Physiotherapy in sacroiliac joint dysfunction

The sacroiliac joint (SIJ) is a joint between the sacrum (a large bone at the base of the spine) and the ilium (a bone in the upper part of the pelvis.) The two sides of the sacroiliac joint normally work together. Sacroiliac joint dysfunction is a common term used to describe the pain of the sacroiliac joint. It is usually caused by abnormal motion (i.e. hyper- or hypo-mobile) or malalignment of the sacroiliac joint. The sacroiliac joint syndrome is a significant source of pain in 15% to 30% of mechanical low back pain sufferers.

Causes of sacroiliac joint dysfunction

1. one of the most common causes of problems at the sacroiliac joint is a trauma. The force from these kinds of injuries can strain the ligaments around the joint. Tearing of these ligaments leads to too much motion in the joint and over time it will lead to degenerative arthritis.
2. Pain can also be caused by an abnormality of the sacrum bone, which can be seen on X-rays.
3. Pregnant women have a greater chance to develop sacroiliac joint syndrome. Female hormones are released during pregnancy, relaxing the sacroiliac ligaments. This stretching in ligaments results in changes to the sacroiliac joints, making them hypermobile. After the fifth decade of life, the sacroiliac joint fuses.

Symptoms of sacroiliac joint dysfunction

• Low back pain
• Thigh pain
• Difficulty sitting in one place for too long due to pain
• Local tenderness of the posterior aspect of the sacroiliac joint (near the PSIS)
• Pain occurs when the joint is mechanically stressed e.g Forward bending
• Absence of neurological deficit/nerve root tension signs
• Aberrant sacroiliac movement pattern.
• The joint can be hyper or hypo-mobile which can cause pain.
• Pain is usually localized over the buttock.  
• Patients can often complain of sharp, stabbing, and/or shooting pain which extends down the posterior thigh usually not past the knee. 
• Pain can frequently mimic and be misdiagnosed as radicular pain.
• Patients will frequently complain of pain while sitting down, lying on the ipsilateral side of pain, or climbing stairs.

Physiotherapy management

A treatment program will be designed to target treatment program to restore maximum strength and function. Treatment will help in safe return to daily activities. Physiotherapy program may include:

1. Patient education- A physiotherapist will work with you to identify and change any outside factors causing pain. The type and amount of exercises to perform, athletic activities, or footwear may be discussed. Suggestions will be made to improve to your daily activities.
2. Pain management- will develop a treatment plan to address, pain that includes applying ice to the affected area. They may use ultrasound, electrical stimulation, and/or other methods to help control pain. Decreasing some activities that causes pain may be advised.
3. Braces- It may be recommended that a brace be worn, such as a lumbar back brace. The braces provide stability during daily activities, as strength returns and flexibility improves.
4. Body mechanics- How you use your body for daily work and other activities can contribute to your SIJ dysfunction and pain. You will be thought ways to improve your unique movement (body mechanics) and the way you sit, lift, or carry objects.
5. Manual therapy- Hands-on (manual) therapy, such as massage, can help correct SIJ dysfunction.
6. Flexibility exercises- Stretching exercises may be prescribed to improve muscle flexibility, and your movement.
7. Strengthening exercises- Strengthening exercises improve the stability of the sacroiliac and spinal joints. They also help reduce pain.
8. Functional training- Once your pain, strength, and motion improve, you will need to safely transition back to your full sport and/or daily activity levels. To reduce the stress and tension on the sacroiliac joint, you will need to learn safe, controlled movements. This training also will reduce your risk of repeated injury. Your physical therapist will teach you how to use and move your body correctly based on your unique physical condition.