‘Sacroiliac’ is one of those strange sounding words we’ve all heard before but probably never knew what or where it is located on our body. That is until it starts to become painful and we look it up quick. Injuring your sacroiliac, or “SI” joint can be excruciating and may get worse by bending forward, putting on shoes, crossing one leg over the other, getting up from a chair or out of bed.
You have two sacroiliac joints. They connect your pelvis with the lower part of your spine. The SI joints aren’t like the joints in the shoulders and knees, that have a wide range of movement. Its main job is to stabilize and support your pelvis, help to transfer the weight of your upper body to your legs, and act as a "shock absorber" when you walk or run. So the sacroiliac rotates and rolls very slightly. The joints are covered by a cartilage layer to provide protection and smooth motion between the joints. Damage to this cartilage from injury or arthritis causes the bones to have direct contact and rub against each other. This can cause pain and inflammation, altering motion and cause a compensation, with strain on other structures having to take over the function of supporting the joint.
The sacroiliac joint can be injured in a number of ways, making even simple activities, like sitting, walking or climbing stairs, painful. Sacroiliac joint pain may come on gradually and is usually felt on one side, but pain on both sides may occur even if only one side side affected. It is often related to a simple motion that combines bending forward, tilting of the pelvis and twisting the trunk like a short golf swing. Pain may or may not be present in the lower back, but some degree of pain is usually felt in the leg or thigh.
The most common cause of SI joint dysfunction is injury from a car accident or fall. But it can also happen from:
- Sports injuries such as a football tackle
- Stress or injury to the joint over and over, such as from jogging for many years
- Older age
- One leg that’s shorter than the other
- A spinal injury
- Scoliosis (abnormal curvature of the spine)
- Spinal surgery, especially operations that fuse the lower part of the spine, called the sacrum
- Pregnancy. The hormones that a woman’s body makes near the time of delivery can cause the pelvis to relax and change position. Weight gain, changes in posture, and the childbirth process can also cause problems in the joint.
The most common of all these is pregnancy. This is due to several things:
- The ligaments supporting the sacroiliac joint become deliberately softened by the body's hormones in order to allow the joints to move apart. This can lead to pain.
- The sacroiliac joints endure additional physical stresses and strains during pregnancy. The pelvis has to widen a lot to allow the baby into the world. The movement takes place at these joints.
Pain is often the main symptom, usually in the lower back and buttocks, and sometimes the back and upper leg.
Pain related to the sacroiliac joints are referred to as dysfunctions, joint syndrome, sprains, strains, arthritis, misalignments and inflammation. The sacroiliac joint may be indirectly affected by conditions which alter normal walking and standing mechanics. There are conditions which alter the length of the legs, either from misalignment of the joints, muscle spasm, an actual longer or shorter length of the leg bone, as well as problems with joints below like the hips, knees, ankles and feet. This can lead to sacroiliac joint pain as well as lower back pain.
Some people also feel SI joint pain in the groin, belly, and even their feet. Aches from SI joint dysfunction usually show up on one side of the body rather than both sides.
Low back and leg pain have many possible causes, so you’ll need to work with your doctor to figure out if your SI joint is the reason you hurt.
As damage occurs to the joint allowing altered and excessive motion, there is a tendency towards sacroiliac joint pain and inflammation as the joint becomes unstable. Stabilizing the joints help provide relief from pain. For example, a condition called ‘ankylosing spondylitis’ affects the joint by causing inflammation and excessive motion which produce pain. As the condition progresses, the joints fuse together and the pain stops. Other conditions which relate to arthritis affecting the joints are gout, psoriatic arthritis and rheumatoid arthritis.
Discovering SI joint dysfunction
If there’s an inflammatory cause of the problem, X-rays and scans will need to be taken. They may show characteristic changes in the joint such as sacroiliitis, which is a type of inflammation seen with ankylosing spondylitis. X-rays may also show osteoarthritis in the joints. These changes are also called sacroiliac joint arthropathy. If instability is suspected, X-rays taken standing on one leg may be suggested. However, like most lower back pain tests, more often than not scans and X-Rays are normal or just show the usual age related changes.
What can help?
This depends on the type of problem and if it is caused by pregnancy.
- Stabilizing exercises are commonly suggested if the joints are too mobile or there is a suspicion of instability.
- Joint manipulation may be helpful if the joints are stiff.
- Pain relieving treatments such as medication, massage and heat may help.
- Acupuncture and/or TENS may also help ease pain (not for pregnant women).
- Corsets and supports are offered during pregnancy.
- Pain relieving injections may be offered and surgery as a very last resort if the joint is very unstable.
- A medical or physiotherapy assessment is essential to identify the type of sacroiliac problem and make the right suggestions for managing it.
If you have any problems with your Sacroiliac joint call our office as soon as possible for a consultation.