What is Sacroiliac Joint (SIJ) pain and how can a PT help???
The sacroiliac joints (SIJ) connect the bones that make up the pelvis (the sacrum and ilium), below the lower back. The SI joints help connect the pelvis to the spine and legs and the SI joints help transfer loads. Pain in this region is very common and often presents itself as pain on either side of the pelvis at this joint, pain in the hip/buttocks muscles, and may also lead to pain radiating down the leg. The symptoms of SIJ pain can sometimes mimic the symptoms of low back pain. This pain can be very debilitating and can impact one’s quality of life.
The three main causes of sacroiliac joint pain are:
Traumatic
Biomechanical
Hormonal
Traumatic SIJ Pain
Traumatic SIJ pain typically comes from a jolt to the sacroiliac joint. There are ligaments surrounding the sacroiliac joints and can be injured due to trauma, such as falling directly on the buttocks or stepping off a curb when you didn’t see it coming. This can then cause a sprain to the ligaments that connect the sacrum to the pelvis. The ligaments can then be inflamed and very painful.
Biomechanical SIJ Pain
Biomechanical SIJ pain typically occurs as a result of muscular imbalances, leg length differences, and pelvic muscle weakness can create misalignment within the pelvis. This can then lead to hypomobility (not enough mobility) or hypermobility (too much mobility). When you have an injury on one side of the pelvis, it can lead to tightness on one side. This can then cause some rotation at the pelvis due to an imbalance on one side, such as the muscles being tight on one side and loose or weak on the other side. This uneven pulling creates a muscular imbalance and can be extremely painful. These symptoms often limit how long we are able to stand, walk, or sit.
Hormonal SIJ Pain
Hormonal SIJ pain is typically what we see at the end of pregnancy and shortly after delivery. There is a hormone that is released, which makes the ligaments increase in laxity, thus they are looser than normal. This is necessary in pregnancy because it opens up the pelvis to allow women to deliver babies. However, this can make it very painful and difficult to stand or walk.
How Can Physical Therapy Help??
In the early (acute) stages of an injury, it is beneficial to perform what I like to call ‘relative rest.’ Basically, this means refrain from excessive activity that irritates or makes your pain worse. Take it easy, focus on light walking for exercise. It can also be beneficial to ice in the initial stages to help calm down any inflammation in the region and to provide some temporary pain relief. Apply the cold for 15 minutes at a time and ensure there is something between the cold/ice and your skin to prevent damage to skin.
Physical therapy can help as your physical therapist will perform a hands-on assessment and perform functional tests to determine the root cause of your pain in order to determine the appropriate treatment plan for you. This may include manual therapy treatment techniques (i.e. soft tissue mobilization, joint mobilization/manipulation, cupping) and therapeutic or corrective exercises.
Below are a few links to various exercises that may help improve the stability surrounding your sacroiliac joints and alleviate your pain. Please consult your physician or physical therapist prior to trialing any of these exercises and stop performing if you experience any pain or discomfort.
Bridge with Isometric Hip Adduction
https://www.youtube.com/watch?v=arhuQmff03Q
Single Knee to Chest Stretch
https://www.youtube.com/watch?v=beEXOoMXIoA
Deadbug
https://www.youtube.com/watch?v=SR3otdMCdBk
Bridge + March
https://www.youtube.com/watch?v=F8EImhZn_so
Figure 4 Piriformis Stretch
https://www.youtube.com/watch?v=2shieY3TXUI
If your pain/discomfort persists, please call 614-437-9002 or email: khartley@grandviewprimarycare.com to schedule an initial assessment with me : )
References
Laslett M. Evidence-Based Diagnosis and Treatment of the Painful Sacroiliac Joint. The Journal of Manual and Manipulative Therapy. 2014; 16 (3): 142-152.