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.
When
there is pain in these joints, it is due to hyper-mobility, which means there
is excess movement in the joints, or hypo-mobility, which means there is
limited movement in the joints; we can say there are two main sources of the low back and leg pain originated by sacroiliac joint dysfunction. Such
as:
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.