PHYSIOTHERAPEUTIC APPROACH TO LOW BACK AND LEG PAIN ORIGINATED BY SACROILIAC JOINT DYSFUNCTION (HIP PAINS)

Whether you are undergoing and going through low back and lower limbs pain, this article is made up for you. There could be many causes of leg and low back ailment but in here you are about to read Sacroiliac joint dysfunction looking at the relationships and physiological function, the so called Sacroiliac joint pain, and how it can be assessed, diagnosed, and treated by your Sports physiotherapist at “MY sports Injury Clinic” based in Manchester City, sports massages centre.  At first instance, you must know.

What is a Sacroiliac joint and how it works?

The sacroiliac joints are located between the sacrum and iliac crest or the pelvis; both of them together perform as shock absorbers settled as a fundamental function, it is usually described as a slightly motion joint, strengthen by powerful ligaments and muscles like the piriformis muscle and the gluteus maximus which provide support and help to have a suitable function of the joint, and it is a true diarthrodial joint.

You must be asking yourself, what is a diarthrodial (synovial) joint, right?

They are connections between skeletal components in which the elements implicated are separated by a narrow joint cavity. Both ends of bone are covered with thin layers of cartilage & joint synovial capsules which secrete fluid to lubricate the joints.

Keeping these concepts in mind, let's follow the order of ideas.

Ø  Instability or Hyper-mobility.

Ø  Fixation or Hypo-mobility.

Now that you know a little bit about anatomy, function and sources of the pain having a thorough assessment and examination at your local Physio / Sports Injury Therapy Centre; physical testing of this issue can be provided through sports physiotherapy sessions following the recommendations and “to do list” “ Rehabilitation Programs “given by certified physio Musculo-skeletal practitioners and Strength & Conditioning experts in Manchester.

(SI Joint) is a term used to describe the place where the sacrum and the iliac bones meet and Sacroiliitis is the inflammation of one or both sacroiliac joints, This Results in Hip Pains. it is very important to be clear with these terms. How does inflammation of the joints affect our body? Sacroiliitis can yield pain in the buttocks or lower back, which can spread to one or both legs. Climbing stairs or standing for a long while can worsen the pain. Sacroiliitis can be tough to diagnose because it can be mistaken for other reasons of lower back pain. It has been linked to a group of diseases that cause inflammatory arthritis in the spine. Treatment may imply medications and physical Manual therapy or specific Joint Mobilisations.

Moreover, it is not just the inflammation of the joints (SACROILIITIS) which can be mistaken with other diseases, sacroiliac joint dysfunction (SI JOINT DYSFUNCTION) as well; remember there are two main sources of (SI JOINT DYSFUNCTION).

Moreover, it is not just the inflammation of the joints (SACROILIITIS) which can be mistaken with other diseases, sacroiliac joint dysfunction (SI JOINT DYSFUNCTION) as well; remember there are two main sources of (SI JOINT DYSFUNCTION).

Let’s get inside the sources of sacroiliac joint dysfunction, which are they?

Ø  Hyper-mobility in the sacroiliac joint can yield unsteady pelvis sensation which generates pain, whenever there is pain due to a lot of movement it is overall experimented as a low back pain or hip pain. Also felt over the groin area.  

Ø  Hypo-mobility in the sacroiliac joint can yield strong pain, muscle tension and most of the time impedes mobility, whenever there is pain due to little movement it is generally experienced over buttocks and just one side of the low back. Also felt down the back of the leg too alike to sciatic pain, this one of the reasons why so many times it is kind of difficult to diagnose the source of the pain.

“There are many similar pains related to lower back and leg pain and it is essential an accurate diagnosis of your Injury by a Physical Therapy practitioner that will assist you with a diagnostic physio-    therapeutic approach.” Do you happen to know, which are the symptoms of sacroiliac joint dysfunction? 

Do you happen to know, which are the symptoms of sacroiliac joint dysfunction? 

