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