Do you have pain on one side of your lower back (in the small dimple) that sometimes travels into your buttock, upper thigh or groin?
Do you also have issues with transitional movements such as rising after sitting, getting in and out of a car, going up and down stairs or rolling in bed?
If you can relate to these questions above then you may have problems with your sacroiliac joint.
What is the Sacroiliac Joint?
The sacroiliac joint also known as the SIJ is the meeting point between two bones; the sacrum (the tailbone) and the ilium (largest part of the pelvis). This joint is very stable and as such should have very little movement. This joint is involved in shock absorption and helps to transmit forces from the lower body to the upper body and vice versa.
What are the Symptoms of Sacroiliac Joint Dysfunction?
Dysfunction of the sacroiliac joint can be painful and disabling. Patients who suffer from this condition will report having pain around the dimple of their low back (where your tail bone and pelvis connect). Pain can also radiate from this joint into the buttock, the thigh and even the groin. This is why it can sometimes be difficult to diagnose and pinpoint the exact root cause. A physiotherapist, chiropractor or sports medicine physician can help determine the cause and differentiate it from the lower back and hip.
What are the Types of Sacroiliac Joint Dysfunction?
A few different things can occur in a dysfunctional sacroiliac joint:
- The joint can be too mobile and unstable in which case it’s called a hypermobile sacroiliac joint.
- The joint be stiff and/or can shift out of place and become stuck. This is called a hypomobile sacroiliac joint.
- The joint can be inflamed (consistently sore, throbbing, warm, swollen) and this is called sacroiliitis.
What are the Causes of Sacroiliac Joint Dysfunction?
There are many different causes of sacroiliac joint dysfunction. Often patients can recall a big fall on their buttock. It can also be caused by consistently placing more weight through one side of your pelvis such as when crossing your legs, leaning on one arm rest or putting one or both legs under your buttock while you sit for long periods. People who by habit stand with their weight on one leg can also be victims of this condition. This is common condition in young moms who carry a child on their hip when standing.
Other causes of sacroiliac joint dysfunction include:
- Osteoarthritis: Wear and tear of the cartilage between the two bones the sacrum and the ilium.
- Pregnancy or Post-Partum Hormones: The hormones present during pregnancy and while breast feeding relaxes the ligaments that hold the sacroiliac joint tight. This makes the joint too loose and increases the chances that it shifts and becomes stuck out of place.
- Leg length discrepancy: If your legs are two different lengths, then there will be more pressure on one side going up your knee, hip and into your sacroiliac joint.
- Arthritis: Various kinds of arthritis’ including gout, rheumatoid arthritis, psoaratic arthritis, and anklylosing spondylitis can affect the sacroiliac joint causing inflammation and pain.
How can a Chiropractor and or Physiotherapist Help with Sacroiliac Joint Dysfunction?
If you believe that you may have sacroiliac joint dysfunction then you should visit a trusted chiropractor and/or physiotherapist. They will help you determine the source of your pain. If the Sacroiliac joint is causing pain there are typically compensations going on in the hip and lower back. Rehab specialists can use a variety of techniques including hands on manual therapy, individualized exercise prescription, acupuncture or dry needling and other therapeutic modalities. They also have the insight to refer you for other services such as massage therapy or a consult with a Sports Medicine Physician. Their ultimate goal with treatment is to alleviate your discomfort and correct the biomechanics of your sacroiliac joint, allowing you to get back to your lifestyle.
How can you Treat Sacroiliac Joint Pain at Home?
If you suspect that your Sacroiliac joint is the source of your pain, you can try to following strategies to help relieve it:
Start with applying ice over the area. We suggest applying it for 10 minutes, ON/OFF, for a total of 3 repetitions up to 3x/day.
Change your sitting habits
Do not sit with a wallet in your pocket, crossed legs or legs tucked under the body.
Log roll in bed
Move your truck as one unit when rolling in bed. Don’t separate the shoulder movement from the pelvis movement.
Sacroiliac joint belt
This belt is created to help support a irritable or hypermobile joint and provide a similar input to the system as the deep core muscles would provide. Rebalance sports medicine carries the Serola SIJ belt. There are also specialized belts for late stage pregnancy which fit better with your growing hips and abdomen.
What are the Best Exercises for Sacroiliac Joint Pain?
Depending on the cause of the pain your rehabilitation exercise goals will change.
- Knee to chest, repeated on other side.
- Hamstring stretch- lying on your back, hold the back of your knee and straighten your leg
- Hip flexor/quad stretch- lying on your stomach reach back and pull your heal towards your buttock (use a towel to assist in the reach if needed) once your feel a nice stretch on the front of your thigh you can try to lift your knee slightly off the ground. (make sure you keep your core engaged and do not arch or strain in your lower back)
Perform all these stretches 3x30sec 2x/day. If you feel shaky or pain with the stretch back off to feel a more comfortable pulling sensation.
- Transverse abdominis activation in crook lying
- Modified Dead bug
Perform 3 sets of 10-15 reps daily of one of the above exercises depending on your stage of healing.
If any of these exercises cause pain or if you don’t notice a change in your symptoms after a few days, we recommend seeing an experienced physiotherapist or chiropractor who will be able to conduct a thorough assessment and offer individualized exercise prescription as part of their treatment program.
What Should be Avoided with Sacroiliac Joint Dysfunction?
When you divide your legs this distance apart it can put a lot of torsion in the pelvis
Of course, if you have stairs at home, you may not be able to avoid them, but try your best to limit your use of stairs and definitely do not use the stair master or run up and down stairs for exercise. For the same reason as above, stairs can increase strain and torsion through the pelvis and further aggravate your symptoms.
Jumping or running
The Sacroiliac joint is a shock absorber and with running or jumping there is more force/load that is being transferred from the lower body through the sacroiliac joint into the trunk. If the sacroiliac joint is already in an irritated state you will provoke the symptoms even further causing more joint irritation.
Crossing your legs or shifting your weight to one side of your pelvis
This will put extra stress on the irritated joint.
Also, listen to your body. It is best to avoid anything that causes your pain to increase. You may have to monitor your activities and modify them to shorter durations or change them all together. Your chiropractor or physiotherapist can help you learn what things may have contributed to the development of pain in the first place and will work with you to find a solution to fits your lifestyle.
How Long Does it Take to Recover from Sacroiliac Joint Dysfunction?
Once you are aware and start to manage your symptoms, modify your lifestyle, and perform rehab exercises you should see improvements in your symptoms within 2-3 weeks with full resolution in 6-8 wks. However, if you delay seeking treatment or have episodes of irritation during the rehab process it can take even longer to resolve.
In some cases, especially if you had some trauma to the sacroiliac/pelvic region, you may experience flare ups or re-aggravations in your lifetime. It is important that you understand your injury very well and that you are in tune with your body so that you can stay on top of the condition and practice prevention strategies. A good physiotherapist or chiropractor is an educator and will teach you about your condition, your body and will show you where your vulnerabilities are and what exercises/strategies you can utilize to keep your sacroiliac joint functioning well.