* Please Note: The following article is provided by Body Mechanics & Gainesville PT for the sole purpose of
educating and informing our current and future patients.
SACROILIAC JOINT DYSFUNCTION and LOW BACK PAIN
Sacroiliac (S-I) joint dysfunction is understood by clinicians as one of many causes of the general category of low back pain. S-I joint dysfunction may wholly be responsible for the low back pain syndrome and/or may be contributory to low back pain in concert with other pathology of the lumbar spine. It is often an overlooked and underappreciated diagnosis.
Brief Anatomy: The S-I joint can be thought of as the bottom joints of the spine relating to the hip bones. The sacrum (bottom of the spine) relates on each side to the ilia (hip bones) to form the sacroiliac joints. The ilia accept the femoral shafts of the lower extremities to form the hip joints. Therefore, as a person walks with reciprocal motion of the legs, the S-I joints also reciprocally move. There are muscles and ligaments that transverse the S-I joint in the front and the back, all of which can be causes of pain and inflammation if these joints are in dysfunction.
Patient Symptoms: Pain is usually reported as being on one side of the low back; however, occasionally there is pain on both sides. The patient reports posterior low back pain, hip pain, buttock pain, groin pain, lateral thigh pain, knee pain and occasionally leg and calf pain. He also reports the need to limp, leg length difference and increased pain with walking, standing or sitting. He may report improvement with resting recumbently or changing positions often.
Clinical Findings: Anatomically leg length differences are demonstrated. There is asymmetry or nonequalized right and left hip bones when compared to each other. There is tenderness to palpation of the posterior S-I joint ligaments. There is associated muscle guarding of the muscles of the low back. There is pain with end range of motion of the hip joints as they stress the S-I joint.
Kinetic tests by the therapist will reveal differences in mobility of the S-I joints when comparing one joint to the other. The therapist may assess the affected joint is moving too little (hypomobile) or moving too much (hypermobile). The therapist will evaluate generalized motion of the lumbar spine and mobility of its associated joints. The therapist will also assess gait pattern deficiencies. Diagnostic testing such as x-ray, CT or MRI do not usually demonstrate abnormalities, and therefore cannot be used for diagnosis of S-I joint dysfunction.
Clinical Treatment: Initial treatment by the therapist will involve joint mobilization of the affected S-I joint to attain symmetry of the pelvis and improved mobility of the affected joint. The lumbar spine will also be treated according to the deficiencies found during assessment.
Following mobilization, the therapist will instruct the patient on proper biomechanics to avoid unnecessary and improper strain of the injured joints. Therapeutic exercise will be taught to improve neuromuscular stability of the low back and pelvis. Applications of neuromodulation modalities to decrease muscle spasm during the early stages of treatment will likely be utilized.
Too much movement of the S-I joint may indicate a laxity of ligaments which would normally hold these joints within normal range of motion. Therefore, additional stabilization procedures (i.e., pelvic belt fixation, non weight-bearing gait with crutches, taping techniques) may be required.
With those patients who continue to demonstrate hypermobility after failing to attain stabilization by conservative means of rehabilitation, an orthopedic consultation for surgical fixation may be necessary.
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