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Sacroiliac Joint Syndrome

Posted by Filed Under: Running Injuries

sacroiliac-joint.jpgYou 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.
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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.

About Lee Miller D.C.

9536 - 87 Street Edmonton, Alberta T6C 3J1 Phone: (780) 426-6777 Fax: (780) 469-6930



13 Comments
  1. links for 2008-02-27 | Disruptive Technocrat on February 26th at 6:25 pm

    […] Sacroiliac Joint Syndrome : Complete Running Network (tags: Running) […]

  2. Mom On The Run on February 27th at 8:34 pm

    Great article! I sprained a ligament in my SI joint 10 yrs ago. The pain generally returns when I let myself get outta shape – weak abs I guess. I then go on a fitness binge and then I don’t feel the pain for a while. That said – it sure came back with a fury both times I was pregnant!

  3. Lee Miller on February 28th at 9:12 am

    Not coincidentally, I do treat many ladies who have their worst SI joint problems when they are pregnant. I think you are correct about the weak abs. I also think the shift in the center of gravity can hyper extend the SI joints too.

  4. Sandra @ Charity Mile on March 26th at 6:33 pm

    Thanks for explaining SIS in more detail and sharing your knowledge. I had a dull lower back pain that gradually got worse over many months. When it started keeping me up at night I finally went to a chiropractor and he determined it was the sacroiliac joint . I started feeling better after just a few treatments. After five weeks of treatment I feel like a new person! Now I’m just going once a week.

    Yoga has always helped with general flexibility and I have to get back into a regular practice. The comments about weak abs are interesting, as I’ve never had strong abs and maybe that is a factor too.

    Sandra @ Charity Mile’s last blog post..Walk, Run, Get Your 15 Minutes of Fame

  5. health concerns on March 7th at 12:31 pm

    I have had a form of Arthritis called Ankylosing Spondylitis for 15 years and have never had any help from my GP. The best thing I ever did was buy a Tens machine. It really does work for my particular ailment. Better than any pills. It should also be good for any back pain.

  6. sami on January 15th at 2:22 pm

    I just recently began to have an issue with my SI joint…
    I’m not exactly sure what happened, biomechenical or injury etc…but my docs just gave me NSAIDS to rectify it. I had already been going to a PT for an ankle injury when he diagnose me as a ‘jammed SI’.

    I currently still have pain post-running. Does anyone have any suggestions as to how I can heal this thing quicker?? I have been told not to do anything for 6-8 weeks..
    Running activities(soccer, lacrosse, football, basketball etc..) are my life, and i don’t feel the same with being sedintary…

    Thanks
    sam

  7. Lee Miller on January 18th at 9:26 am

    Sami,

    These tend to respond very favorably to manipulation. If you have a “jammed SI” NSAIDS don’t do anything to improve the biomechanical situation. Find a chiropractor who works with runners’ (word of mouth is the best way to find one, so ask around). Get a functional assessment done and get treated; more often than not the assessment will find other regions (lumbar spine, piriformis muscle) that have also been impacted by the SI problem, and these can be looked after too.

    Hope this helps!

    Lee

  8. Sangini on January 20th at 9:35 pm

    A treatment approach called postural restoration works very well for SI pain (and other runners/chronic injuries) You can check their website Posturalrestoration.com or hruskaclinic.com.

  9. sami on February 11th at 9:09 am

    update on my condition – pain has minimized but every morning, my lower left SI area still doesn’t feel right. I see my Physiotherapist about 1-2/ week and he does mobilisations. (i.e pulling pressure on my left leg, and bending left knee toward chest, as well as ultrasound on my lumbar/SI area). Does anyone know of any other manipulations or mobilisations.

    I still haven’t ran or done any heavy biking. I’m walking, and lightly biking to get some cardio, but miss running and sports.

    I’ve had x-rays done with nothing seen, and have a specialist appointment this month as well. Is there anything that I should bring up?

    Thanks for all the previous advice, but i’m not covered for chiro, and don’t want to pay an arm and a leg for 5 minutes of time?
    Any help or adivce would be greatly appreciated.
    thanks
    sami

  10. Lee Miller on February 11th at 10:01 am

    I would think that if manipulation fixes the the problem, it would be money (and time) well spent. The last time I checked, chiropractic was less expensive than physiotherapy, massage therapy and acupuncture.

    I also do not think it is feasable to have a 5 minute visit if you are a new patient being assessed for a chronic problem. There is a consultation that includes a history and examination that must be performed which may pick up any underlying causes or contributary factors to your problem.

    Just say’in it ’cause I work with this sort of thing every day!

    Having said that, since you have a specialist appointment, make sure they rule out all the nastier stuff such as inflammatory disease etc, which can mimic SI mechanical problems.

    Good Luck!

  11. Frisco Chiropractic on April 30th at 7:53 pm

    Ruling out inflammatory disease is excellent advice sami.

    Once that is done it may be appropriate to seek out a local practitioner of Active Release Techniques. Several of these techniques are appropriate to accurately diagnosed SI problems and could quickly give you pain relief.

    Dr. Grant Stowell, D.C.
    .-= Frisco Chiropractic´s last blog ..Frisco Chiropractor: Four Steps To Finding The Best =-.

  12. Slim on June 3rd at 3:20 am

    I had lower back pains for many years. I tried everything. Nothing worked. My massage therapist suggested an osteopath, who manipulated the joint. The pain disappeared instanly. Now I can run pain free 🙂

  13. michael on August 26th at 10:31 am

    Slim is the osteopath in NYC by Chance. Having si joint issue for a while now. I do lots of self massage on gluteus, piriformis, quadratus lumborum etc as well as stretching quads,psoas, hamstrings etc which help. I was a competitive runner doing 50-60 miles week and went to zero miles. Now back to 30 miles week but cannot shake the ache in the si joint.

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