for sacroiliac joint (SIJ) dysfunction
SIJ dysfunction occurs when the ligaments that help stabilise the joint between your pelvis and spine are compromised. These ligaments restrict the small a amount of movement that occurs in this region, as well as help to reduce forces and loading placed on the area. When they fail to stabilise the region, irritation and inflammation at the joint occurs. This can result in localised pain to the buttocks, sciatic pain, pelvic pain (pudendal neuralgia), groin pain, spasm through the gluteals and hip pain. People with SIJ dysfunction will often report an increase in pain with high-impact activities such as running, hopping and lateral movements. This is because the area is unable to cope with high levels of shearing and loading.
What causes sacroiliac joint dysfunction?
SIJ dysfunction is frequently caused by high-impact accidents, including car accidents and general trauma to the area following a fall, hard running, twisting or awkward lifting. Pregnancy, as well as repetitive loading, can also instigate issues throughout the area.
How do I know if I have sacroiliac joint dysfunction?
Common symptoms will include localised pain to the buttocks region. This will generally be on one side and will travel down the side of your tailbone. Pain can radiate from the buttocks and down the side of the leg (or into your pelvis, scrotum, labia or penis). Additionally, sufferers can experience spasm throughout their gluteal muscles, as well as pain across the base of their lower back.
Aggravating activities can include arching your back, twisting in bed, long car journeys, walking up hills and going down stairs. SIJ dysfunction is difficult to diagnose with more common forms of imaging such as MRI and X-ray. Currently, the most-effective method is a ‘SPECT’ CT scan, which has a high rate of clinical accuracy. This condition is most commonly found in women (68 per cent), as demonstrated in a study conducted by Arthritis Care in 2010, but can also occur in males.
How can physiotherapy help with sacroiliac joint dysfunction?
A physiotherapist skilled in the area of lumbopelvic and hip pain can differentiate sacroiliac pain from other areas that can refer to the region, including the lower back and hip. Your physiotherapist can then design a comprehensive plan of manual therapy to the pelvis and surrounding joints and muscles as needed. This hands-on treatment will be supported with a comprehensive and progressive functional exercise program to build control and dynamic strength through the lumbar spine, pelvis and hips, for everyday life, work and sport.
How effective is physiotherapy for sacroiliac joint dysfunction?
Physiotherapy has been shown to be the most effective treatment for sacroiliac dysfunction. In a landmark research study based in Sydney, 1200 patients were diagnosed with SIJ incompetence both clinically and on CT scan (SPECT). Of these patients, 80 per cent went on to overcome their issues with a comprehensive physiotherapy program, without requiring further specialist injections or surgery. Further, research published in the British Journal of Sports Medicine in November 2012 showed that pelvic pain caused by SIJ dysfunction can be 95 per cent resolved by musculoskeletal physiotherapy.
What can I do at home?
Laying on your stomach with a pillow under the lumbar spine, and a hard-covered book under the pelvic bone, on the painful side, can often help alleviate the pain. This can be combined with ice on the painful joint if inflammation is present, or heat on the bottom muscles if they are tight and overactive. Gentle sit-to-stand exercises from a chair, stopping just before you sit on the chair, can help build the bottom muscles that support the sacroiliac joint. Bike and compression shorts or female contouring undergarments may also be useful for providing compression to the area for pain relief and control.
How long until I feel better?
Generally, SIJ dysfunction requires a change in biomechanical patterning and an increase in strength, particularly through the core and gluteals. This will take a minimum of 12 weeks to achieve. Patients can expect a prognosis between 12-24 weeks before symptoms completely disappear. Ongoing performance of strengthening exercises is required to prevent reoccurrence.