Treatment Options for Sacroiliac Joint Dysfunction (SIJ)

Sacroiliac Joint Dysfunction

Sacroiliac joint dysfunction or (SIJ) occurs when there is hyper or hypo- mobility at one or both of the sacroiliac joints.  The sacroiliac joints are located either side of the spine between the two ilium bone of the pelvis, which attach to the sacrum.

Sacroiliac Dysfunction Symptoms

At our East Perth Physio clinic patients present with pain, usually localised over the buttock, often described as sharp, full, achy, stabbing or shooting pain directly over the joint.  A sharp, stabbing or shooting pain often extends down the back of thigh, usually not past the knee.

Patients with SIJ dysfunction will often report pain in positions of sustained bending forward (lumbar flexion) such as cooking over a bench top, brushing teeth over the sink, pain in the lumbo-sacral region with long periods of sitting and even pain in single leg stance (activities like stairs and putting on pants).  Unfortunately for most, this can be a chronic and ongoing issue or in other cases it is an acute onset that continues to cause pain.

Common Causes & Population of Sacroiliac Dysfunction

Pregnant women – The most common population to suffer with Sacroiliac Dysfunction both during and after pregnancy.  During pregnancy hormones are released relaxing the sacroiliac ligaments to allow for the expansion of the birth canal in preparation for birth.  This makes the sacroiliac joints making them hyper mobile. This can lead to SIJ dysfunction that may resolve spontaneously following the birth, or may continue postnatally.
Women whom have had 1 or more vaginal births are at greater risk of SIJ dysfunction. This includes women who have attempted vaginal delivery but required a caesarian.

Trauma – Forces sustained during a trauma can strain the ligaments supporting the joints, leading to increased motion at the joint.

Surgical Fusion of Lower Lumbar Spine – In the case of a lumbar fusion, the involved lumbar segments become immobile meaning the SIJ has to contribute greater movement to overall range of movement.

Pelvic Ring Fracture 

Hyper-Mobility Disorders 

Two Primary Functions of SIJ

  1. Provide shock absorption for the spine and to transmit forces between the upper body and lower limbs
  2. Seperate to allow for widening of the birth canal

Accurate Diagnosis of Sacroiliac Dysfunction

Several factors make this condition difficult to diagnoses meaning it is often overlooked!

  1. The joint can be hyper or hypo- mobile
  2. The sacroiliac joints usually only have 2-3 degrees of movement, meaning dysfunctional movement is almost impossible to eye ball.
  3. Imagining cannot be used to diagnose SIJ dysfunction, it requires a diagnostic injection
  4. Symptoms very closely mimic an acute lower back pain presentation almost identical presentation in some cases.

This means SIJ dysfunction is often misdiagnosed as acute lower back pain.

Treatment for Sacroiliac Joint Pain

Our East Perth Physio’s are confident in the conservative rehabilitation for SIJ and is more favourable the earlier it is commenced.  Physiotherapy can assist through manual manipulation, soft tissue treatment, strengthening exercises and movement pattern re-training.  Our East Perth Physio’s can also help with support belts or strapping methods which may help to temporarily alleviate symptoms.  For exercise rehabilitation to make meaningful change it needs to be commenced early, regularly and consistently.

In the case that conservative treatment is not sufficient there are a few other options, which are unfortunately are a little costly and timely, in addition to being quite painful in their own right. However, some of them do show very promising results.

  1. Radiofrequency ablation (aka rhizotomy)
  2. Strip ablation
  3. Prolotherapy
  4. Sacroiliac joint fusion

Sacroiliac Joint Diagnosis

In summary, the sacroiliac joint can be difficult to diagnose and treat, however with correct diagnosis and commitment from patient and an Experienced Trained Physio, there is a lot that can be done to relieve pain and improve function.

Our East Perth Trained Physio’s can provide a thorough assessment of your current and previous training, taking into account all lifestyle factors that may be adding to your injury or pain state.  A full body and movement assessment will identify any weakness, imbalances or loading issues and can provide you with movement re-training and strength and conditioning programming and load management advice to keep you training and prevent or resolve any current injuries!  BOOK ONLINE TODAY!

Written by: Olivia Strelein

BSc. Physiotherapy (Honours)
BSc. Exercise and Sport Science
Personal Trainer