SIJ pain… say what?
What is a SIJ?
The SIJ (sacroiliac joints) are two joints located on each side of the spine where the two pelvic bones attach to the sacrum. These joints have multiple ligaments that provide stability to the joints. The sacroiliac joints are also surrounded by some of the most powerful muscles of the body, however they do not influence the movement of the joints itself.
The main function of the sacroiliac joints is to provide shock absorption for the spine and to transmit forces between the upper body and the lower limbs.
Why does the SIJ become painful?
The exact cause of SIJ pain is not always that well understood. Pain occurs as a result of wear and tear to the joints as a whole, strain to the ligaments providing stability to the joint and the inflammation as a result thereof.
One of the most common causes of SIJ pain is trauma, such as falling on your buttocks, motor vehicle accidents and an accumulative trauma history of lifting heavy objects and running.
Pregnancy also increases the risk of developing SIJ pain. The hormones released during pregnancy causes a laxity of the sacroiliac ligaments resulting in a hypermobile sacroiliac joint. Thus, more wear and tear to the joints. Small, uncontrolled movements such as miss stepping a curb or a step, or stumbling over something could also strain the joint causing pain.
In a study it was also found that weakness of the gluteal muscles and tightness or shortening of the hamstring muscles were associated with SIJ pain.
What does SIJ pain look like?
Sacroiliac joint syndrome is one of the leading causes of lower back pain.
The main symptoms of SIJ pain are:
⦁ Low back pain
⦁ Pain spreading into the buttock and thigh
⦁ Sitting in one place for too long increases pain
⦁ Local tenderness of the posterior aspect of the SIJ
⦁ Increased pain with bending forward
⦁ SIJ pain is usually not associated with neurological symptoms
How to get this SIJ pain away?
The initial goal of treatment is to reduce inflammation surrounding the SIJ. This is usually achieved through medical treatment. Once inflammation is under control, the second goal is to improve the mobility of the joint. Chiropractors and Physiotherapists are important in providing this phase of treatment. In the case of too much mobility, support braces and exercises could be useful to decrease pain.
- Pain medication, Anti-inflammatory medication, muscle relaxants
- Injections such as a local anesthetic or anti-inflammatory medication
- Manual manipulation of the sacroiliac joint may relieve pain associated with a hypo mobile joint
- Manual therapy: mobilisation of the spine and the sacroiliac joints itself are used to improve mobility of a hypo mobile joint and helps to decrease pain.
- Manipulation: manipulation of the lumbar spine and the SIJ could be performed by a physiotherapist to improve mobility and decrease pain.
- Soft tissue release: deep massage and myofascial release of the surrounding muscles are used to decrease pain caused by spasms and increased tension in the muscles.
- Dry Needling: this is used to decrease muscle spasms and trigger points in the muscles surrounding the SIJ if they become too tight and cause strain on the joints.
- Exercise: exercises that focus on strengthening the stabilizer muscles of the spine, the core muscles, helps to provide stability to the sacroiliac joint if the reason for pain is due to a hypermobile joint. These muscles include the transverse abdominis and the multifidus muscles.
- Interferential current / TENS: this electrotherapy model is used to decrease inflammation and pain surrounding the sacroiliac joints.
- Kinesio taping: taping is used to provide stability and to help with circulation, thus decreasing inflammation and pain.