Sacroiliac Pain Demystified

Talk to patients about sacroiliac joint dysfunction.
 
Pain in and around the sacroiliac joint is one of the more common causes of low-back pain. With approximately 80 percent of the population suffering from low-back pain at some point in their lives, the sacroiliac joint dysfunction likely represents about 15-25 percent of those cases.
 
The following points will help you educate your patients about the sacroiliac joint dysfunction.
 
What Is Sacroiliac Joint Dysfunction?
  • Sacroiliac joint dysfunction (SJD) is a broad term often applied to pain in the sacroiliac joint region—the largest joints at the base of the spine.
  • SJD can be painful and debilitating, but it is rarely life-threatening.
  • SJD rarely requires invasive types of treatment such as surgery.
Symptoms and Causes
  • SJD symptoms include low-back pain, typically at the belt line, and pain radiating into the buttock or thigh.
  • These symptoms are hard to distinguish from other causes of low-back pain, such as disc herniations or facet joints disease.
  • Most often, SJD is caused by trauma. For example, rotation of the joint when lifting or participating in some vigorous activity may cause tears in small ligaments surrounding the joint, resulting in pain and dysfunction.
  • While more serious conditions such as fracture or dislocation, infection and inflammatory arthritis can cause sacroiliac joint pain, minor trauma is considered a much more common cause.
  • The risk of SJD may also increase with true and apparent leg-length inequality, abnormalities in gait and prolonged exercise.
  • Pregnant women may suffer from SJD because of hormone-induced relaxation of the pelvic ligaments during the third trimester, weight gain and increased curvature of the lumbar spine.
Evaluation
  • Because SJD pain resembles other types of low-back pain, it is often difficult to isolate it as the actual cause of the patient’s discomfort and disability.
  • Diagnostic imaging procedures, such as X-ray or MRI, aren’t very helpful in evaluating SJD.
  • The mostcommonly used diagnostic procedures are physical examination and anesthetic blocks of the sacroiliac joint.
  • Physical examination involves stressing the joint in various body positions and movements.
  • During anesthetic blocks, a procedure with unproven validity for SJD diagnosis, the anesthetic solution often creeps outside the sacroiliac joint and may relieve pain from other structures.
Treatment
  • Because it is often difficult to isolate SJD as the source of pain, an appropriate management strategy is hard to implement. Once SJD is determined as the cause of the problem, many therapies are available.
  • Chiropractic manipulation and mobilization of the sacroiliac joint has been shown to be beneficial.
  • Exercise focusing on strengthening the core stabilizer muscles of the spine and trunk and on maintaining mobility of the sacroiliac joints can also be helpful.
  • Patients with a leg-length inequality may benefit from a shoe inserts helping to properly distribute weight borne by your lower back and sacroiliac joints.
  • For those with abnormal gait biomechanics, gait training may be needed. 
  • To reduce the excess rotation that sometimes occurs with SJD, a pelvic belt can help stabilize the sacroiliac joints.
  • In cases of fractures and dislocations of the sacroiliac joints, surgery is needed.
Prevention
  • Use proper lifting techniques and ergonomics during your daily activities.
  • Maintain a regular exercise program and a healthy diet to help you function at peak capacity and prevent injuries.