Unlocking Relief: How to Manage Sacroiliac Pain and Dysfunction
Sacroiliac (SI) pain and dysfunction are common causes of lower back and pelvic pain, yet they are often overlooked or misdiagnosed.
The sacroiliac joints, located at the base of the spine where the sacrum meets the pelvis, play a vital role in supporting the body and transferring weight from the upper body to the lower extremities. When these joints become irritated or move improperly, it can lead to debilitating pain and dysfunction. In this blog, we’ll dive into what sacroiliac pain is, its underlying causes, and the most effective, evidence-based treatments to manage and alleviate symptoms.
What is Sacroiliac Pain and Dysfunction?
Sacroiliac pain and dysfunction refer to discomfort or abnormal movement in the sacroiliac joints. These joints are located on either side of the lower spine, connecting the sacrum (the triangular bone at the bottom of the spine) with the ilium (part of the pelvis). The SI joints are crucial for weight distribution and shock absorption when walking, running, or standing.
When the SI joints become inflamed or experience abnormal motion (either too much motion—hypermobility—or too little motion—hypomobility), it can cause pain in the lower back, buttocks, or even radiate down the legs. This type of pain is often sharp or dull and can be exacerbated by certain movements, such as standing up, walking, or climbing stairs.
Pathophysiology of Sacroiliac Dysfunction
Sacroiliac dysfunction occurs when the sacroiliac joint moves abnormally due to either hypermobility (too much movement) or hypomobility (too little movement). In both cases, the result is irritation of the joint and surrounding tissues, leading to pain.
Hypermobility: In some cases, the SI joint becomes too mobile, often due to ligamentous laxity (loose ligaments). This instability can cause improper movement of the sacrum and ilium, resulting in pain, inflammation, and discomfort.
Hypomobility: On the other hand, the SI joint can become stiff or "stuck" when it does not move as it should. This is usually caused by wear and tear, postural imbalances, or muscle tightness, and it often leads to a restriction of motion and localized pain.
Inflammation of the SI joint can also occur due to factors like pregnancy (due to hormonal changes), trauma, or underlying conditions such as arthritis.
Symptoms of Sacroiliac Pain and Dysfunction
The symptoms of sacroiliac pain can vary, but the most common include:
Localized Pain in the Lower Back and Buttocks: The pain is typically felt in the lower back or buttocks, often on one side of the body, and can sometimes radiate down the leg (though not usually below the knee).
Pain with Specific Movements: Pain often worsens with activities such as sitting or standing for long periods, bending, twisting, or climbing stairs. The discomfort can also be exacerbated by transferring weight from one leg to the other.
Stiffness and Limited Range of Motion: Individuals may experience stiffness in the lower back and pelvis, making it difficult to perform certain activities like walking, bending, or even getting in and out of a car.
Pain After Prolonged Sitting or Standing: Sitting for long periods, especially on hard surfaces, or standing for an extended period can lead to increased discomfort. Many people with sacroiliac dysfunction report feeling better when they lie down or rest.
Causes and Risk Factors for Sacroiliac Pain
Several factors can contribute to sacroiliac pain and dysfunction, including:
Trauma or Injury: A fall, car accident, or direct impact to the lower back or pelvis can cause damage to the sacroiliac joint or surrounding structures, leading to dysfunction and pain.
Pregnancy: Hormonal changes during pregnancy, particularly increased levels of the hormone relaxin, can cause the ligaments around the SI joint to loosen, leading to instability and pain.
Postural Imbalances: Poor posture, especially sitting for long periods or standing in an improper alignment, can lead to uneven loading on the SI joints and contribute to pain and dysfunction.
Leg Length Discrepancy: Having one leg shorter than the other can cause uneven stress on the pelvis and sacroiliac joints, increasing the risk of SI dysfunction.
Arthritis: Conditions like osteoarthritis or ankylosing spondylitis can cause inflammation in the SI joint, leading to pain and stiffness.
Repetitive Movements: Repetitive motions or overuse, especially in activities like running, jumping, or heavy lifting, can put stress on the SI joints and contribute to dysfunction.
Evidence-Based Treatments for Sacroiliac Pain
Effective treatment for sacroiliac pain typically involves a combination of conservative methods, with a focus on physical therapy, pain management, and lifestyle changes. Here are some evidence-based treatments that have been shown to help relieve pain and improve function:
1. Physical Therapy
Physical therapy is one of the most effective treatment approaches for sacroiliac pain. Research consistently shows that targeted exercises can help reduce pain and improve mobility. A study published in The Journal of Orthopaedic & Sports Physical Therapy found that specific exercises targeting the hip and pelvic muscles can improve stability and reduce inflammation in the SI joint. Physical therapy interventions often include:
Stabilization Exercises: Strengthening the core, gluteal muscles, and hip stabilizers can help provide better support for the SI joint and reduce stress on the area.
Stretching and Mobilization: Stretching tight muscles and mobilizing the SI joint through manual therapy techniques can reduce stiffness and improve joint mobility.
Postural Training: Education on improving posture during daily activities, such as sitting, standing, and lifting, can reduce strain on the SI joints and alleviate pain.
2. Pain Management
For acute pain, rest, ice, or heat therapy can help alleviate discomfort. Ice is particularly effective in the first 48 hours to reduce inflammation, while heat can relax muscles and improve circulation in later stages of pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) can also be used for short-term pain relief.
In more severe cases, corticosteroid injections into the SI joint may be recommended to reduce inflammation and provide temporary relief. Research has shown that corticosteroid injections can be highly effective in managing acute SI joint pain, allowing individuals to engage in rehabilitation exercises.
3. Manual Therapy and Dry Needling
Manual therapy, including joint mobilization and myofascial release, can be effective in treating sacroiliac dysfunction by improving the movement of the SI joint and reducing muscle tightness. Dry needling, which targets trigger points in muscles around the pelvis and lower back, has also been shown to reduce pain and muscle spasms in individuals with sacroiliac pain. Learn more about dry needling here.
4. Lifestyle Modifications
Adopting healthy habits, such as improving posture, avoiding prolonged sitting or standing, and incorporating regular exercise into your routine, can help prevent and manage sacroiliac dysfunction. Ergonomic adjustments at work or home can reduce strain on the SI joints and support long-term recovery.
Conclusion
Sacroiliac pain and dysfunction can significantly impact your quality of life, but with the right treatment plan, relief is possible. Physical therapy, pain management, manual therapy, and lifestyle adjustments are all effective evidence-based approaches to managing and treating SI joint pain. If you're experiencing sacroiliac pain, it's essential to work with a physical therapist to develop a personalized treatment plan that addresses your specific needs.
At Wildflower Physical Therapy & Wellness in Indianapolis, we specialize in treating sacroiliac dysfunction and other musculoskeletal conditions. Our team of experts will guide you through a comprehensive recovery plan to help you feel better and get back to the activities you love. Contact us today to schedule your appointment and take the first step toward unlocking relief from sacroiliac pain!
If you are struggling with illness or injury and would like to get your body moving, schedule a physical therapy appointment with us today! At Wildflower Physical Therapy & Wellness, we can help you to get back to the life you want to live through pain management strategies, activity promotion and exercise. Our Cash Based Physical Therapy model allows us to deliver a highly individualized treatment plan without the fuss of insurance companies. Interested in trying dry needling to support your exercise routine and maximize recovery? Reach out to us today!