In previous blogs we have attempted to shed some light on the low back pain that the majority of us experience every day. Unfortunately there are far too many potential causing factors when discussing the matter of low back pathology. Disk pathology, facet joint pathology, spinal column rotations, tight musculature, and muscle spasm are just a few examples of possible underlying causes of low back pain. Within this blog however, we will discuss the often frustrating and bothersome Sacroiliac dysfunction.
Sacroiliac dysfunction refers to pain and dysfunction at the Sacroiliac joint (SI joint). This joint is located towards the bottom of the spine near the buttocks. The sacrum of the spinal column meets up with the ilium of the innominate bone on either side creating two SI joints. The joints are connected by a network of stabilizing ligaments that allow very little movement. Majority of forces acting on the body, either from ground reaction forces or from the upper extremity, are distributed by the lumbopelvic region.
Although the joint normally restricts large amounts of movement, some motion is needed for normal functional movement. With the occurrence of pathological movement, dysfunction and inflammation may appear. As with other issues in the low back there is a number of potential reasonings for this uncharacteristic movement including impact (such as falling from a height), hypomobility in surrounding structures, weakness in musculature, and tightness in surrounding musculature.
Volumes could be written on diagnosing the exact cause of each case of SI joint dysfunction, for the sake of brevity this blog will address clinically realizing the presence of and treatment of SI joint dysfunction. For the evaluation portion, follow the link below to see a live demonstration of the examination. Prior to watching the video it may help to review the positioning of the iliac crests, anterior superior iliac spine, and the medial malleoli. Upon examination the clinician takes note of the positioning of the before mentioned anatomical landmarks. Most often the clinician will either see an upslip or rotation of one of the innominate bones. An upslip occurs when one of the innominate bones moves superiorly and rotation often happens when one of the innominates “turns” anteriorly. In the majority of cases, unequal pelvic positioning is due to an upslip. Either one of these movements causes issues on the backside at the SI joint and can lead to debilitating pain.
With a few examples of possible SI joint dysfunctions in mind, let’s discuss some possible treatment routes. Prior to strengthening the joint, proper positioning must be achieved. By adding stabilization to a malaligned joint, faulty movement is only being reinforced, think of building a nice new house on a poor foundation. Techniques such as self-mobilization, muscle energy, and manipulation can be used to realign the pelvis. Refer to the videos below to see this maneuvers in action.
Upon proper alignment, stability should be the focus of rehabilitation. Depending on the cause of the malalignment, stretching or strengthening should be implemented to hold the joint in its proper positioning. General core strengthening is important to practice due to the proximity of the core musculature with the pelvis. Although the pelvic levels can be quickly adjusted, they can just as easily return to their poor positioning, this is why it is important to maintain proper alignment with strengthening techniques.
In more serious and chronic cases, SI joint injection may be used but conservative care should be used first. An injection will decrease inflammation and pain but does not correct the anatomical and functional underlying issues, the relief of pain may assist in rehabilitation however.
In any case of this injury, an orthopedic specialist should be consulted prior to attempting your own care.
References and videos: