Drugs with this as their primary active ingredient should also be administered after a fiber-rich meal; this will reduce the possibility of stomach ulcers, although this is rare. Usually, a proton-pump inhibitor auxiliary drug is prescribed alongside Naproxen for patients with past health conditions that could put them at risk. Carefully inspect the package insert and avoid taking any if you have had duodenal ulcers, gastric ulcers or similar conditions. It is commonly sold under the brand names of Naprelan, Aleve, Naprosyn, and Anaprox.
- Methyl salicylate-based analgesics: These take the form of heat rub gels, also known as wintergreen or wintergreen oil. These are types of an organic ester, meaning they are naturally produced by many plants such as wintergreens. The gel is synthetically produced and intended for topical use. Avoid ingesting this medicine and apply a moderate quantity over the skin of the affected area. Other names for this substance include Betula oil, salicylic acid, methyl ester, or methyl 2-hydroxybenzoate.
- Selective COX-2 inhibitors: Another type of NSAID similar to Ibuprofen or Naproxen, these inhibitors directly target the cyclooxygenase-2 enzyme. This is the enzyme accountable for inflammation and pain, which can also reduce the risk of peptic ulceration when inhibited through this medication. This drug is commonly sold under the generic name of Celecoxib. Thoroughly read the package insert before taking, as these chemicals increase complications in patients with heart problems or under treatment for cancer.
In cases where damage to the sacroiliac joint is more extreme, some steroid-based medications may be required for a complete recovery. These will assist greatly in recovering any muscle, tissue or bone that has deteriorated, but some side effects may occur in the process. Be sure to consult your doctor before trying these, as they require a prescription in order to legally obtain them. Some common forms of corticosteroids include:
- Cortisone: This is a steroid hormone produced normally by the adrenal gland in response to stress. In its artificial form, cortisone can be administered via multiple routes: intravenously, or through the bloodstream via IV; orally, or taken in a pill; intraarticularly, or inserted directly into the affected joint; and transcutaneously, or absorbed by the skin with a patch. Cortisone suppresses the immune system, which reduces inflammation and pain. Long-term use, especially when taken orally, can trigger the following side-effects: diabetes, mellitus, hyperglycemia, drastic changes in insulin levels, osteoporosis, mood swings, amenorrhoea, cataracts, Cushing’s syndrome, glaucoma, and so on. Speak to your doctor to see if you’re fit for cortisone treatment.
- Growth Hormone: Called GH for short, it is also known as somatotropin or human growth hormone. GH is a peptide hormone that stimulates cell reproduction, regeneration and tissue growth in humans and other animals. Studies have shown that GH can aid significantly in the reconstruction and tensile strengthening of bones. Ask your doctor if you’re fit for a short GH cycle, but be aware of the side effects from administration. These side effects include hormone imbalances, mood swings, raised blood pressure, and potentially hair loss in men.
- Selective androgen receptor modulators: SARMs, also known as partial androgens, are a novel class of androgen receptor ligands. These work by simulating the effects of androgenic substances such as anabolic steroids, but with reduced side-effects such as virilization, heightened cholesterol levels, and damage to the testes, prostate, or liver. Ask your doctor to see if these new-gen drugs may benefit you.
- TB-500: This is another new-gen peptide drug which regulates the cell-building protein called Actin, resulting in strong anti-inflammatory proprieties. TB-500 contains a fraction of the human protein called thymosin beta-4, made up of 43 amino acids encoded by the TMSB4X gene. It’s has been proven to aid in tissue regeneration of muscles, heart, skin, and corneas, while also drastically lowering inflammation. The TB-500 molecule has a very low molecular weight, allowing it to be injected anywhere and in many ways: subcutaneously, intramuscularly, and intravenously. This is because it travels fast and doesn’t bind to the extracellular matrix.
Narcotic painkillers such as opiates and opioids can provide instant long-lasting pain relief. However, these painkillers can also cause severe addiction, so it is important to only administer them when you are in debilitating pain, such as immediately after surgery. Talk to your doctor before taking such powerful drugs, as you will most likely need a prescription in order to legally obtain them, and be careful not to overdose or prolong the recommended administration period. Some common opioids include morphine, oxycodone, and codeine.
In many minor cases of hip joint pain, simply following the RICE protocol while supplementing with NSAIDs should treat your condition within a week. However, if you are still experiencing pain after prolonged rest and ice treatment, the next step in treatment is physical therapy. These procedures will require the assistance of a medical professional, such as a doctor or physical therapist.
