What is the sacroiliac (SI) joint?

The sacroiliac joint, often abbreviated as the SI joint, is a crucial junction in the lower part of your spine, connecting the sacrum and the ilium. Let’s break it down.

1. Location:

   • The sacroiliac joint is located where the sacrum, a triangular bone at the base of the spine, meets the ilium, one of the pelvic bones. There are two sacroiliac joints, one on each side of the spine.

2. Structure:

   • The joint is a synovial joint, meaning it has a fluid-filled capsule that allows for some movement. However, it is designed to be a stable and relatively immobile joint.

3. Function:

   • The primary function of the sacroiliac joint is to transfer forces from the upper body to the pelvis and legs. It provides stability to the spine and pelvis, especially during activities like walking, standing, and lifting.

4. Ligaments:

   • Strong ligaments surround the sacroiliac joint, providing additional stability. These ligaments help limit excessive movement and prevent dislocation.

5. Articular Surfaces:

   • The joint surfaces are covered with cartilage, allowing for smooth movement and reducing friction between the bones.
     

What can cause dysfunction of the SI joints?

Various factors can contribute to SI joint dysfunction. Here are some common causes:

1. Trauma:

   • Injuries: Accidents, falls, or direct impacts to the pelvis can cause trauma to the sacroiliac joint, leading to dysfunction.

2. Pregnancy:

   • Hormonal Changes: During pregnancy, hormonal changes, particularly the release of relaxin, can affect the ligaments around the sacroiliac joint, potentially leading to increased mobility and discomfort.

3. Arthritis:

   • Osteoarthritis: Degeneration of the joint cartilage due to wear and tear over time can contribute to sacroiliac joint dysfunction.

   • Inflammatory arthritis: Types of inflammatory arthritis such as ankylosing spondylitis or rheumatoid arthritis can affect the sacroiliac joints and lead to stiffness and pain.

4. Anatomical Variances:

   • Hypermobility: Some individuals naturally have more mobility in their joints, which can predispose them to sacroiliac joint dysfunction.

   • Leg Length Discrepancy: A significant difference in the length of the legs can affect the alignment of the pelvis and contribute to dysfunction.

5. Muscle Imbalances:

   • Weakness or Tightness: Imbalances in the muscles surrounding the sacroiliac joint can affect its stability and lead to dysfunction.

6. Inflammatory Conditions:

   • Infections: Infections in the pelvic region can cause inflammation and affect the sacroiliac joint.

   • Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis have been associated with sacroiliac joint inflammation.

7. Overuse or Repetitive Stress:

   • Activities: Repetitive movements or overuse of the sacroiliac joint, especially in certain sports or occupations, can contribute to dysfunction.

8. Weight Changes:

   • Obesity: Excess body weight can place increased stress on the sacroiliac joint, potentially leading to dysfunction.

9. Degenerative Changes:

   • Age-Related Changes: As individuals age, the sacroiliac joint may undergo degenerative changes that can contribute to dysfunction.

10. Previous Surgeries:

    • Pelvic or Spinal Surgeries: Previous surgeries in the pelvic or spinal region can alter the biomechanics of the sacroiliac joint.

It's important to note that sacroiliac joint dysfunction can result from a combination of factors, and the specific cause may vary among individuals. Diagnosing the underlying cause is crucial for developing an appropriate treatment plan.

What are signs and symptoms of SI joint dysfunction?

Some common indicators of SI joint dysfunction include:

1. Lower Back Pain:

   • Pain in the lower back, usually on one side, is a hallmark symptom of SI joint dysfunction.

   • The pain may be localized over the SI joint and can radiate into the buttocks or thigh.

2. Pelvic Pain:

   • Discomfort or pain in the pelvic region, often felt on one side.

3. Hip Pain:

   • Pain in the hip or groin area may be present.

4. Pain with Movement:

   • Pain or discomfort with specific movements, such as standing up from a seated position, walking, or climbing stairs.

   • Prolonged sitting or standing may exacerbate symptoms.

5. Altered Gait:

   • Changes in walking patterns or gait due to pain or discomfort.

6. Painful Sitting:

   • Discomfort or pain while sitting for extended periods, especially on a hard surface.

7. Tenderness:

   • Tenderness over the SI joint area, which may be elicited by pressing on the region.

8. Stiffness:

   • Stiffness in the lower back or pelvic area, particularly after periods of inactivity.

9. Radiating Pain:

   • Radiating pain down the back of the thigh or into the lower leg. This can sometimes mimic symptoms of sciatica.

10. Leg Length Discrepancy:

    • A sensation of leg length discrepancy or the perception that one leg is shorter than the other.

11. Pain during Pregnancy:

    • Pregnant individuals may experience SI joint pain due to hormonal changes and increased stress on the joints.

12. Difficulty Standing on One Leg:

    • Difficulty standing on one leg or performing activities that require balancing on one side.

It's important to note that the symptoms of SI joint dysfunction can overlap with other conditions, such as lumbar spine disorders or hip problems. Accurate diagnosis often involves a thorough medical history and physical examination.

How do you treat SI joint dysfunction?

Treating SI joint dysfunction involves addressing pain, improving stability, and restoring normal function to the sacroiliac joint. Some common strategies for treating SI joint dysfunction include:

1. Exercise:

   • Exercise is integral to providing stability to the SI joint. Exercises should also address any limitations above and below the SI joint, as these limitation may predispose to recurrent episodes of SI joint dysfunction.

2. Manual therapy:

   • Techniques such as joint mobilizations and manipulation are effective means of directly addressing joint stiffness.

   • Soft tissue therapies such as massage therapy and ART/FR are helpful for addressing concurrent issues with the ligaments and musculature supporting the SI joint.

3. Supportive Devices:

   • Occasionally a sacroiliac belt or brace may be recommended in the short term to provide additional support to the SI joint.

   • These devices can help stabilize the joint and reduce pain during activities but should not be relied upon, as they do not address the underlying dysfunction.

4. Activity Modification:

   • Avoiding activities that exacerbate symptoms, such as prolonged sitting or standing, can help manage SI joint dysfunction.

   • Proper body mechanics and posture education may be emphasized.

5. Weight Management:

   • Maintaining a healthy weight reduces stress on the SI joint and can contribute to symptom relief.

How long does it take for SI joint dysfunction to resolve?

The duration for SI joint dysfunction to resolve depends on various factors, including the severity of the dysfunction, the underlying causes, and the effectiveness of the chosen treatment approach.

Acute cases of SI joint dysfunction, often resulting from a recent injury or trauma, may show improvement within weeks to a few months with appropriate treatment.

Chronic cases, where symptoms have persisted for an extended period, may take longer to resolve.