Sacroiliac joint pain can be a physically debilitating problem that’s often confused with hip, groin or lower back problems.
Physiotherapy treatment for sacroiliac joint pain and dysfunction involves a range of techniques depending on the underlying cause.
Read on now to learn:
- Where your sacroiliac joints are located
- What causes sacroiliac joint pain and dysfunction
- Symptoms of sacroiliac joint dysfunction
- Physiotherapy treatment for sacroiliac joint problems
Sacroiliac Joint Locations
There are two sacroiliac joints (SI joints) in the body. These joints are located at the back of the pelvis positioned either side of the sacrum or tail bone (shown right).
The sacroiliac joints are directly beneath the ‘Dimples of Venus’ on your lower back. If you press on these dimples you may experience pain with SI joint dysfunction.
The sacroiliac joints transmit force from the trunk through the spine down through the pelvis to the lower limbs. They also absorb the shock that passes between the spine and the lower limbs. This is one reason why sacroiliac joint pain can occur when standing on one leg.
2. What Causes Sacroiliac Joint Pain and Dysfunction?
The sacroiliac joints are stiff and usually only allow for a small amount of movement.
These joints are held together by a combination of their interlocking surfaces (shown right), strong tissues (ligaments) and muscles that all work together to stabilize the pelvic bones.
There are two main causes of sacroiliac joint pain and dysfunction:
1. SI joints moving too much (hypermobile)
2. Stiffness and insufficient SI joint movement (hypomobile)
The most commonly occurring sacroiliac joint pain problem involves hypermobile joints particularly in women.
Muscle weakness is a very common cause of sacroiliac joint pain. When specific muscles that stabilize the pelvis become weak, the sacroiliac joints can become hypermobile, inflamed and painful. Sacroiliac joint pain and dysfunction can also cause muscles to stop working well resulting in muscle weakness.
Pregnancy is another major cause of sacroiliac joint pain and instability. Hormones released during pregnancy soften the pelvic support tissues. This softening combined with the weight of the growing foetus can allow the sacroiliac joints to move more than they should, especially with insufficient pelvic muscle strength and control.
3. Symptoms of Sacroiliac Joint Dysfunction
Sacroiliac joint symptoms can depend upon the underlying problem. Sacroiliac joint pain can be confused with lower back or hip conditions.
Sacroiliac joint pain may occur on one side of the lower back/buttock or both sides depending upon the type of dysfunction involved.
Some commonly occurring sacroiliac symptoms include:
- One sided buttock pain/ache/burning sensation
- Pain standing on one leg e.g. walking, dressing, using stairs
- Lower back, groin or hip pain
- Sciatic nerve – type pain in the buttock may radiate down the back of the leg
- Pain is usually relieved by lying down on the back or unaffected side of the body
Pelvic Floor Exercises Workout
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Strengthen your pelvic floor with daily Kegel exercises.
This evidence-based pelvic floor training workout guides you step by step towards a strong well functioning pelvic floor.
Presented by Pelvic Floor Physiotherapist Michelle Kenway
Track 1 – Introduction to Successful Strengthening
Track 2 – Finding your Pelvic Floor
Track 3 – Feeling your Pelvic Floor Muscles
Track 4 – Using the Correct Pelvic Floor Exercise Technique
Track 5 – Beginners Pelvic Floor Exercises Workout
Track 6 – Intermediate Pelvic Floor Exercises Workout
Track 7 – Progressing and Maintaining your Strength
4. Physiotherapy Treatment for Sacroiliac Joint Pain and Dysfunction
Physiotherapy treatment of sacroiliac joint pain and dysfunction varies according to the underlying problem, so it varies from patient to patient. Your physiotherapist will structure your sacroiliac joint treatment based upon a thorough assessment of your condition.
Sacroiliac Joint Physiotherapy treatment
1. Easing Sacroiliac Joint Pain and Inflammation
- Medication including pain relief and non steroidal anti inflammatory gel or medication
- Ice or cold therapy is usually most effective for sacroiliac joint pain relief
- Heat packs can provide pain relief
- Education and advice regarding avoiding aggravating factors e.g. standing on one leg or sleeping on the affected side of the body
- Dry needling of related areas
2. Treatment of Sacroiliac Joint and Tissue Dysfunction
- Realigning pelvic joints
- Moving (mobilizing) stiff or painful pelvic joints
- Taping techniques or bracing to stabilize the pelvis
- Soft tissue massage of affected muscles
- Muscle stretching for tight shortened muscles
- Trigger point therapy
3. Therapeutic Exercises to Restore Muscle Function
- Core stability exercises (lower back, deep abdominal and pelvic floor muscles)
- Gluteal strengthening exercises for sacroiliac joint stability
- Posture exercises
- Movement retraining e.g. walking, running
- Balance exercises
- Restoring normal movement
- Muscle stretching for shortened tissues
4. Preventing Sacroiliac Joint Reinjury
- Education about modifiable predisposing factors e.g. muscle weakness, excess body weight
- Pelvic mobility and alignment maintenance
- Strength and flexibility maintenance
- General exercise and fitness guidance
Sacroiliac Joint Exercise Treatment Videos
1. Hungerford B, Gilleard W, Hodges P. (2003) Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac joint pain. Spine 28: 1593– 1600.
2. Richardson C. A, Snijders C. J, Hides J. A, Damen L, Pas M. S, Storm J. (2002) The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain. Spine 27(4):399–405
3. Unsgaard-Tøndel, M., Vasseljen, O., Woodhouse, A., & Morkved, S. (2016). Exercises for Women with Persistent Pelvic and Low Back Pain after Pregnancy. Global journal of health science, 8(9), 54311.
Image of Sacroiliac Joint courtesy of Wikimedia Creative Commons Henry Gray (1918) Anatomy of the Human Body https://commons.wikimedia.org/wiki/File:SI_joint.png Henry Vandyke Carter [Public domain]
Image of woman’s trunk Image attribution Rodrigo Paredes from Rio de Janeiro, Brasil [CC BY 2.0 (https://creativecommons.org/licenses/by/2.0)] https://commons.wikimedia.org/wiki/File:Cannes_-_Costas_(2410144169).jpg