- Chiropractic treatment: Adjustments to your back and spine by a chiropractor can help relieve pain. He’ll use techniques that move your muscles and joints, which can correct your posture and gait as well as relieving pain.
- Radiofrequency neurotomy or radiofrequency ablation (RFA): This technology uses medium frequency alternating current between 350 kHz and 500 kHz to scar and destroy the nerve endings that transmit pain to the brain. A lateral branch neurotomy (ablation) provokes small heat lesions on the nerve endings and is usually paired with local anesthetics or conscious sedation anesthesia. Both the medial and lateral nerve branches pose little risk towards such invasive interventions as they’re not that important, and the loss of these nerves has been proven to be safe. The success rate for pain relief is somewhere between 30% and 50%. If successful, patients undergoing such treatment will experience pain relief for at least 2 years, after which the nerve endings regenerate.
- Prolotherapy or regenerative injection therapy: This is an alternative medicine treatment that seeks to relieve pain and ligament laxity by injecting an irritant solution intraarticularly, or directly into the joint. The compounds used are usually saline, sugar, polyol substances, or artificial numbing solutions. Side-effects are rare, but some potential ones include lightheadedness, allergic reactions, bruising, infection, nerve damage, back and neck pain, and disc injury.
- Nerve treatment: For this procedure, the nerve endings that send pain signals to the brain are permanently damaged. This method is rarely deployed due to the fact that it may cause unwanted numbness and other neurological dysfunctions. However, in extreme cases where pain cannot be otherwise relieved, this method is very effective at relieving said pain.
- Water therapy: In many cases, water therapy provides immediate symptom relief. This is due to the buoyancy effect of the water, which can relieve joint and ligament pressure. Standard water treatment involves performing basic exercises in a heated pool or tub. This can be performed at a physical therapy clinic or at home with a special therapeutic tub.
- Orthopedic devices: Supports, braces, belts, and other non-invasive devices such as these may prove extremely beneficiary: especially custom-made orthopedics. More commonly, a wide belt called a sacroiliac belt is the best orthopedic device for relieving SI joint dysfunction. This belt works by wrapping around the hips in order to tightly support the sacroiliac joint.
Surgery (Sacroiliac Joint Fusion)
Particular severe cases of the injury may require invasive procedures. If many other treatment methods have been attempted with limited effectiveness, some doctors may recommend that you undergo a surgical procedure. One such procedure is called sacroiliac joint fusion, which seeks to restore the joint and ligaments to their normal function. The operation consists of removing the articular cartilage from both sides of the joint-forming bones. Then, the two bones are attached artificially, with the use of plates and screws, until the two bones fuse together. This stops the abnormal motion and eliminates pain.
Complications of sacroiliac joint fusion
With all major invasive surgical procedures, some complications may occur. This includes problems with anesthesia, thrombophlebitis, infection, nerve damage, implant or hardware problems, nonunion, ongoing pain, and so on. Your doctor and surgeon should advise you about the risks this surgery can pose.
- Anesthesia: Problems such as allergic reactions or impaired lung function may occur in certain patients as a result of a negative reaction to anesthesia. Discuss your medical history with your anesthesiologist, including allergies and any issues with your respiratory system, before undergoing treatment.
- Thrombophlebitis: Also known as deep vein thrombosis (DVT) or blood clots, this condition can occur after any invasive operation due to the blood-thickening drugs and patient’s extended period of immobility. Symptoms include swelling, warmth, bruising, discoloration, and engorged superficial veins. This condition, if left untreated, can lead to a life-threatening disease called pulmonary embolism (PE) in which the deep vein blood clot dislodges and travels to the lungs, putting the patient’s life at risk. Make sure to request blood-thinning drugs post-surgery.
- Infection: Although rare, infections developing in the areas where surgery is performed has been known to occur. Deep infections can travel to the bones and bloodstream which can be life threatening. This is why it is important to rest after surgery, and to schedule several follow-up visits.
- Nerve damage Damage to your nerve endings post-surgery is also a rare complication and can occur whenever invasive procedures are performed on the spinal cord or spinal nerves. Such complications occur because of human error, unexpected tissue inflammation, or scarring. Any surgery that is done near the spinal canal can potentially cause injury to the spinal cord or nerves. Injury can also occur from bumping or cutting the nerve tissue with a surgical instrument, from swelling around the nerve, or from the formation of scar tissue. It is best to find a surgeon experienced with this kind of procedure to operate on you in order to avoid this injury.
- Implant or hardware problems: These are rare and usually only occur in countries where the medical system is weak or neglected, such as in third world countries. Additionally, human bone grafts can present various problems if performed incorrectly. Such procedures must be periodically inspected, and additional hardware may sometimes need to be inserted after the initial surgery.
- Nonunion or pseudarthrosis: Also known as a false joint, this can occur if the targeted tissues fail to unionize. In such cases, a second operation is needed to correct the nonunion by placing additional hardware and instrumentation.
- Ongoing pain: This may occur in cases of complex surgeries, including sacroiliac joint fusion. Immediate pain and discomfort after the surgery are normal, but in some cases, pain may continue long after the surgery. Treating chronic pain long after an operation may require further invasive or noninvasive treatment.
After a non-invasive treatment for sacroiliac joint dysfunction, you’ll have to refrain from strenuous physical activity for a couple of weeks. After this extended period of rest, you can then proceed towards a comprehensive rehabilitation program. It is recommended that you consult a physical therapist or perform the exercises listed below in the Prevention section.
After a sacroiliac joint dysfunction surgery, you’ll have to wait around six weeks before attempting a rehabilitation program, which will usually last for about 6 to 8 weeks. Expect a full recovery after 6 months. Patients will usually have a guided behavioral program designed around their specific situation so as to avoid interfering with the rehabilitation progress. This will be outlined by your doctor, surgeon, or physical therapist, and it usually involves controlling day-to-day activities such as walking, going to the bathroom, working, and so on. You may also need some orthopedic devices such as a splint or brace during the recovery, and pain medication may be prescribed to you as well.
Whether you’ve just recovered from a case of sacroiliac joint disorder, or you’re looking to avoid having to deal with it in the future, these techniques and strategies will help the majority of individuals avoid becoming injured. Some general tips for preventing injury are to avoid competitive sports such as contact sports, weightlifting, high-impact cardio such as running, basketball, volleyball, and generally hard twisting movements of the torso; these can certainly aggravate the sacroiliac joints and ligaments. Try to find low-impact alternatives such as swimming, static elliptical, static bike, isolating machines, treadmills or jumping rope.
The different techniques listed below are referred to as Lumbopelvic Stabilization Training, meaning they are effective at training the lower back and pelvis. They include general body weight exercises, stretches, and some yoga poses. Performing these exercises will decrease your chances of SI joint injury for a few reasons. First, the added flexibility will prevent strain from tissues contributing to joint degeneration. Second, the strength increase in your muscles will provide better protection for your bones and joints, decreasing the chance of becoming injured from trauma. Some of these exercises will require additional materials, such as a mat, rug, or resistance band. Some light soreness should be expected when performing these movements, but stop immediately and see a doctor if you begin to feel sharp pain, as this could potentially lead to injury.
1. Knee-to-chest stretch
The knee-to-chest stretch is one of the safest exercises for rehabilitating sacroiliac joint dysfunction. It stretches the back, hips, glutes, and thigh.
Begin by lying supine, or face up, on a soft mat. Proceed to grab the back of one of your knees with both your hands, gently pulling it toward your chest until you feel your muscles stretch. Hold this position for about 10 seconds and then return your leg to its initial position. As a bonus, the negative movement of this exercise will slightly work your abdominals and thigh muscles. Alternate legs and repeat this movement, performing this exercise for a couple of sets every day.
An alternative method of performing this stretch is to perform it with both legs at the same time. Regardless of how you do it, be sure to avoid sharp pain. In the event of pain, one technique you can try is to only do the negative repetitions (returning to initial position) if there’s no pain on the way back.
2. Piriformis stretch
This stretch targets the piriformis muscle, a small muscle located in your lower back that is responsible for hip movement. Increasing flexibility in this muscle group will help to prevent joint pain as a result of moving your hip at extreme angles.
Lie supine on a soft mat and cross your legs with the leg of the affected side on top and form a triangle, resting the lateral malleolus on the opposite tight, just above the knee. Then, grab the bottom leg and pull towards your chest until you feel a stretch in the buttock and hip area. Hold the stretch for half a minute and alternate. Do a couple of holds on each leg every day.
3. Knee swipes/hip twists
Lie supine on a soft mat with your knees flexed and feet firmly planted on the mat. While keeping your knees together, proceed to rotate your lower body left and right. You’ll be outlining an arch with your knees by alternating the rotation. Hold for a few seconds on each side to stretch the glutes, thigh, and back. Contract your abdominals to switch sides and hold the final twisted position for another few seconds. Perform dozens of repetitions a set and complete a few sets every day.
