Sacro-Iliac Dysfunction

Back and pelvic pain affects much of the western populations. The significance of the pelvis in producing low back pain and referred pain to the buttocks and legs is becoming increasingly evident. It is believed that up to 30% of chronic low back pain has some symptoms related to the sacro-iliac joint.

ANATOMY

The sacroiliac joint (or SIJ) is the joint in the pelvis between the sacrum (tail-bone) and the ileum. It is bound together by strong ligaments. The joint is a strong weight-bearing synovial (meaning surrounded by capsule) joint with irregular ridges and grooves that lock together to enhance congruency and thus stability.

The pelvis is the bony link between the spine and the lower limbs, and its main function is for transmission of forces from the spine to the legs and to provide attachment sites for 30-odd muscles.

It is believed that there is a very small amount of movement that occurs at the SIJ and the pubic symphysis joint at the front, and if this small amount of movement is altered it can result in pain.

 

SYMPTOMS

The symptoms of SIJ dysfunction can be varied. Often people complain of pain over the buttock area, groin, front hip, side thigh, and occasionally into the lower back or lower leg. Some can have altered control of bladder function.

This pain can be present with sitting, rising from sitting, turning over in bed and commonly with walking and standing on one leg. Pain can arise after a fall onto the bottom or knee, a lifting injury, or maybe during labour. In some cases pain has arisen insidiously from poor control of the muscles that surround and attach to the pelvis. SIJ dysfunction is common during pregnancy, related to the increased levels of relaxin hormone that increases the laxity of the pelvic ligaments.

 

TREATMENT

Treatment is based on a thorough assessment from your Physiotherapist.

Usually treatment consists of deep muscle release with massage and then techniques to help ‘re-align’ the pelvis. It is then important to maintain the pelvic alignment by activating the stabilising muscles.

Stability of the lumbopelvis occurs initially from good control of the deep ‘core’ muscles, namely pelvic floor muscles, transversus abdominus and lumbar multifidus. These muscles can be viewed with a real-time ultrasound machine, which is the ‘gold-standard’ for assessment and training activation. Lumbopelvic stability is assisted by global muscles, or the outer unit, during more dynamic movements and high-level activities. Occasionally stability needs to be enhanced with a sacro-iliac support belt for a period of time.

Co-ordinated activation of all the appropriate muscle forces produces optimal muscle and joint function for movement.

Your Physio will design an individual-specific program to address the above motor control problems. Clinical pilates is also a great way to improve strength and function of the spine and pelvis, especially to address the dynamic challenges that come with sport.

 

Web resource:
www.amta.com.au

Reference:

Lee, D. (2004). The Pelvic Girdle; an approach to examination and treatment of the lumbo-pelvic-hip region. Edinburgh: Churchill Livings