Physical Therapy for Sacroiliac Joint Dysfunction [Infographic]

Sacroiliac joint dysfunction (SI joint) involves injury to the sacroiliac joint that typically presents as low back pain on one side of the body. The main function of the SI joints is to provide a stable yet flexible support to the upper body while distributing the load from the lower extremities throughout the rest of the body. SI joint dysfunction can arise due to an acute trauma to the joint, pregnancy and childbirth, or conditions like arthritis and scoliosis. Physical therapy can address SI joint pain, help to stabilize the joint, and improve function through targeted stretching and strengthening exercises and manual therapy.

Anatomy of the Sacroiliac Joint

The sacroiliac joints (SI joint) are located on either side of the base of the spine, connecting the sacrum, a large triangular bone at the base of the spine, to each hip bone. The SI joints provide stability for the lower body and act as shock absorbers for the spine, absorbing much of the impact from walking and other activities.

The bones of the SI joint connect with strong ligaments that stabilize the joint and allow for minimal movement. The main function of the SI joints is to provide stable yet flexible support to the upper body while distributing the load from the lower extremities throughout the rest of the body.

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What is Sacroiliac Joint Dysfunction?

Sacroiliac joint dysfunction involves injury or inflammation of the SI joints that typically presents as low back pain on one side of the body. In fact, SI joint dysfunction is involved in up to 30% of cases of lower back pain. Women are more susceptible to SI joint dysfunction as women have more flexibility in the SI joint.

Symptoms of sacroiliac joint dysfunction include:

·      Dull aching pain across the sacral region (can be sharp at times)

·      Pain in both buttocks that extends down the thigh to the knee

·      Numbness or tingling in the legs

·      A stiff pelvis

·      Pain that increases when standing up after prolonged sitting

·      Legs that feel weak and unable to support the body

·      Limping and abnormal gait

Most SI joint injuries (88%) are due to repetitive microtraumas or acute trauma with a higher prevalence among athletes, while twenty percent of SI joint dysfunction cases are pregnancy related.

Sacroiliac joint dysfunction can be caused by a variety of traumatic or chronic issues:

• Acute injury from a fall, a car accident, or from blunt impact, such as during high-collision sports

• Spinal surgeries that fuse vertebrae of the lower spine, which affects the spine’s flexibility and can increase stress on the SI joint

• Osteoarthritis due to the protective cartilage that cushions the ends of the sacroiliac joint bones deteriorating, which causes the bones to rub against one another and resulting in pain and inflammation.

• Inflammatory arthritis like ankylosing spondylitis or psoriatic arthritis, which can inflame the SI joints and lower vertebrae in the spine

• Pregnancy and childbirth can cause laxity in the ligaments and joints of the pelvis. As a woman’s body prepares for childbirth, the body releases hormones that loosen ligaments and joints in the pelvis, changing the way the SI joint moves and making it less stable. The additional weight of pregnancy and the growing baby also places stress on the SI joint.

• Conditions like scoliosis can contribute to SI joint pain due to the impact of the spinal curvature on the spine and the alignment of the SI joint.

• Repetitive lower back stress like jogging or a physical labor job where feet are frequently pounding on hard surfaces can increase risk of SI joint pain.

Physical Therapy for Sacroiliac Joint Dysfunction

Physical therapy can address SI joint pain, help to stabilize the joint, and improve function through targeted stretching and strengthening exercises and manual therapy. Conservative physical therapy treatment of SI joint dysfunction is recommended prior to any invasive treatments. In fact, over 75% of SI joint cases respond to conservative management with physical therapy.  Research has shown that physical therapy has long-term benefits for those with SI joint dysfunction by focusing on spinal stabilization through targeted strengthening of the lower back muscles, hips, and core, stretching of the iliopsoas and piriformis muscles, manual therapy, and gait mechanic instruction.

Physical therapy treatment for SI joint dysfunction can include:

• Targeted strengthening and stabilization of the core, trunk, low back, and pelvic regions to address weakened muscles and improve the stability of the SI joint by improving the strength of the surrounding musculature. Pelvic girdles may be used initially to support the core.

• Manual therapy soft tissue and joint mobilizations to restore normal movement in tissues and correct positioning and mobility in the SI joint, spine, and leg

• Daily activity modification to minimize pain, such as avoiding repetitive twisting or asymmetrical movement

• Body mechanic instruction and gait training to restore optimal alignment and posture and address abnormal walking patterns that may be aggravating the SI joint

• Stretching exercises, particularly of the iliopsoas and piriformis muscles to relieve tightness and relax tense muscles and ligaments that limit natural motion in the joint

Numerous research studies have found that physical therapy is effective in reducing SI joint pain, improving flexibility, and enhancing overall function. A recent 2023 review of 10 studies involving 498 participants found that physical therapy that combined exercises and manual therapy was significantly more effective than traditional approaches to decreasing SI joint pain and lowering levels of disability among patients.

One study used an intervention of exercise therapy over eight weeks to address SI joint dysfunction with the aim of restoring normal pelvic position and maintaining it during functional movement in order to stabilize the lumbar-pelvic-femoral complex. Researchers noted that at discharge patients showed no signs of disability and were free of pain. Another study combined exercise and manual therapy mobilizations and manipulations to treat SI joint pain; results showed improvements in pain and restoration of normal pelvic position after the intervention.

Are you experiencing persistent SI joint pain? Work with a physical therapist today to address SI joint-related pain and improve your function safely!