Research has shown that surgical treatment in appropriately selected individuals is more effective than non-surgical interventions. However, the key phrase here is appropriately selected. Several non-surgical interventions are just as effective.
SI Joint (also known as the sacroiliac joint) pain is pain felt in the lower back and buttocks. Even though it is named after the sacroiliac joint, the pain is reflected more in the lower back. It is often caused by anomalies in the SI joint, which is located between the spine and the hip.
The sacroiliac joint (SIJ) is the joint formed between the sacrum of the spine and the ilium of the pelvis. The SIJ isn’t like the other joints in the body because it is a synovial plane joint with a very shallow joint articulation. This means that the joint is very prone to abnormal movements that can cause the articulating parts sliding out of place.
Regardless of this, the SIJ is a very stable joint because it is supported by ligaments all around, keeping it steady. This is particularly important because the joint is responsible for transferring the weight from the upper body to the lower body. This is also why the joint is so prone to dysfunction, as we will see.
Another thing peculiar to the structure of the SIJ is that there is very little movement involved with it. As mentioned earlier, it has a very shallow joint space and is mainly held together by ligaments. This restricts its movement to a bare minimum. In fact, the only movements that occur at the SI Joint are during stretching, and bending motion (forward and backward bending). The network of ligaments and muscles around the joint help absorb the shock and keep it stable.
Sacro Iliac Joint dysfunction is an abnormality in the SIJ, either as a result of abnormal motion (too much or too little). Other less common causes of Sacroiliac joint dysfunction are trauma and arthritis. Sacroiliac joint dysfunction can lead to moderate to severe pain, depending on the extent of the impairment. The pain usually manifests in the low back and may radiate along the legs.
The pain in Sacroiliac joint dysfunction is what is called sacroiliac joint pain. In this way, there is no difference between the two, except that while one refers to the causes, the other refers to the effects. However, in practice, they are used interchangeably, as they can be said to be caused by the same things, and have the same effects.
What Causes SI Joint Pain?
The most prevalent and most impactful cause of SI joint pain is movement. As mentioned earlier, there is very little involved in the joint and so, any action that interrupts this dynamic can lead to dysfunction, and pain.
The two culprits in SI joint pain are:
Excessive movement of the joint: This is also referred to as hypermobility or instability. Too much movement in the joint will often lead to pain that reflects in the low back. The causes of hypermobility/instability are
Hypomotility or too little movement: Hypomobility in the SI joint is usually about other pathologies. The SI joint has a range of movements. And even though exceeding it can lead to dysfunctions, too little movement is just as harmful. Pathologies that can cause hypomobility in the SIJ include ankylosing spondylitis, osteoarthritis, and other pathologies of that affect the spine and surrounding muscles
Low back pain is a very common condition, and about 9 out of 10 people will experience it at some point in their life. It is estimated that 10% to 25% of these low back pain cases are as a result of SIJ dysfunction.
The risk factors of SI Joint pain are:
There is no evidence to show that SI joint pain is more prevalent in women than in men. The evidence seems to suggest that it is equally prevalent in both sexes.
The symptoms of SIJ dysfunction are mainly pain and reduction in functionality. Because it manifests as low back pain. It may be difficult to diagnose, due to the several other causes of low back pain. Some of them include:
The pain felt is usually a dull, continuous ache that is often relieved by actions like lying down. It is increased by aggravating movements like bending forward, climbing the stairs, and standing up. Other pain patterns associated with SI joint pain are seen when the individual sits in a cross-legged position.
Individuals may also experience pain when they lie on their side for extended periods. Reports also show that it is increased during sexual activity in some individuals, as well as during menstruation in women. However, this is very variable. (citation)
Besides low back pain, individuals suffering from SI joint dysfunction may also experience pain running down their legs. This is known as radiculopathy, and it happens when the displaced SIJ pinches on lumbar nerves. The pain ranges from a shooting sensation to burning, shocking and even pins and needles.
Other symptoms of SI joint pain are stiffness and instability.
The physical exam could include a vaginal or rectal exam. During the exam, the doctor applies pressure to the nerve to see if it produces any kind of pain, similar to what the individual has been experiencing.
Physical tests like cranial sheer test and Gaelen’s test are performed to try and elicit the pain present. The tests are positive if the individual feels the same kind of pain
A complete history can help identify risk factors and potential causes of SI joint pain. Factors like age, sedentary living, and osteoarthritis can help differentiate the condition from similar ones.
X-rays can help identify changes in the SI joint, as well as reduced or increased joint space. Others, like the CT and MRI scans, can also be used to examine the joint and identify the sources of the pain, as well as a rule out other causes.
Medication
Analgesics can be prescribed to help manage the discomfort associated with SI joint pain. Additionally, drugs called Disease-modifying anti-rheumatic drugs (DMARDs) like Methotrexate can be prescribed to slow the progression of additional pathologies that may be present; pathologies like arthritis.
In addition to exercises, other physiotherapy modalities can also be sued to treat the condition. Modalities like ultrasound and shortwave diathermy can be used to heat the surrounding tissue. They also facilitate the production and release of endorphins, the body’s natural pain killers. These reduce the pain felt by the individual.
Self-Treatment
Although self-medication is often ill-advised in most medical conditions, it can be very helpful in this case. This treatment refers to exercises that individuals can perform to reduce the amount of pain felt and even remedy some of the anatomical abnormalities associated with the condition. Self-administered treatments in the management of SI joint pain include different kinds of exercises like stretches, and strengthening routines for the lower back and gluteus muscle.
Another factor that leads to neck pain of muscular origin is stress (like lifting a backpack that’s heavier than what you’re used to).
Muscular neck pain usually resolves on its own over time, but analgesics and rest can speed up the recovery.
Manual Manipulation
If the dysfunction is caused by too little motion, manual manipulation by a doctor, physiotherapist or other qualified professionals can help relieve the pain. Some studies have shown the restorative effects of manual manipulation on SI joint pain.
Surgery
Research has shown that surgical treatment in appropriately selected individuals is more effective than non-surgical interventions. However, the key phrase here is appropriately selected. Several non-surgical interventions are just as effective.
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