SI Joint Pain and Treatment

Sacroiliac Joint Dysfunction

What are and where are the Sacroiliac Joints?

The sacroiliac joints are 2 large joints in the pelvis that connect the pelvis to the bottom of the spine, or sacrum. These joints are named for their position: sacro (like sacrum) + iliac, or the ilium, which is part of the pelvis. You can find these joints on yourself by finding the dimples at the back and top of your pelvis. Just to the midline and slightly below this are each of your sacroiliac joints. 

In children and adults of childbearing age (<50 years of age), the SI joints naturally rotate as we walk and move. The SI joints also need to be flexible enough to allow for giving birth. However, as we age, the SI joints become stiffer. In one study, 37% of SI joints in men over the age of 50 were so stiff that they had become completely fused. (Brooke R: The sacroiliac joint. J Anat 58:299-305, 1924)

Am I suffering from Sacroiliac (SI) Joint Pain? What are the Symptoms of Sacroiliac Joint Dysfunction?

Sacroiliac joint pain, low back pain, and hip pain can be very similar in nature and may be very hard to differentiate from one another. It is thought that SI joint pain can account for 25% of lower back pain cases. (Simopoulos TT, Manchikanti L, Gupta S, Aydin SM, Kim CH, Solanki D, Nampiaparampil DE, Singh V, Staats PS, Hirsch JA. Systematic Review of the Diagnostic Accuracy and Therapeutic Effectiveness of Sacroiliac Joint Interventions. Pain Physician. 2015 Sep-Oct;18(5):E713-56. [PubMed]). 

Typically, sacroiliac joint pain can be pinpointed to one side of the bottom of the spine just to the midline and below the dimples in your pelvis. In fact, the ability to point a finger to this precise area, if painful, is called the Fortin finger test, a fairly reliable indicator of SI joint pain as a pain source. Pain from the SI joints can radiate into the buttock and the upper thigh, but pain typically does not radiate pain below the knee. Demographically, the majority of SI joint problems occur in younger adults, although a smaller proportion of older adults can suffer from SI joint pain as well.

In people suffering from SI joint pain, rolling in bed, lying on the affected side, weight bearing on the affected leg, sitting down on the affected side, and climbing stairs can all be very uncomfortable activities. Sometimes SI joint pain can cause a clunking or clicking feeling to occur in the pelvic region at the bottom of the spine.

What causes Sacroiliac joint Dysfunction? What are the Types of Sacroiliac Joint Dysfunction?

Most commonly sacroiliac joint dysfunction is seen in younger adults as a problem of hypermobility, or where the joints move too much and cause pain. This is very common after childbirth when the joints of the pelvis are traumatized and stretched to make way for the baby. When the SI joint moves too much, this can cause pain. 

The sacroiliac joints can also move too little and also cause pain. These joints can either be stiff and move less than normal (termed hypomobility), or they can lock out of their normal position and  not be able to move at all (termed subluxed). 

Sometimes muscle imbalance, where certain muscles that attach to the pelvis are too stiff and other muscles that are too weak, can cause the pelvis to be misaligned, function incorrectly and create SI joint pain.

How is Sacroiliac Joint Dysfunction treated?

Your physiotherapist will assess your lower back, pelvis and hip region to properly diagnose the source of your pain. Once it is determined that your SI joint is problematic, there are several physiotherapy approaches available to give you relief, depending on the type of problem found:

  • Stretching exercises for the lower back, pelvis and hip region
  • Core stability and strengthening exercises
  • Joint mobilization or manipulation
  • Ergonomic or postural advice
  • Use of a sacroiliac joint brace
  • Frictions to trigger points found in tight muscles
  • Acupuncture or dry needling techniques for pain control or to resolve trigger points
  • Electrophysical agents for pain control such as interferential current or ultrasound

COVID-19 Policies and Procedures

Covid-19 Physiotherapy Policy

With respect to the need for our community to observe social distancing and minimize the risk of spreading COVID-19, we initially closed our doors March 27th to in-person physiotherapy services, and implemented a plan for Tele-rehabilitation services. This is a method of virtual care, also known as Telehealth or Teletherapy, allowing our valued clients to connect with their physiotherapist from the safety of their own home using teleconferencing technology. We’ve had much success supporting our valued clients through tele-rehabilitation since April 6th, and as of May 4th, we have transitioned to a hybrid model of care. This includes a combination of in-person physio and tele-rehabilitation based on client screening, prioritization and appropriateness. Massage therapy appointments available starting June 15th. You are welcome to contact us for an appointment.

