The Sacroiliac Joints and Lower Back Pain
Where are the Sacroiliac (SI) joints located?
The sacroiliac joints (SI joints) are two joints located in your pelvis. As their name suggests this joint is the union between the two bones, the sacrum and ilium. If you look at their design, their main function is to transfer the upper body weight from the spine through the pelvis to the legs. The SI joint has a complex system of ligaments that further strengthen the joint. Up until the 1950’s anatomical textbooks stated that these joints don’t move. It is now proven that they move but they don’t move much compared to the knee, elbow or shoulder.
How do we injure these joints?
Acute injuries to these joints occur when participating in sporting or work activities in which the SI joints are subjected to twisting and torsion (eg. golf, tennis, baseball, squash, pickle ball). If there is too much twisting or torsion, or if the movements of the joint are outside the normal range for the joint, the joint becomes irritated and create protective spasm around the joint. This causes the joint to be stuck (immobile).
Chronic SI problems occur when muscle imbalance patterns develop as tissues become strained from overuse, underuse, or abuse. Sustained imbalance causes the SI joint to bear weight incorrectly. The tissues that make up the joint become inflamed and painful. The body reacts to the inflammation and pain by instructing the muscles in the area to tighten up. This leads to the therapeutically challenging pain/spasm/pain cycle that is often hard to break. Pregnancy, a short leg, flat feet, scoliosis, injured knees or ankles also affect the SI joints.
What type of symptoms does the patient experience?
The pain is located either on the right, left or both sides of your low back. The pain can range from an ache to a sharp pain, and may restrict movement. The pain may radiate into your buttocks, lower back or to the front of the groin. Occasionally there may be referred pain into the leg, giving sciatica type symptoms.
Classic activities that are difficult with SI joint problems are turning over in bed, struggling to put on shoes and socks, getting out of a chair or a car after sitting for long periods.
What is the diagnostic term for this problem?
There are many different terms used to describe this problem. Chiropractors call it a subluxation or Sacroiliac syndrome; others call it an up slip, down slip, pelvis forward or pelvis backward.
How common is this condition?
This condition is very common and is estimated to represent 90% of all low back complaints.
What type of treatment is best?
I have learned that everyone responds differently to the various types of treatment. Most treatment is aimed at restoring the movement in the joint, decreasing the inflammation and lessening the pain. Chiropractors manipulate and mobilize the joint. Physios use various modalities to get the joint to move and decrease the inflammation in the area. Massage therapists massage to relax the compensating muscles. Medical doctors prescribe anti-inflammatories or muscle relaxants. All of the above give stretches that try and ease the spasm in the area as well as suggest that you ice the area.
In chronic SI problems, the muscle imbalances need to be addressed. Proper exercises, stretching and working on the core are necessary.