Understanding Sacroiliac Joint Dysfunction
Sacroiliac joint dysfunction (SIJD) is a condition that affects the sacroiliac joints, located where the sacrum (the triangular bone at the base of the spine) meets the iliac bones of the pelvis. You may refer to my earlier post at here. I explain the anatomy of the low back in detail. These joints play a vital role in absorbing shock between the upper body and the legs. When they become inflamed, misaligned, or restricted, they can cause significant discomfort and dysfunction. SIJD can be challenging to diagnose, as its symptoms often mimic other conditions like sciatica or hip problems.
What is Sacroiliac Joint Dysfunction?
The sacroiliac joints (SI joints) are responsible for transferring weight and forces between the upper body and lower body. They are located on either side of the sacrum, where the sacrum meets the ilium (the large bones of the pelvis). These joints are reinforced by a complex system of ligaments and tendons that help stabilize the pelvis.
Sacroiliac joint dysfunction occurs when there is either excessive movement (hypermobility) or insufficient movement (hypomobility) in these joints. When the joints don’t function properly, they can become inflamed, irritated, or misaligned, leading to pain in the lower back, buttocks, and pelvis. Remember the last article we discuss on the types of pain, this is considered nociceptive in nature as it is, by definition, strictly a mechanical problem. In some cases, the pain may radiate down the leg, which can make it difficult to distinguish from sciatica.
What Causes Sacroiliac Joint Dysfunction?
Several factors can contribute to the development of SIJ dysfunction. Here are the most common causes:
Trauma or Injury: A fall, car accident, or sports-related injury can cause a misalignment of the sacroiliac joint. In some cases, a traumatic injury may cause the joint to become hypermobile or hypomobile, leading to dysfunction.
Pregnancy: During pregnancy, the body releases the hormone relaxin, which helps loosen the ligaments to prepare for childbirth. While this is a natural process, it can cause the sacroiliac joint to become unstable, leading to pain. Many pregnant women experience temporary SIJD as a result.
Arthritis: Conditions such as osteoarthritis or rheumatoid arthritis can lead to degeneration in the sacroiliac joints. This degeneration can cause inflammation, stiffness, and pain. Inflammatory conditions like spondyloarthritis (a type of arthritis that primarily affects the spine and sacroiliac joints) can also contribute to SIJD.
Uneven Leg Length: People with a leg-length discrepancy may develop sacroiliac joint dysfunction. The uneven distribution of weight on the pelvis can place additional stress on one side of the sacroiliac joint, leading to inflammation and pain.
Repetitive Stress and Poor Posture: Poor posture, especially while sitting for extended periods or lifting improperly, can lead to misalignment of the pelvis and sacroiliac joint. Over time, this can lead to chronic irritation and dysfunction.
Degenerative Changes: Through age and weakening of the ligaments and cartilage in the sacroiliac joint, it may lead to reduced stability and increased friction. This wear-and-tear can result in SIJD symptoms.
Symptoms of Sacroiliac Joint Dysfunction
The symptoms of SIJD can vary, but the most common signs include:
Lower Back Pain: This is often felt deep in the lower back or directly over the sacroiliac joints. It can be a dull ache or sharp pain.
Pain in the Buttocks and Hips: This is a hallmark symptom of SIJD. The pain may be localized to one side of the body, but it can also affect both sides.
Pain Radiating Down the Legs: Similar to sciatica, the pain from SIJD can sometimes radiate down the thigh or leg. However, the pain from SIJD is usually more localized to the lower back or pelvis.
Stiffness and Limited Mobility: People with SIJD often experience stiffness in the lower back and pelvis, especially when getting out of bed or standing after sitting for long periods.
Pain with Certain Movements: Movements like sitting for long periods, standing up from a seated position, bending forward, or climbing stairs can worsen symptoms.
Pain While Sleeping: Lying on one side, especially for long periods, can increase pressure on the sacroiliac joint, making the pain more noticeable at night.
How Is Sacroiliac Joint Dysfunction Diagnosed?
Because the symptoms of SIJD can overlap with other conditions, such as herniated discs or sciatica, diagnosis can be challenging. A healthcare provider will usually begin with a thorough physical exam and review of the patient’s medical history.
Diagnostic techniques may include:
Palpation and Movement Tests: Pressing on the area around the sacroiliac joints will elicit tenderness or show signs of swelling. There's an orthopedic test called Gaenslen test where I use to decipher the source of pain.
Imaging Tests: X-rays, MRI scans, or CT scans may be used to rule out other causes of pain, such as fractures, tumors, or herniated discs. However, imaging tests alone often cannot definitively diagnose SIJD, unless it's autoimmune in nature.
Injections: In some cases, a diagnostic injection of local anesthetic into the sacroiliac joint may be used. If the injection relieves the pain, it can confirm that the SI joint is the source of discomfort.
Preventing Sacroiliac Joint Dysfunction
While some causes of SIJD (such as pregnancy or trauma) are unavoidable, there are steps you can take to reduce your risk:
Maintain a healthy weight to reduce stress on your joints.
Stretching the gluteal (buttock) muscles, as well as, the piriformis muscles.
Stay active and engage in regular exercises that strengthen the core, hips, and lower back.
Practice good posture while sitting, standing, and lifting.
Wear cushioned shoes with good support to help maintain proper alignment.
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