Dysfunction in the sacroiliac joint or SIJ (a large joint in your lower back connecting your sacrum to your pelvis) can sometimes cause lower back and/or leg pain. Dysfunction of this joint basically means that it is not operating normally.
For decades, the sacroiliac joint was suspected as a common cause of low back and/or leg pain, although difficulty in accurate diagnostic testing has made this difficult to substantiate. Today it is estimated that the SIJ is responsible for 15% to 30% of lower back pain cases.1
The primary mechanisms of SIJ dysfunction include:
- Too much movement in the SIJ can cause the pelvis to feel unstable, leading to pain. Pain from too much motion is typically felt in the lower back and/or hip and may radiate into the groin area.
- Not enough movement can cause muscle tension, pain, and may inhibit mobility. Pain is typically felt on one side of the low back or buttocks and can radiate down the back of the leg like sciatica pain.
SIJ dysfunction is more common in young and middle-aged women. Women who are pregnant or have recently given birth may also be more susceptible to SIJ pain.
Physiotherapy diagnosis for SIJ dysfunction uses a variety of orthopaedic provocation tests to ensure that the SIJ is the real cause of the pain.
Initial treatment for SIJ pain dysfunction includes:
- Brief rest period. A rest period of 1 to 2 days may be advised. Resting for longer than a couple days is not recommended, as doing so may worsen stiffness and cause increased pain and generalised weakness.
- Applying ice or heat. Ice applied to the low back and pelvis can reduce inflammation and alleviate pain and discomfort. Later on, heat applied around the joint may help relieve pain by reducing muscle tension or spasms.
- Improving core stability.
- Manual manipulation. Manual manipulation provided can be highly effective if sacroiliac joint pain is caused by too little movement. This therapy consists of physical manipulation applied to the SIJ and lower back region with the goal of restoring normal movement in the joints.
- Supports or braces. When the SIJ is moving too much, a pelvic brace can be wrapped around the waist and pulled snugly to stabilise the area. A pelvic brace is about the size of a wide belt and can be helpful when the joint is inflamed and painful.
There is no single approach to managing SI joint pain that will work for everyone. A combination of treatment as determined by your Physiotherapist is usually necessary for effective pain relief.