Joint Function, Diagnosis and Treatment
The sacroiliac joint is stabilized primarily by a network
of ligaments, muscular support and proper spinal alignment.
The main function of the ligaments that support the SI joint
is to limit motion in all planes of movement. The normal sacroiliac
joint has a very small amount of normal motion (about 2-4
mm of movement in any direction). For women the SI ligaments
are less stiff than men, allowing the increased mobility necessary
for the purpose of childbirth. Given their location between
the spine and the hip, the sacroiliac joints are responsible
for transferring and absorbing the forces that are occurring
between the spine and lower extremities. The SI joint is particularly
vulnerable to injury because of its location and the crucial
balance between stability and mobility that is required for
normal sacroiliac function.
Injury to the SI Joint
The largest study to look at how common injury to the SI
joint occurs (Bernard and Kirkaldy-Willis) found that 22.5%
of patients with reported low back pain had sacroiliac joint
pain. The problem is that the SI joints can withstand only
1/20th the compression force (lifting) and half the rotation
force (twisting) that the lumbar spine can withstand during
these movements. These are the two motions that often strain
and injure the sacroiliac joint and thus the mechanism of
SI joint injury has often been described as a combination
of vertical compression and rapid rotation (i.e. carrying
a heavy object and twisting). Additional causes of SI joint
pain include arthritis, leg length discrepancy, gait abnormalities,
prolonged vigorous exercise, scoliosis and spinal fusion to
the sacrum. Lumbar spine surgery has also been reported to
trigger sacroiliac joint pain due to SI ligament weakening
and postsurgical hypermobility.
Diagnosis of Sacroiliac Joint Pain
One of the most challenging aspects of treating sacroiliac
joint pain is the complexity of diagnosis. Literally dozens
of physical examination tests have been advocated as diagnostic
aids in patients with presumed SI joint pain. One physical
finding that has consistently been shown to indicate whether
a person has sacroiliac related back pain is specific point
tenderness at the SI joint.
Treatment of SI Joint Pain
The treatment of SI joint pain is widely acknowledged to
be one of the most challenging problems confronting doctors
and physical therapists. Most treatments can be divided into
two categories: those directed at correcting the mechanical
problem and those aimed at alleviating symptoms.
Conservative treatment of sacroiliac joint pain should ideally
address the underlying pathology. Treatments with a physical
therapist will typically focus on restoring normal pelvic
and core stability (Transversus Abdominis, Multifidus and
Pelvic Floor) along with developing good control of general
spinal stability with body mechanics retraining, posture correction,
etc. Additional exercises will often include general strengthening,
stretching and conditioning. Non-surgical stabilization will
also be assisted by use of an SI joint stabilization belt
that will reduce the movement of an unstable SI joint. In
patients with leg length discrepancy, treatment might include
the use of shoe inserts to more equally distribute the load
exerted on the sacroiliac joints. For SI joint pain resulting
from spine misalignment, or if your health care provider feels
that your SI joint is hypomobile or too stiff, sacroiliac
joint manipulation and/or mobilization will often be recommended.
How can two treatments for one joint be so different? Basically,
in some cases, SI joint pain is the result of excessive mobility
and reducing the mobility of the sacroiliac joint with an
SI belt will decrease the pain, on the other hand, if an SI
joint is "stiff" or "locked" it may need
to be more mobile to function correctly and in this case mobilization
or manipulation is the treatment of choice. Furthermore, in
many patients a combination of SI joint mobilization and stabilization
with an SI belt may be the best treatment.
Sacroiliac Belts and Supports
Pain reduction and stabilization at the SI joint is often
best achieved with use of a sacroiliac stabilization belt
(SI belt). The SI belt wraps around the hips and pelvic girdle
to compress the SI joints and pubic symphysis together, creating
the compressive stabilization force that has been lost due
to: ligament injury/laxity, core weakness or abnormal SI joint
alignment. While many people with sacroiliac related back
and pelvic pain experience pain relief using an SI belt, recent
biomechanical research has given us insight into why the ACTIVE
SI BELT® for Sacroiliac Pain works better than any other
sacroiliac belt that is available!
Additional Treatment Options:
Sacroiliac joint injections with corticosteroid and novacaine
have been shown to provide good to excellent pain relief lasting
from 6 mo to 1 yr. There have been reports of significant
SI joint pain relief for patients who have received a series
of 3 intraarticular injections with hyaluronic acid. Prolotherapy
is another injection that has been advocated as a treatment
for SI joint pain. The rationale behind the use of "prolotherapy"
is that the hypermobile sacroiliac ligaments, in a patient
with SI joint pain, can be strengthened through injecting
a drug that promotes ligament stiffness.
In patients with SI joint pain unresponsive to more conservative
measures, some have advocated surgery for SI joint stabilization.
Based on the existing studies the long-term success rate for
SI joint fusion appears to be in the range of 70%. Unfortunately
this means that 30% of patients who have sacroiliac joint
surgery have increased pain or no change in pain after surgery.
As such, surgery is always the last treatment that should
be considered for SI joint pain.
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back pain, self-care suggestions and treatment options.
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for Sacroiliac Pain over all the others for their patients.