Have you ever wondered why you have those two dimples at the base of your spine? Your sacroiliac joints (SI joints) lie beneath these dimples! If you’ve ever had pain in this area you most likely have suffered from SI joint dysfunction. SI joint dysfunction is probably the most misdiagnosed musculoskeletal problem around, but it’s also the easiest to treat in the hands of a well informed physical therapist. It’s one of my favorite things to treat because you can assess the problem and fix it in less than five minutes. My patients walk out of my office happy and pain-free!
Let’s start with the anatomy. You have two illium bones in your pelvis, one right and one left. In the middle is one sacrum (or tailbone). The SI joint is where the sacrum and illium meet. This means you have two SI joints in your body. There are many ligaments that hold these joints together and over 30 muscles that attach onto your pelvic girdle and have an influence on your SI joints.
SI joint problems are most often one-sided. Pain will most often be present on just one side as well. Symptoms include a sharp pain when putting weight on one leg (just under that dimple), a dull ache in the buttock region, or a diffuse ache down the leg. Your symptoms depend on the level of inflammation, duration of symptoms and what type of dysfunction you are experiencing. Females are more at risk than males because of the shape of their pelvis and the hormonal effects on the ligaments that hold the SI joints together. Menstruation, pregnancy, and lactation all loosen the pelvic ligaments and there is a much higher incidence of injury during these times. Individuals who are hypermobile (aka double-jointed) in general have a higher rate of SI joint dysfunction because their ligaments are looser. People with leg length discrepancies and scoliosis also have a higher rate of SI problems because of the chronic asymmetrical forces placed on their joints. All of the above fall into the more chronic category of dysfunction, but you can also have incidental cases. These most often result from a fall onto the buttocks, a missed step, asymmetrical lifting or a car accident.
In order to get rid of your SI joint dysfunction you’ll need to be properly diagnosed by your doctor or physical therapist. We look at where your pain is located, how your SI joints move, and use bony landmarks to assess the position of the illia and sacrum. From there a physical therapist will direct a treatment specifically for your dysfunction. If the correct treatment is chosen and applied sufficiently, pain should be resolved, and motion and position should be restored to normal. The treatment is easy to apply and can be taught to be done at home, as needed. Abdominal and gluteal strengthening exercises and hip stretching are also commonly prescribed in order to prevent recurrence.
Click here to view one exercise that may help.
Contact BaySport for an injury check or if you think you have SI joint dysfunction.
Jennifer just so happens to be pregnant, hypermobile, scoliotic, and have a leg length discrepancy….therefore, she also has SI joint dysfunction. This article was written with personal and professional experience.
Work cited: The Pelvic Girdle, Richard Jackson, PT, OCS
Hi,
I am a PAc working with many auto cases and I found many SI dysfunction.
I usually suggest steroid injection as my treatment plan. Can you help me out from a physical therapy perspective. Thanks advance.
Ruan PAC
Hi Ruan,
This is the response from our BaySport Physical Therapy team:
A physical therapist would be able to do movement testing to see which SI joint is affected. The painful side is not always the affected side. And, of course, the lumbar spine should be cleared to make sure there are no segments referring to the SI area. In addition, there are muscles that can refer to the SI area as well. Most times, after my physical therapy assessment, I will find various components causing pain over the SI area. We, as physical therapists welcome referrals from PA.C’s. Physical therapy would be directed to correcting any lumbar or SI dysfunctions, teaching appropriate stretching and strengthening exercises to maintain corrections, and posture and body mechanics instruction.
I am conducting a study with NSF to understand the sacroiliac pain patients needs. Please contact me at jeremileasure@mdevdev.com asap if you would like to be included in these interviews.