We are committed to keeping our valued clients and staff safe through the following methods in our clinic:

  • Waiting room seating capacity reduced, with visits by appointment only. Staff and clients to wear masks and adhere to social distancing recommendations
  • Facilitating the completion of paperwork & intake forms that can be completed before (rather than during) appointments
  • Reducing therapists’ client caseloads to 50% of normal (or less)
  • Physical distancing: Our clinic configuration has been changed to increase physical distancing between clients
  • Non-contact thermometers and COVID-19 screening questionnaires are done daily for all staff and clients
  • Personal Protective Equipment: A cough screen has been installed at our reception desk, and we require continuous masking by all clients and staff, along with the use of gloves and face shields by staff when appropriate
  • Diligent Hygienic and Cleaning Practices: All staff and patients are required to use hand sanitizer/wash hands upon entering the clinic as well as before and after using treatment/exercise equipment. Therapists continue to wash hands frequently, with extra diligence. Exercise equipment is sanitized between each use. Our cleaning staff regularly wipe down all points of contact between clients and therapists in our clinic with an AHS-recommended disinfectant solution. 
Using technology for tele-rehabilitation.

Our massage therapy services resumed on June 15th, 2020, following the Alberta provincial strategy for re-opening, as directed by the Chief Medical Officer of Health.

We are closely following developments and health authority recommendations regarding the global COVID-19 pandemic. We are acutely aware of our responsibility to minimize the risk to our clients and employees and we are following guidelines set by the Government of Alberta and Alberta Health Services (https://www.albertahealthservices.ca/topics/Page16947.aspx).

For more information on coverage and funding for physiotherapy, including physiotherapy through tele-rehab, check out our Announcement Page.

Tele-Rehabilitation Announcement and Coverage

Edmonton Tele-Rehabilitation Direct Billing through Tawa Physiotherapy

Great news, Tawa Physical Therapy is approved for direct billing for Tele-Rehabilitation sessions through our secure video Tele-Rehabilitation platform. Just let us know who your provider is and your plan number, and we can do the rest for you.

Will my insurance pay for Tele-Rehabilitation physiotherapy?

Yes! Workers Compensation Board (WCB) is paying for Tele-Rehabilitation physiotherapy treatment. All personal/group/extended health benefits insurance companies that bill through the Telus Health Portal accept Tele-Rehabilitation services. Here are the specific insurance companies that are included under Telus Health as well as their contact phone numbers:

BPA – Benefit Plan Administrators 1-800-867-5615

Canada Life 1-800-957-9777

Canadian Construction Workers Union 416-240-0047

Chamber of Commerce Group Insurance 1-800-665-3365

CINUP 1-800-665-1234

ClaimSecure 1-888-513-4464

Cowan 1-888-509-7797

Desjardins Insurance 1-800-463-7843

First Canadian 1-866-212-5644

GMS Carrier 49 1-800-667-3699

GMS Carrier 50 1-800-667-3699

GroupHEALTH 1-833-344-6944

GroupSource 1-888-547-6947

Industrial Alliance 1-877-422-6487

Johnson Inc. 1-866-773-5467

Johnston Group Inc. 1-800-893-7587

LiUNA Local 183 416-240-2103

LiUNA Local 506 416-506-8841

Manion 1-866-532-8999

Manulife Financial 1-866-407-7878

Maximum Benefit 1-800-893-7587

Sun Life Financial 1-855-301-4786

TELUS AdjudiCare 1-877-944-7100

In addition, Blue Cross 780-498-8000 , Green Shield 1-888-711-1119, SSQ 1-888-651-8181, and Empire Life 1-800-561-1268 also cover Tele-Rehabilitation. 

Most MVA insurers are paying for Tele-Rehabilitation. With respect to motor vehicle injuries, we recommend you call your insurance adjustor directly to confirm that they will cover physiotherapy fees for Tele-Rehabilitation sessions. 

Alberta Health Services (AHS) recently announced their support for funding Tele-Rehabilitation through contracted clinics. As of April 24th, we are able to provide AHS funded Physiotherapy Virtual Services for those that meet the criteria set out by AHS.

Does Tawa Physical Therapy direct bill to my insurance provider? 

Yes! We will direct bill all insurance companies that are serviced through the Telus Health Portal. As various plans differ even within specific insurance companies, please call your insurance provider directly to check on your specific plan details.

Vertigo and Inner Ear Issues such as BPPV and vestibular neuritis

Symptoms: dizziness, spinning sensation, nausea, can be constant or episodic in nature depending on the cause
Cause: BPPV associated with age >50, linked with osteopenia, vestibular neuritis caused by an inner ear infection
Treatment: manual therapy techniques such as the Epley Maneuver or BBQ Roll, therapeutic exercise for adaptation and habituation of the vestibular apparatus, patient education
Other Interventions: SERC or antiemetic medication for dizziness or nausea, consult with an ENT, otologist, or neurologist to rule out other more serious conditions that might require surgery