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Vicki Sims, PT, CHT
Gainesville Physical Therapy
1296 Sims Street, Suite A
Gainesville, GA 30501
Phone: 770.297.1700
sijd@gainesvillept.com
www.gainesvillept.com
David Mesnick, PT, cMDT
Body Mechanics Physical Therapy
550 Peachtree Street, Suite 1760
Atlanta, Georgia 30308
Phone: 404.817.0734
dmesnick@bodymechanicsatl.com
www.bodymechanicsatl.com
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FAQs
Question: How do I stabilize my unstable SI joint dysfunction?
A. You must first get the SI joint in alignment and do self corrections 3 to 4 times per day to keep it in
alignment. So the ligaments will heal.
B. You must use some external bracing such as a SI belt or postural taping to help hold the joint in alignment
as it heals.
C. You must avoid activities that frequently malalign the joint for 6 weeks such as: prolonged walking, stair
and hill climbing, twisting and bending activities.
Question: What is the most common test for SI problems?
A. A diagnostic SI injection. Usually it cannot be diagnosed by x-ray or other imaging studies.
Question: What are the common associated problems associated with SI problems?
A. Sacroiliac Joint Dysfunction can occue as an isolated condition, or associated with other spinal disorders.
B. Torsion injuries can cause damage to the disc annulus, facet joints, lamina, pedicle and ligaments, as well as
to the sacroiliac joint.
C. Facet Joint: Torsion or axial rotation causes the facets to flex and laterally bend towards the side of the
rotation crushing the facet articular surfaces on the rotation side and distracting the capsile with tearing or
avulsion on the side opposite the rotation.
D. Nerve Root: The lateral portion of the facet joint is long and slender, making it easily deformed. Torsion causes
facet impingement on the torsion side. Distraction on the opposite side can stretch the nerve root. Therefore, neural
arch deformation can cause bilateral nerve root entrapment.
E. Disc: Torsion causes annular tears which can weaken the annulus leading to an annular bulge, or herniation, of the
nucleolus pulposis. The iliolumbar ligament can become taut due to sub-luxation of the sacroiliac joint. Its fibers are attached
to the transverse rocess of L4, and chronic tension can lead to bulging of the disc. It is not uncommon to see an L4 annular
bulge on the MRI of a patient who has chronic sacroiliac joint instability.
F. Effect on Muscle: Janda, an expert on muscle imbalance, has pointed out that postural muscles become inhibited and weaker
as the result of articular dysfunction. With long-standing dysfunction, anatomic changes in the muscle bundles can take
place that are irreversible. The piriformis is one of the most adversely affected muscle in chronic sacroilic instability
(piriformis syndrome). Pelvic wall muscle spasm, or contracture, may lead to pelvic floor dysfunction. Other muscles
affected include the iliopsoas, hamstrings, adductors, gluteus, quadrates lumborum, and the
tensor fascia lata.
G. Effect on Nerves: Due to long-standing spasm, or secondary fibrosis, the chronically shortened piriformis can entrap neurovascular
structures that accompany it through the greater sciatic foramen (superior and inferior gluteal nerves, the sciatic
nerve and the pudendal nerve.) The lateral femoral cutaneous nerve passes just medial to the anterior superior iliac spine. It can be injured
as it passes form the pelvis to the thigh by changes in anatomic positioning associated with sacroiliac joint
subluxation (meralgia paresthetica).
H. Pubic Symphysis Instability: With chronic sacroiliac joint instability the cotralateral sacroiliac joint
and the pubic symphysis may destablize.
Question: What is the most common symptoms of SI joint dysfunction?
A. Reports of not being able to maintain any static position such as prolonged sitting, standing, lying or walking.
People report they must change positions often.
Question: What is malalignment syndrome?
A. Distortion of the pelvi ring with associated changes in alignment of the skeleton, so that there appears
to be a reorientation from head to toe. This reorientation causes compensatory changes in the soft tissue structures.
The malalignment may cause pain in places other than the pelvis such as mid back and/or neck and shoulder pain. Pain
may migrate south into the hips or knees.
Question: What is a resonable amount of time to stabilize the SI joint?
A. If the proper alignment techniques and exercises are being done faithfully you should have significant improvement
within 6 to 8 weeks.
Question: Will acupuncture and/or massage help to cure an SI problem?
SI dysfunction is a biomechanical problem and must be corrected by a maneuver that will align the SI joint. This is the basis for
healing.
Question: Will SI joint dysfunction get better with core strengthening exercises?
A. No. You must correct the preliminary problem of skeletal alignment then address the muscle imbalance that has
occurred with the skeletal malalignment.
B. Then you must participate in biomechanically appropriate/safe activity to facilitate healing.
C. Do not bend and twist at the waist as it torques the pelvis.
Question: Can I have si joint dysfunction without an injury?
A. Yes. It can start due to:
I. Pregnancy causing laxity of ligaments - due to hormonal changes,
II. Muscle imbalances may cause dysfunction
1. Muscle spasm and an inhibition due to disc derangement
2. Muscle tightness and/or weakness due to other injury or disease
III. Dysfunction in the kinetic chain
1. Leg length discrepancy
2. Abnormal gait due to lower limb injury
3. Vertebrae movement dysfunction
4. Restrictions in hip motion
5. Abnormal foot biomechanics
Question: I know it is common to have a piriformis syndrome with SI joint dysfunction. What is the treatment
for the piriformis syndrome?
A. Stabilize the SI joint dysfunction as the piriformis is a stabilizer of the joint and it will tighten to try
to stabilize the joint as long as it is out of alignment.
B. Gently stretch the piriformis while the joint is in alignment.
C. If the piriformis syndrome persists for 1 month after the SI dysfunction has been stabilized you may
need to consider getting a steroid injection in the tendon of the muscle where it connects to the hip. We have
found sometimes 3 injections are required to completely resolve the problem.
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