Sacroiliac Joint Syndrome

You innocently bend over to pick something off the floor and suddenly— low back pain! Examination by your doctor reveals that you haven’t got a disk injury or a hip problem and your blood work doesn’t demonstrate any inflammatory arthritic conditions, yet you still don’t have a diagnosis. What could this be?

One possibility is that you have injured your sacroiliac joint. This injury can be difficult to diagnose and can be missed during an evaluation.

What is it? Sacroiliac joint syndrome (SIS) involves irritation and dysfunction to the joint located between the sacrum and ilium. This joint normally has a small amount of movement required for proper mobility and is crucial for weight transfer from the trunk to the pelvis. Usually dysfunction occurs as a loss of mobility within the joint itself, but can also involve a sprain injury to the ligaments holding the joint together.

What are the causes/predisposing factors of injury? Multiple causes can lead to SIS. Simple bending, lifting or twisting movements may irritate the area, as can too much backward bending (hyperextension). Abnormal biomechanics such as overpronation of the foot, flat foot and leg length inequalities can also cause SIS. Muscle imbalances in and around the area may also contribute to the problem and must be addressed during treatment.

What are the symptoms? SIS consists of a dull ache over the joint that can become sharp with backward bending or when shearing forces are applied to the joint. To distinguish this pain from lumbar spine joint pain, the SIS pain is located below the lowest spinal vertebrae and off to the side. Referred dull achy pain may be felt in the back, leg, groin and even into the foot. This pain is distinct from true sciatic, or nerve, pain which must be ruled out.

What can be done to prevent or treat this injury? Prevention should begin by reducing any biomechanical fault that can lead to SIS. For example, if overpronation is diagnosed, then appropriate corrective footwear or orthotic devices may be required. Muscle imbalances due to lack of flexibility, strength or stamina must be addressed as does weakness in core muscles. The sacroiliac joint can also be examined by manual testing to see if there is joint locking or abnormal mobility.

The first phase of treatment is to reduce inflammation. Anti-inflammatories, ice, pulsed ultrasound and other modalities can be used to this end. In the second phase of care, manipulative therapy and mobilization techniques are used to restore proper joint biomechanics. Additionally, rehabilitative regimens for specific muscle or movement pattern disturbances and correction of underlying biomechanical faults should be included in the overall management of SIS.