What is Sacroiliac Joint Dysfunction, and What are its Implications for Exercise?

Sacroiliac Joint Dysfunction can have very uncomfortable symptoms, such as sharp or hot pain in the lower back, as well as a referred pain which feels like it is shooting down the buttocks and legs. It can make being active very unappealing, but with the right treatment and co-operation between your physiotherapist and/or chiropractor and a qualified exercise specialist, certain types of physical activity can play a key role in managing and alleviating this condition.

What is the Sacroiliac Joint?

UntitledThe Sacroiliac Joint (or SIJ) is the site where the sacrum (or lower part of your spine) joins the ilium (your pelvis).

Its main purpose is to provide stability and to act as a shock absorber, although its supporting ligaments do allow for a small degree of movement in order to minimise the distribution of forces through to the lower body [1,2,6,7]. This means that while there is some degree of movement within this joint, you cannot move it voluntarily – there are no muscles which cross this joint.

How does Sacroiliac Joint Dysfunction develop?

Sacroiliac joint dysfunction describes any deviation in the normal movement of the joint. This includes hypermobility – too much motion – and hypomobility – restricted motion. When dysfunction occurs, inflammation of the ligaments can cause pain at the site, or interfere with nerves and cause referred pain, including a pain that mimics sciatica [1].

Sacroiliac joint dysfunction and its associated localised and referred pain can be experienced during pregnancy, as the ligaments throughout the whole body are more lax at this time due to high levels of the hormone relaxin [2,4]. Other common causes include impact or trauma (such as from a car accident), a discrepancy in leg lengths, or chronic postural and muscular imbalances.

How is it treated?

Treatment for sacroiliac joint dysfunction can include rest, ice-packs, heat therapy and anti-inflammatory medications; chiropractic manipulations; exercise therapy; corticosteroid injections; and in chronic cases which do not respond to other treatment, surgery to fuse the joint. [8]

Understanding of the structures and muscles which influence this joint, however, also leads to an understanding that correctly prescribed exercise can play an important role in managing this condition.

Before a rehabilitative exercise program is designed, the client needs to be assessed, along with the function of the surrounding joints, such as the knee and hip, as any dysfunction in these joints can also have an effect on the movement of the sacroiliac joint.

The role of the inner core unit and the thoracolumbar fascia (a corset-like band of connective tissue that surrounds the abdomen) and the muscles which act on it must also be considered. Multifidus, latissimus dorsi, gluteus maximus, and erector spinae, when activating correctly, all contribute to stability of the sacroiliac joint by increasing tension through the thoracolumbar fascia. [5]

The rehabilitation of sacroiliac dysfunction usually begins with a reprogramming phase, where the client is taught to correctly isolate and activate transversus abdominus and to stabilise the pelvis statically. Once this can be achieved, the client’s ability to stabilise the core and pelvis while moving the extremities is trained. Once the pelvis is stable, the other larger phasic muscles (particularly those that act on the thoracolumbar fascia) are trained. [5]

What does this mean for me?

After your initial assessment, which may include an assessment of your posture, flexibility and walking gait, a rehabilitative program will be designed based on the specific areas identified for improvement, along with information supplied by your physiotherapist or chiropractor. Because there are many different ways that SIJ Dysfunction can develop, exercise programs must be highly individualised.

It is most likely that your rehab program will include a range of core exercises. I don’t mean sit-ups or leg-raises – these exercises will appear deceptively easy, but require a lot of focus on isolating muscles of the inner core unit, such as transversus abdominus. These exercises are most effective when performed well within your abilities at high frequency. You won’t be “feeling the burn” with this type of program, but you will be asked to be disciplined in performing the exercises once or twice per day in your own time.

Your program will be progressed based on improvements in your ability to isolate and activate your inner core. Simple exercises to improve pelvic stability, along with stretches to relieve tightness of any muscles which are contributing the SIJ Dysfunction, may also be necessary. Eventually your program will include exercises designed to help you to stabilise your core and maintain correct posture while your limbs are moving, and when appropriate when your core itself is moving. Finally, work may also be done on the larger muscles which can increase the supportive tension of the corset-like thoracolumbar fascia.

I cannot emphasise enough the importance of getting personalised assessment, treatment and exercise programming, due to the many individual factor involved in this condition.

If you’d like to read more about one of my clients’ experience with exercise and SIJ Dysfunction, please click here.

 

If you’re interested in incorporating exercise into your strategy for managing injury or chronic pain, call me on 0422 124 244, e-mail me at maelinleow@gmail.com or leave a comment in the space below.

 

Reference List

 

1. Buijs, E, Visser, L & Groen, G 2007, Sciatica and the sacroiliac joint: a forgotten concept, British Journal of Anaesthesia, viewed 27th August 2013, <http://bja.oxfordjournals.org/content/99/5/713.full.pdf+html>

2. Cohen, S 2005, Anesthesia & analgesia, International Anesthesia Research Society, viewed 27th August 2013, <http://www.anesthesia-analgesia.org/content/101/5/1440.full.pdf+html>

3. Houglam, P 2005, Therapeutic exercise for musculoskeletal injuries second edition, Human Kinetics Publishers, Urbana-Champaign.

4. Kendall, F, McCreary, E, Provance, P, Rodgers, M, Romani, W 2005, Muscles: testing and function with posture and pain; fifth, North American edition, Lippincott Williams & Wilkins, Baltimore.

5. Lee, D 2005, Recent advances in the assessment and treatment of the sacroiliac joint – stability & the role of motor control, Diane Lee & Associates, viewed 27th August 2013, <http://www.dianelee.ca/articles/RecentAdvancesoftheSIJl.pdf>

6. Nestor, K & Sheilder, K, Sacroiliac joint, Physiopedia, viewed 12th October 2013, <http://www.physio-pedia.com/Sacroiliac_joint>

7. Ullrich, P 2010, Sacroiliac joint anatomy, Spine-Health, viewed 12th October 2013, <http://www.spine-health.com/conditions/spine-anatomy/sacroiliac-joint-anatomy>

8. Yeomans, S 2010, Treatment options for sacroiliac joint dysfunction, Spine-Health, viewed 12th October 2013, <http://www.spine-health.com/conditions/sacroiliac-joint-dysfunction/treatment-options-sacroiliac-joint-dysfunction

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