What is sacroiliac (SI) dysfunction?
The sacroiliac joint is the junction where the sacrum meets the ilium in your pelvis. Sacroiliac dysfunction is pain or movement limitation in this joint. Studies have documented that motion does occur at this joint, therefore slightly subluxed and even locked positions can occur. Pain generated from this region can be localized or it can refer pain into your buttock and low back. Muscles and ligaments surround and attach to the SI joint in the front and back, primarily on the ilial or sacral surfaces. These can all be a source of pain and inflammation if the SI joint is dysfunctional. The sacroiliac joint is highly dependent on its strong ligamentous structure for support and stability.
SI joint dysfunction is sometimes referred to as “sacroiliac joint instability” or “sacroiliac joint insufficiency” due to the lack of support from once strong and taut ligaments. Hormone imbalances, particularly those associated with pregnancy and the hormone relaxin, can cause a ligamentous laxity resulting in the weakening of the sacroiliac structure. Hypomobility (too little movement) of the sacroiliac joint is an intra-articular disorder in which the joint locks due to wearing down with age or degenerative joint disease. Hypomobility can occur with an inflammatory disease such as ankylosing spondylitis, rheumatoid arthritis or infection.
Women are more likely to develop pain and limitations from this joint due to several factors. First women have a wider pelvis with looser ligaments in order to reproduce. Second, many women will experience SI dysfunction during pregnancy or after the baby is born (pelvic girdle pain can occur in up to 50% of women). If not treated appropriately it can lead to chronic pain and instability. Men can also experience dysfunction in this region but at a rate far less then women. Most likely men who do experience dysfunction in this region are a result of direct trauma, degeneration or inflammatory conditions. Both men and women as they age will experience less pain from this region due to natural aging process.
Risk factors for developing SI dysfunction
Traumatic events, pregnancy, smoking, poor physical health, family history and lifting injuries.
What are common symptoms associated with SI dysfunction
The SI joint can cause pain in the pelvis, low back, groin and hips. Pain can range from dull ache to sharp and stabbing and can increase with physical activity. Prolonged sitting, sustained standing and climbing stairs/hills can increase pain as well.
What to expect with Physical Therapy
Your physical therapist will take a complete history of your condition and perform multiple tests and measures to try to elicit your pain. They will look at your low back, pelvis and hips to complete a comprehensive evaluation. A plan of care will be established based on the findings of your exam. A personalized home exercise program will be developed by your physical therapist to help adjunct your treatments.