Sacroiliac (SI) joint dysfunction, once the most commonly diagnosed cause of lower back pain, fell out of the medical mind in the 1930's when herniated discs became the main scapegoats for back pain. Recently the diagnosis of SI joint dysfunction began to reemerge on the medical scene. Some estimate that it is to blame for 15% of lower back pain instances, but is often confused with sciatica or disc damage.
The SI joint is located on each side of the body where the sacrum at the bottom of the spine connects with the ilia, or the large bones of the pelvis. This joint is less than one inch long and has a very small range of motion. It is responsible for transferring the forces of the upper body to the lower body.
If an SI joint is misaligned, or if it moves too much or too little, then SI joint dysfunction is present. The condition entails pain at the site of the affected joint that can radiate through the lower back, buttocks, hip and sometimes into the leg, particularly the back of the thigh.
There are a number of ways in which SI joint dysfunction can manifest. A genetic cause is leg length discrepancy. This will cause the pelvis, and therefore the joints, to be misaligned.
Another cause of SI joint dysfunction is muscle imbalance. The pelvis is the site of many muscles that work closely together to control the movements of the lower body and to support the weight of the upper body. If a muscle imbalance exists, the web of tough ligaments that supports the joint will be tugged in one direction, pulling the joint out of its proper position either upward, downward, to the front or to the back.
An example of muscle imbalance causing SI joint dysfunction is that of tight lower back and hip flexor muscles combined with weak hamstrings and abdominal muscles. Hip flexors (muscles in the hip that work to pull the knee upward) and lower back muscles often become tight due to poor posture and improper bending and lifting technique, two biomechanical problems that also lead to underused, weak abdominal and hamstring muscles. The pulling action of the tight, shortened muscles on the pelvis causes it to tilt forward. The ligaments of the joint are strained by this, and the joint may become dislodged.
Another cause of SI joint dysfunction is trauma. A hard fall or other blow to the pelvis can wrench the SI joint out of place. This can create hypermobility or hypomobility of the joint, and both abnormalities provoke the body's inflammatory response to block off the area. Significant pain results.
Other causes of the condition include infection, pregnancy hormones and osteoarthritis.
How to Test for SI joint dysfunction
The only medically certain diagnostic test for this condition involves injecting a numbing agent into the joint and seeing if this alleviates pain.
There are other, less certain tests that are still deemed valid for diagnosing the condition. One indicator may be obvious to you without the help of a medical professional: if one side of your pelvis is higher or more forward than the other side.
Other methods of diagnosis can be viewed at http://www.youtube.com/watch?v=5RcVGbg2tGM.
Resolving SI Joint Pain
SI joint pain may be difficult to treat; the body's response to inflammation is to lock up the muscles surrounding the joint. This defense makes it hard to exercise, stretch and receive chiropractic adjustment. It may be necessary to pursue self-myofascial release (SMR) first.
Once muscles are loosened, a chiropractor can reset the joint by applying pressure and manipulating the joint's position.
Physical therapy will be needed to resolve any muscle imbalances that may have contributed to your SI joint dysfunction. The therapist can identify which muscles are overly-tight and which ones need conditioning to create a balanced workforce of core muscles.
Stabilizing the joint means stabilizing the whole pelvis; this is why physical therapy and chiropractic care often rely on each other in the treatment of this condition. It may not be possible to perform exercises with the joint out of place, since a hypomobile joint will severely limit range of motion and a hypermobile one may cause posture to be unstable. It will also be impossible to keep the joint aligned after a chiropractic adjustment without resolving muscle imbalances that influence its position.
It is always best to perform exercises for this condition under the guidance of a physical therapist. You can view examples of SI joint stabilizing exercises at http://www.youtube.com/watch?v=D6iQJ1a2-rA&feature=related.
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