The paired sacroiliac joints (SIJ’s) are located at the base of the spine where the sacrum (tailbone) meets the two iliac (pelvic) bones. You can feel them as the two bony ‘dimples’ located above each buttock, just below and to either side of the low back.
The SIJ’s are major weight-bearing joints designed to transfer large loads between the spine and pelvis upon bipedal activities such as walking, running and jumping. The SIJ’s are important for both shock absorption and transferring weight from the upper body and spine to the lower extremity.
The SIJ’s are sometimes also referred to as the pelvic joints and pain from these joints is sometimes referred to as pelvic girdle pain (or PGP).
The SIJ’s have proven to be one of the top three sites capable of generating low back pain, both acute and chronic.
The pelvic joints may be injured any number of ways, but one of the most common is bending and twisting in combination, such as when picking up something incorrectly. Unexpected movements such as a trip, slip or fall, repetitive twisting (raking, mopping, sweeping or vacuuming), a poor golf swing, digging or chopping wood or even sitting on an uneven surface prolonged periods may also irritate or injure the joint.
The pelvic joints undergo changes during pregnancy in order to make them more mobile for the birth process, which may predispose expectant mothers to pelvic girdle pain during the final trimester. People with chronic or recurrent pelvic joint problems commonly have other underlying problems such as issues with the lower limb on the same side, be it foot, ankle, knee or hip. Often there will be weakness in key supporting muscles about the hip and pelvis. Limited mobility about the hips tends to place more strain on both the pelvic joints and the lumbar spine.
Lastly, the pelvic joints are also susceptible to a number of arthritic processes such as ankylosing spondylitis, rheumatoid arthritis, psoriatic arthritis, osteoarthritis and Reiter’s syndrome. Fortunately, these are relatively rare causes of back pain.
The pain is usually localised to the joint, which is off to one side over the ‘dimples’ above each buttock. It is usually an annoying deep dull ache but can be quite sharp and severe, even capable of producing a limp when acute. The pain may radiate across the low back, into the buttock, groin and thigh, but rarely beyond the knee. The pain may be worse when lying on the painful side and it can ‘catch’ when rolling over in bed. Getting in and out of a car seat is often difficult, as is standing on one leg to put on the underwear or socks. Walking up and down stairs may also be difficult.
Most cases of SIJ pain respond dramatically to manipulation, and the initial pain may subside rapidly, however most cases take between 2 – 6 weeks to resolve. It is important to note however, that even if symptoms subside within this time frame, the injured tissues usually take at least 6 weeks to heal fully, and care must be taken when returning to normal activities during this period.
Chronic cases will often have dramatic but only transient relief from manipulation and require a longer period of rehabilitation to see a more lasting result.
Cases of pelvic instability and inflammatory arthritides are generally not suited to manipulation, often require further rehabilitation, bracing and usually take longer to heal. Fortunately, these are relatively rare causes of SIJ pain.
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