4. Pelvic tilt
Lie supine on a mat or rug with your legs flexed and your feet planted on the floor. Proceed to slowly raise one leg at a time about 6 inches or 15 cm off the floor toward the ceiling. Hold the position at the top for about five seconds, then switch legs and repeat. Perform a dozen total reps for each leg every day.
5. Bridges/hip thrusts
This exercise will strengthen your glutes, allowing you to bear more weight and providing additional protection to your pelvis. Begin by lying face-up with your feet planted on the ground and your knees flexed. Proceed to thrust your hips towards the ceiling while supporting your weight with your arms. Hold the top position for a couple of seconds and slowly lower yourself back down to the starting position. Perform a few sets of twelve each day.
At the top of this movement, concentrate on squeezing the glutes, hamstrings, and back muscles while stretching your lower abdominals. This will help to activate and engage these core muscle groups while performing this exercise, ensuring you get the most out of each movement. Advanced versions of this exercise involve adding additional weight by placing a barbell across your pelvis, but this is only recommended for experienced lifters.
6. Cobra/bhujangasana pose
This is a pose from yoga that increases flexibility in your lower back. Begin by lying prone on a soft mat, face down. Plant your hands just beneath your shoulders as you would with a push-up. Proceed to push your upper body weight with your arms while looking towards the ceiling, all while keeping your legs unbent and touching the floor. Extend your arms fully, stretching your back, and try to pull your shoulders away from your ears. Focus on the stretch and muscular contraction of the back and glutes. Hold the top position for half a minute and then lower yourself back flat on your stomach. Do a couple of reps every day.
7. Triangle/trikonasana pose
This next yoga pose is ideal for increasing flexibility in your legs and groin. It is also very effective at improving balance and can correct posture issues. It is performed while standing up and will greatly stretch the outer thigh, lower lateral abdominals, back, and glutes. Let pain be your guide, making sure to stop if mild discomfort turns into sharp pain.
Assume a wide stance, slightly wider than shoulder width and extend your arms laterally to form a “T” shape. Then, proceed to touch one foot with your hands while maintaining the position of your arms, keeping them outstretched so they are parallel to the ground. Be sure to point your feet in the same direction as your arms, keeping them to the outside, and hold the final position for a couple of seconds before switching directions and touching the other foot. While holding the final position, make sure to turn your head towards the free hand which should be pointing to the ceiling. Alternate touching each foot with your hands twelve times to complete one set, and perform one to two sets every day.
8. Child’s pose/proskynesis stretch
This resting pose from yoga is highly effective at extending your lower back and opening up your hips. Begin this pose by bowing your body with your arms extended in front of you, face down on the ground while sitting on your knees. Tighten your lower body and stretch the arms in front of you, keeping them flat on the mat and aligned with your lower legs and feet. Maintain this position for a minute or so and try to stretch your back, glutes, and upper body. Assume this position a few times every day.
9. Bird Dog Pose
Performing this pose in yoga is great for relieving back pain, as it works to straighten and strengthen your lumbar spine muscles. Begin by kneeling on all fours, using a mat or rug. Proceed to lift one leg up parallel to the ground and then lift the opposite arm in the same fashion. Don’t arch your back, keeping it parallel to the ground. Hold both your arm and opposite leg up for a couple of seconds, slowly lower them down, and then alternate so that the opposite arm and leg are outstretched. Do two to three sets of twelve every day and focus on the squeeze at the top of your delts, glutes, hamstrings, and lower back.
Diet and lifestyle
Diet and lifestyle are very important to your general health and rehabilitation. A plant-based diet or a strict vegan diet will benefit you greatly, keeping inflammation to an absolute minimum and giving your body the best possible nutrients for recovery and prevention. With a plant-based diet, you’ll reduce all-cause mortality and feel better all-around with tangible improvements. Furthermore, on top of your plant-based or vegan diet, you’ll also need a proper sleep pattern and adequate hydration alongside a drastic reduction of harmful vices such as smoking, drinking, and coffee. It is advised that you monitor your micro and macro nutrient ratio, especially when transitioning to veganism. Make sure you’re meeting your needs in terms of Calcium, B12, and Vitamin D since it can be difficult for vegan diets to have adequate levels of these nutrients. In the event that you do not wish to adopt a vegan diet, incorporating lean meats such as fish, grilled chicken, or turkey can have positive health benefits as well. Here are some potential sources of necessary nutrients that can promote positive health benefits.
- Whole grains such as rice, buckwheat, barley, bread, whole wheat pasta etc.
