What is the sacroiliac joint (SIJ)?
The sacroiliac joint (SIJ) attaches the sacrum (which is the base of your spine) to the pelvis. Because of its location at the base of the spine and pelvis, there is a significant amount of weight-bearing forces being transmitted through this area. For this reason the joint is fairly stiff and is held together by thick bands of ligaments. However, the SIJ does allow a small degree of movement in the pelvis and sacrum to allow us to walk and use our legs individually.
What is SIJ pain?
SIJ pain occurs when there is a lack of force closure to support and stabilise the SIJ. Force closure is created by the muscles surrounding the SIJ maintaining a force to close and stabilise the joint. When these muscles are weak or imbalanced, force closure is decreased. This leads to excessive movement in the joint causing extra stress on the ligaments which is accompanied by irritation and inflammation in the joint.
Symptoms of SIJ pain
People with SIJ pain may experience:
- Pain in the hip, buttocks or groin area
- Pain in the lower back
- Sciatic like pain
- Spasms in the glute muscles
- Pain with walking, going up or down stairs, or with any single leg activity
- Pain with standing from a sitting position, turning in bed, bending, or twisting
- Feeling of instability in the pelvis like it is going to give way
- Muscle tightness and tenderness in the hip/buttock region
- Pain with prolonged sitting
- Pain that is worse when standing and walking, and eases when sitting or lying down
Causes and risk factors for SIJ pain
Some common causes and risk factors of SIJ pain include:
- High impact accident to the pelvic region
- Gait issues such as leg length discrepancies
- Pregnancy or recent childbirth
- Activities which repetitively stress the joint
Treatment strategies for SIJ pain
SIJ pain can be managed with conservative treatment which focuses on alleviating pain, restoring your functional range of motion and strengthening muscles to improve force closure and stability around the SIJ. A physiotherapist can differentiate SIJ pain from other conditions such as lower back pain or hip impingement as well as assess body alignment, muscle imbalances and functional biomechanics. A treatment plan will then be created by a physiotherapist in collaboration with the patient which may include manual therapy and targeted exercises to rehabilitate the joint and prevent ongoing pain. Some treatment strategies may include:
- Anti-inflammatory medication: Due to the inflammation in the joint, initially you may want to take anti-inflammatory medication for the first 5 days to reduce the pain and inflammation. Simple over the counter anti-inflammatories will suffice, however, if you require something stronger it is best to speak with your GP.
- Bracing: Wearing a brace around the pelvis will help to keep the pelvis stable and prevent excessive stresses on the SIJ. Wearing a brace is only a temporary treatment strategy to alleviate pain and support the joint while the muscles are still building strength.
- Manual therapy: This includes soft tissues release, dry needling and joint mobilisation to help release stiff joints and tight muscles to bring the pelvis back into its optimal alignment and alleviate the pain. This is also a temporary treatment strategy as the body will revert back to the painful position with our daily habits. The physiotherapist can show you how to release the muscles yourself with stretches and foam rolling to maintain the muscle length.
- Pelvic stability exercises: The physiotherapist will make a tailored exercise program that will target the muscles which are weak and causing the pelvis to be unstable. Pelvic stability generally relies on strengthening the deep core muscles and the deep gluteal muscles. Below are some exercises you can try to improve your pelvic stability.
Dead Bugs and Bent Knee Fall Outs
Glute Bridge and Clams