The sacro-iliac joint (SIJ) is the joint that is formed where the sacrum, which is the large bone at the base of the spine, meets the ilium, which is the bone in the upper part of the pelvis. Typically, the two sacro-iliac joints work together, and dysfunction may occur when one or both joints:
- become stiff resulting in a lack of coordinated movement.
- become lax which may happen during pregnancy with an increase in the production of relaxin.
- are affected by muscular imbalances.
- present with arthritic changes.
- are injured as a result of a fall, an impact, over-training, gait changes or a repetitive activity all of which may place excessive stress on the joint.
- experience mechanical changes as a result of injury or dysfunction in the surrounding joints or muscles.
The SIJ typically has extraordinarily little motion. Small movements in the joint will allow for shock absorption and for bending forward and backward. It is a very robust joint that is reinforced by the strong ligaments and muscles that surround it. SIJ pain may occur because of hypermobility or hypomobility when these structures are not functioning at their best.
A sacro-iliac joint dysfunction may present as:
- muscle tightness or a feeling of tenderness in the low back, the hip, or the buttocks.
- A dull aching pain or a sharp stabbing pain in posterior aspect of the pelvis, the low back, the coccyx (tailbone) or the groin.
- Pain may radiate down to the knee.
- Pain that may become worse with walking, standing, and prolonged sitting.
- Pain that may increase with moving from sitting to standing, rolling over in bed, and/or bending forward.
The goal of the first stage of treatment is to reduce inflammation in and around the joint. This is typically followed by the restoration of movement through stretching/exercise, mobilizations, and/or manipulations. Strengthening of the musculature including the abdominals, the back muscles, the hip musculature, the pelvic floor muscles, and the lower extremity muscles will round out treatment and ensure that there is education to prevent re-injury.
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