- Vegetables such as sweet potatoes, winter squash, whole corn etc.
- Non-Dairy Milk such as almond, soy, or rice milk
- Hemp seeds
- Nut Butter such as almond or peanut butter
- Sprouted-grain bread
- Lean beef
- Grilled chicken
- Nuts and seeds
- Vegetable oils
- Peanut, almond, and cashew butter
- Imitation meats
- Coconut oil
Here are some other things that are important for a healthy lifestyle. Incorporating adequate levels of these nutrients and practices will prevent a variety of injuries, and will ensure a proper recovery in the event that you sustain injuries.
- Calcium: Men and premenopausal women should consume at least 1000 mg of calcium every day. Postmenopausal women should consume 1200 mg of calcium every. Don’t take more than 2000mg of calcium a day, in total, or you can run the risk of developing kidney stones. Calcium can be found in dairy, kale, and salmon with bones.
- Vitamin D: Men and women should consume between 600 and 800 international units (IU) of vitamin D per day. Don’t take more than 800 IU of vitamin D a day as high doses can be toxic, especially after proceed periods of time. This can be obtained through direct exposure to sunlight, vitamin-enriched milk, or through supplements.
- B12: This vitamin is especially important on both a vegan and non-vegan diet because it’s produced by certain bacteria and might lack in our modern foods. As a result, it is important that you monitor your intake and eat B12-fortified foods or take supplements.
Recommended Daily Amount (RDA) of B12 in micrograms (μg)
Age RDA (μg)
- Sleep: Sleep is very important for your body, allowing it to heal after strength-building exercises or recover from injuries. Because of this, you should aim for 7-9 hours of restful sleep each day.
- Water: Adequate hydration is also very important because the majority of the body’s processes need water. The common wisdom of drinking 8 glasses of water every day is a good idea, but not actually backed by any scientific study. If you find yourself unable to drink 8 glasses of water every day, simply drinking enough to satisfy your thirst is adequate. Trust your body and what it tells you. For greater hydration you should also avoid soda, as these drinks often contain high amounts of sodium which can dehydrate you further. Instead, try drinking unsweetened teas or low-sodium carbonated drinks such as La Croix.
- Sunlight: Get at least 1 hour of sunlight every day, as it is important for calcium synthesis and a good source of Vitamin D. Continue maintaining a physically active lifestyle to encourage positive health benefits in the body.
Sacroiliac joint dysfunction is a relatively common condition that affects between 15% and 38% of the general population, with women being 3 to 4 times more likely to be affected than men. It’s a cause of pain, discomfort, and impaired mobility, but it can, fortunately, be treated with both invasive and non-invasive treatments. P.R.I.C.E. first aid method is recommended whenever symptoms are first discovered or immediately after a crisis ensues. A comprehensive rehabilitation program is often needed afterward, consisting of training the glutes, back muscles, abdominals, quadriceps, and hamstrings. In addition, a healthy diet rich in required nutrients such as calcium and Vitamin D can work to prevent bone injury, further preventing damage to your joints.
Constant medical supervision is paramount during the treatment and recovery process, as complications can be life-threatening. The information contained in this article has been pulled from credible references, which can be accessed in the Sources section below. Although this article has been researched thoroughly with legitimate sources, it is meant for informational purposes only and should not be taken as professional medical advice. Please consult a healthcare provider for further information.
Co-written by Mike Valverde
Curated by Diana Rangaves, PharmD, RPH
- Comprehensive Diagnostic Approach for the Sacroiliac (SI) Joint, Spine Health ,
- THE HESCH METHOD OF TREATING SACROILIAC JOINT DYSFUNCTION: INTEGRATING THE SI, SYMPHYSIS PUBIS, PELVIS, HIP AND LUMBAR SPINE , Hesch Institute ,
- Is Your SI Joint Giving You Back Pain?, Web MD ,
- Sacroiliac Joint Dysfunction Health Center, Spine Health ,
- Radiofrequency Neurotomy for Facet and Sacroiliac Joint Pain, Spine Health ,
- The Fortin finger test: an indicator of sacroiliac pain., US National Library of Medicine National Institutes of Health ,
- Sacroiliac Joint Dysfunction , Ortho Gate ,
- Sacroiliac Joint Dysfunction, SIJ Pain ,
- Fortin's Sign, The Student Physical Therapist ,
- SI Joint Dysfunction, SI Bone ,
- 7 Best Sacroiliac Joint Pain Exercises, and 5 to Avoid , Braceability ,