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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Information on SIJD
The sacrum is the lower portion of the spine where several vertebrae are fused together. The sacrum has a joint on
either side with the ilium, the back part of the pelvis. The pubic rami, the front part of the pelvis, fit together in the front forming the pubic
symphysis. The sacroiliac joints are L shaped in contour with a shorter upper and longer lower arm. Normally the sacroiliac joint
is configured in such a way that the bones have an interlocking structure, which assists in keeping them properly
aligned. In some cases the opposing joint surfaces are quite flat. This type of joint is much less stable and can
lead to a shearing or sliding malalignment. Some sacroiliac joints reverse the normal concave-convex 'locking' relationship, which
can lead to rotational malalignment. The variation in joint configuration results in a corresponding variation in integrity. This means
that some sacroiliac joints are inherently weaker or more prone to malalignment.
A clear understanding of the difference in the signs and symptoms of sacroiliac joint dysfunction and other pathologies
is key in making the proper diagnosis. Because the diagnosis of SI joint dysfunction is made primarily from the
patient's subjective complaints and the physical evaluation, its diagnosis is somewhat problematic for the clinician.
The most common manifestation of sacroiliac joint dysfunction is acute pain in the low back, in the area of the
Posterior Superior Iliac Spine (PSIS) positioned approximately 2 inches from the midline and very deep-seated. Usually, tenderness is found near the lumbo-sacral promontory
and in the PSIS area, one more pronounced than the other. Radiating pain into the buttock, hip, groin and thigh is often
experienced. The pain is frequently increased by prolonged sitting, standing, walking or lying. The patient reports that frequent position
changes are needed to maintain any degree of comfort.
LIST OF COMMON SYMPTOMS OF SACROILIAC DYSFUNCTION
1. Lumbosacral pain
2. Buttock Pain
3. Pain radiating to the leg
4. Hip pain
5. Groin pain
6. Urinary frequency
7. Iliac crest pain
8. Transient numbness, prickling or tingling
9. Increased pain with menstruation
10. Increased pain with sexual intercourse
11. Increased pain with stair climbing
12. Increased pain with sustained positions (i.e., sitting, walking, lying)
Patient self-evaluation of symptoms revealed the following:
96% Increased discomfort with sustained positions (i.e., standing, sitting, lying)
66% Radiating buttock pain
39% Discomfort with stair climbing and/or hill climbing
26% Groin pain
23% Radiating leg pain
20% Pain with forward flexion
15% Loss of stregth in the legs
10% Urinary frequency
The most commonly reported position of comfort by patients in the study was side lying (left or right), with a
pillow between the knees.
The most frequent complaint from patients with sacroiliac joint dysfunction is increased discomfort with sustained positions
such as standing, sitting and lying, with the inability to attain a position of comfort. A disc patient can often find a
position of comfort, especially when lying down. Sacroiliac joint symptoms will intensify with activity and decrease with rest, while disc
symptoms will usually be worse upon rising in the A.M.
The second most common symptom of sacroiliac joint dysfunction is radiating buttock pain. This is reported as a generalized distribution
of "achiness" which can radiate into the thigh.
The third most common symptom is increased discomfort with stair or hill climbing. This is a result of
increased demands on the skeletal and soft tissue system of the pelvic girdle during these activities. This symptom
may also be present in disc pathologies, but is primarily reported as increased discomfort with forward trunk flexion.
Vicki Sims, PT, CHT
David Mesnick, PT, cMDT