According to Steven Yeomans’ release (2018) “The most common symptoms include:

Ø  Lower back pain can be rank up from mild to acute, felt on one side or both sides.

Ø  Pain that spreads to several zones like the groin, buttocks and the hips. The buttocks, upper back and side of the thigh are highly known as recurring areas of sacroiliac joint pain. Felt it either one side or both sides.

Ø  Worsened pain; jogging or running, lying or putting excessive weight on one side and climbing stairs can worsen the pain by adding great effort and pressure on the sacroiliac joint.

Ø  Sciatic-like pain in the backs of the thigh and buttocks also can include numbness and tingling. 

Ø  Instability; in the pelvis or lower back makes it feel like it's going to fade and can cause discomfort in simple movements like standing and walking.

Ø  Stiffness; this means that there is a limited ability to specifically move the lower back, groin, hips, and pelvis. This makes it difficult to perform ordinary actions like bending over and climbing stairs.”

There are several risk factors and causes that can increase the chances of sacroiliac joint pain.  

The following are examples of these risk factors:

Ø  Aging the older a person is, the more likely they are to develop sacroiliac joint pain due to the degeneration that comes with aging. Over time, ligaments and muscles will deteriorate, and movement can easily cause joint swelling and pain.

Ø  Obesity is simply unhealthy for the body, and even for the sacroiliac joints. The sacroiliac joints are joints that support the weight of the upper body. Weight gain can result in increased pressure on the joints, which can eventually cause inflammation and degeneration.

Ø  High impact sports athletes who participate in contact sports are more likely to develop sacroiliac joint pain due to trauma. If you are a high impact sports athlete keep reading this, it gets more interesting.

The following are examples of causes:

Ø  Pregnancy, it is a common cause due to weight gain, hormonal changes, and pelvic changes. After pregnancy, ligaments sometimes remain loose and can cause pain in the sacroiliac joint.

Ø  Injury, the injury that causes torn ligaments can cause pain in the sacroiliac joint. It can be a one-hit spinal trauma, such as high-impact sports, in which an athlete falls on their buttocks or due to repetitive stress on the joints from labor-intensive jobs, such as sitting for a long time.

Ø  Previous lumbar surgery, sacroiliac joint pains have been shown to be more likely after lumbar spinal fusion surgeries due to limited movement in the lumbar spine and therefore increased movement in the joints.

Ø  Aging as a person gets old, the joints deteriorate. In fact, in a 30- or 40-year-old person, joint changes occur such as the formation of cracks and clumping of cells in the ligaments. Eventually, later in the years, there will be erosions. These changes can yield limited movement in the joints, which can produce pain in the lower back and lower limbs.

Ø  Overweight; obesity can put more pressure on the joints because the sacroiliac joints are responsible for supporting all the weight of the upper body. The increased pressure can cause inflammation and degeneration. This will also cause limited movement in the joints due to degeneration.

In order to get an accurate diagnosis there are multiple tests that must be taken into account. What are they?

As we already know (SI joint pain) acts pretty similar to other conditions, such as lumbar herniated disc (leg pain) along with others. During the physical exam, your physio may try to identify the cause of the pain by pressing on different parts of the hips and buttocks. You could move your legs in different positions to put light pressure on the sacroiliac joints. Also a thorough physical examination includes questions that will be made by your physiotherapist in Manchester like: ·     

How is your diet based on? 

How are your sports/physical habits?      

Do you sleep tight at night?       

Have you been through any recent surgeries?

The necessary physiotherapy maneuvers to diagnose (SI joint pain) are:

Got to look back on that every individual is neither the same nor has the same symptoms or pain level (could be mild or acute), some of the procedures used by your physio to find the source of the pain are: ·     

Sacral thrust test. ·     

Distraction test. ·     

FABER test. ·     

Palpation test.

Gold standard process to diagnose sacroiliac joint dysfunction is a sacroiliac joint injection.

