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SACROILIAC JOINTGENERALSacroiliac joint pain (or sacro-iliac joint or simply SIJ) is unique because it is a most unusual joint, like no other in the body. Thus it comes as no surprise that the diagnosis and treatment of the sacroiliac joint requires specialized tests and training. Medicine has long doubted that a joint that moves as little as the SIJ can cause so much back pain. In fact early medicine denied there was any movement in the SIJ. This was ultimately proved by an innovative Swiss chiropractor Dr FW Illi who did research on fresh human cadavers, proving that the SIJ was indeed a moveable joint. The symptoms of back pain emanating from the SI joint are difficult to distinguish from other types of low back pain. Specialised testing of the SIJ is required.
FROM THE COAL-FACE"Doctor, I have pain down here in my buttock.' Mrs Thompson was an attractive thirty year old woman, obviously in the last trimester of her pregnancy.'Is your pregnancy otherwise routine? No problems?' 'Yes, I'm fine. My doctor says it's part of pregnancy, and there is nothing to be done. He said it will go away after the birth.' 'Yes, and no. A hormone is released around this time making you vulnerable to sacro-iliac pain. No, because there is much to be done. We have various techniques that can treat you quite safely. And no, because there is no guarantee it will go away after your baby is born.' 'What should I do?' 'Let's start with an examination to see if this is a chiropractic problem or not.
ANATOMYThe pelvis consists of a ring of three bones: Two large pelvic bones, each called an ilium (plural ilia, adjective iliac) joined in the front at the Symphysis Pubis. The sacrum (or tailbone) makes a movable joint, called the sacroiliac joint, where it connects with each ilium. The sacrum, sitting neatly between the two iliac bones, thus forms the foundation for the whole spine.The skilled doctor has little difficulty in detecting SI joint motion, and the lack thereof, during the normal physical examination. One of the big problems is that the SIJ may also lock in other syndromes. For example, it often fixates in the patient with an arthritic hip. Which is the primary problem remains open to debate and further research. Could it be a fixated SI joint could be a major contributor to arthritic degeneration in the hip?
CAUSESCommon causes of sacroiliac joint pain are injuries: a direct fall on the buttocks, as in skating, a motor vehicle accident, or even a blow to the side of your pelvis, as may happen in a fall in the kitchen. A fall on the sacrum is particularly dangerous. The force from these falls can further strain the tough bands of ligamentous tissue that hold the ilium and the sacrum tightly together. Tearing of these ligaments can lead to excessive motion in the joint, eventually leading to wear and tear of the joint.However, it is considered that degenerative arthritis is even more likely to be caused by joint locking, which starves the joint cartilage of nutrients and oxygen, and causes the build up of waste products in the joint. Sometimes pain occurs because of an abnormality of the sacrum bone itself. The sacrum is actually a very specialized set of bones, like the bones that make up the spine. These bones fuse together around the twelfth year. However, in some people, the bones that make up the sacrum never fuse together properly, creating a malformed sacroiliac joint; a false joint occurs. This is sometimes called a "transitional” segment, possibly causing a greater likelihood of low back pain. Women are at risk for developing SI joint problems in pregnancy and after childbirth. During pregnancy a female hormone is released that allows the ligaments in the pelvis to relax. This is necessary so that during a normal birth, the female pelvis can stretch enough to allow the baby through the ring of the pelvis. This stretching results in changes to the SI joints, making them "hypermobile" - extra or overly mobile, and vulnerable to injury. During pregnancy, the SI joints can cause discomfort both from the effects of the hormones that loosen the joints, and from the stress of carrying a growing baby in the pelvis, and from fixations that may form in the sacro-iliac joint.Many other diseases sometimes can lead to degenerative of the SI joints. Chiropractors believe that fixations or ‘locks’ in the SIJ are one of the main causes of low back pain. SYMPTOMSSacroiliac joint problems have numerous symptoms: Low back pain Buttock painThigh and groin painSciatic-like pain - pain that travels from the sciatic nerve in the lumbar region into your buttocks, back of the thighs, and sometimes the calf and foot. The pain is typically caused by irritation of the nerve roots that join outside the spine to make up the sciatic nerve. You might feel numbness, tingling, or burning sensations in the leg.Sitting is often difficulty and painful, especially in the car. Using the clutch and accelerator may be painful.Often there is a confusing pattern of back and pelvic pain making diagnosis of SI joint problems more difficult..DIAGNOSISThe diagnosis usually begins with a history of the problem. Your health care provider will want to ask you questions such as:Have you been seriously injured?How long the problem has been bothering you?Where is the pain?Does it keep you up at night?Is there weakness or numbness in either leg?Do you have problems urinating?Following this, your doctor will perform a physical examination to try to find the source of your back pain. Many of the tests will be trying to determine whether the problem is coming from the spine or from the SI joint, or even the hip joint. What complicates the diagnosis of the SIJ is that fixations are often accompanied by a different clinical condition, the lumbar facet syndrome. For more information, click here. Your clinical exam may include the following orthopedic tests used to determine if the SI joint is indeed the primary problem. TESTS
The joints in the lower leg are vulnerable if the SIJ is fixated. Ankle sprain for example may occur. For more information about the ankle, MOTION PALPATIONAccording to Magee, in his textbook Orthopedic Physical Assessment: "All joints, to some extent, are capable of an active range-of-motion, termed voluntary movement. In addition, there is a small range of movement that can be obtained only passively by the examiner; this movement is called JOINT PLAY, or accessory, movement.These accessory movements of the sacroiliac joint are not under voluntary control; they are necessary, however, for full painless function of the joint and full range-of-motion of the joint. Sacroiliac Joint dysfunction signifies a loss of JOINT PLAY movement. The existence of joint play movement is necessary for pain free voluntary movement to occur. If the JOINT PLAY movement is found to be absent, this movement must be freed before functional voluntary movement can be fully restored. This is best done by skilful manipulation. X-raysX-rays may be recommended by your chiropractor to determine if there are abnormalities of the sacroiliac joint or a malposition due to injury or a short leg.This is also to rule out other disease, and degenerative change in the pelvis which is common as we age.
"A picture is worth a thousand words." Sometimes a picture's not worth a cent. It may even be very misleading. Love to read? You'll enjoy this true story. TREATMENTIf your MEDICAL doctor feels that your back pain is coming from sacroiliac joint, you will likely be presented with two completely different treatment options which may appear to be exact opposites - MANIPULATION or STABILISATION. Why would the two treatments for one joint be so different?No one really knows what causes the pain from an sacroiliac joint that is not suffering from severe degenerative arthritis. In some cases, it appears that the joint is "too stiff" or "locked" and needs to be more mobile to function correctly. In these cases, the pain seems to respond to mobilization and manipulation of the joint. In other cases, especially when there are definitely arthritis changes noticeable on X-rays, reducing the mobility of the joint for a period may decrease the pain. The appropriate treatment is still hotly debated by many health providers. Your CHIROPRACTOR is more likely to take the mobilization/ manipulation approach but the stabilization approach using a belt is favoured by some cases. MOBILISATION of the joint may include exercises and manipulation. This type of therapy is directed to loosening up the joint ligaments, allowing the joint to move in a normal fashion. Stabilization of the joint may TEMPORARILY find benefit in a corset, but muscle strengthening and pelvic stabilization exercises are in the LONG TERM of more benefit. Today, the surgical fusion of the SI joint is not a common operation, except after extreme trauma to the pelvis..
Return from TREATMENT to general SIJ page.
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