What is a sacroiliac joint injection? Named sacroiliac joint block as well, overall it is an injection of lidocaine that goes directly into the joint; if the pain fades away we will be talking about a sacroiliac joint dysfunction confirmed as diagnosis. Although the diagnosis may be accompanied with imaging tests like MRI, CT scans and X-ray to rule out other causes of the pain.  

Backgrounds encountered of sacroiliac joint dysfunction in cases reported by Shuji Hamauchi and others (2010) “Three patients, 38 years old and 24 years old men and 32 years female were diagnosed with (SJD) by using sacroiliac joint injection, MRI scans and one finger test. All of them were presenting slightly degenerated lumbar lesions in their MRI scans. They were having leg pain and two of them were showing tenderness over the groin area specifically the iliac muscle right after the application of the injection, it was an improvement symptom. The men got back to work and have not recurred pain, on the other hand the female patient has been recurring pain every 2-3 months requesting regular sacroiliac joint injections to relieve the pain, it is important to know that she has a daily lifestyle as a housewife. Around 10% of low back pain is the prevalence of (SIJ) dysfunction.”

Options treatments “best scenarios”, what are the effectiveness of these therapies?

You have to know that most of the sacroiliac joint pain cases are effectively treated without using unnecessary surgical procedures and the primary goal is to relieve pain and get back normal function of the joint.  When you are being treated of (SIJD) you may experience many procedures at therapy sessions like a trial to try to find the best treatment options for your condition because there is not just a single way to manage it.

Which are the most effectiveness non-surgical treatments to tackle sacroiliac joint pain?

Established treatments to approach it are:  ·      Short rest period. ·      Applying heat or ice. ·      Pain medication. ·      Manual medication. You can view on this blog info about it (add link). ·      Braces or supports. ·      Sacroiliac joint injections.

What Modalities are indicated to treat (SIJ) dysfunction/pain by Physical therapy approach?

Every patient is different so the physical therapy has to be customized to their pain, the assignments are: ·      Stretching, to reduce muscle tension on the affected areas. ·      Stretching exercises, to get a better support of the sacroiliac joint and low back.  ·      Aerobic exercise, includes water aerobics, stationary cycling and running on an elliptical.

“Surgical and nonsurgical treatments to manage the pain sacroiliac joint dysfunction incorporate osteopathic manipulation, physical therapy, nonsteroidal anti-inflammatory drugs, corti costeroid injections and surgery in the worst scenarios. Individuals may respond to a combination of them or just one is good enough to relieve pain” aforementioned from Phys Sportsmed (2008) authors Robert E Poley, James R Borchers.        

References ·      

• Cohen SP, Chen Y, Neufeld NJ. Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment. Expert Rev Neurother. 2013 Jan; 13(1):99-116.

• McGrath C. Clinical considerations of sacroiliac joint anatomy: a review of function, motion and pain. Journal Osteopathic Medicine 2004; 7(1):16-24.   ·      Guan F, Sun Y, Zhu L, et al. Risk Factors of Postoperative Sacroiliac Joint Pain for Posterior Lumbar Surgery: ≥2-Year Follow-up Retrospective Study. World Neurosurg. 2017.  

• Bise CG, Piva SR, Erhard R. Manual Therapy. In: Orthopaedic Physical Therapy Secrets. Elsevier; 2017:85-94. doi:10.1016/b978-0-323-28683-1.00012-6.

• Frontera WR. Sacroiliac joint dysfunction: Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation.  

• Navallas M, et al. Sacroiliitis associated with axial spondyloarthritis: New concepts and latest trends.

• Ledonio CG, Polly DW, Swiontkowski MF, Cummings JT. Comparative effectiveness of open versus minimally invasive sacroiliac joint fusion. Med Devices (Auckl). 2014;7:187 93.   

• Kube RA, Muir JM. Sacroiliac Joint Fusion: One Year Clinical and Radiographic. Results Following Minimally Invasive Sacroiliac Joint Fusion Surgery. Open Orthop J. 2016;10:679-689.