Physical Therapy for Sacroiliac Joint Dysfunction
Sacroiliac joint dysfunction involves pain and altered function in the sacroiliac joints of the pelvis and is often associated with low back pain. The sacroiliac joint absorbs shock placed on the lower body to reduce pressure felt in the lower spine. Sacroiliac joint dysfunction can occur due to arthritis, direct trauma, repeated irritation from overuse, or muscle imbalances that cause the sacroiliac joint to become too stiff or too loose. Physical therapy is an essential component of sacroiliac joint dysfunction rehabilitation, reducing pain and restoring normal pelvic symmetry through therapeutic exercise and manual therapy.
Sacroiliac Joint Dysfunction
The sacroiliac joint connects the spine to each hip, joining the sacrum, a triangular bone at the bottom of the spine, to both hip bones. Ligaments stabilize the front and back of the joint; multiple muscle groups cross over the joint, providing additional stability. The sacroiliac joint (SI joint) absorbs pressure that is transmitted between the upper and lower body, absorbing shock placed on the lower body from walking, running, or jumping to reduce pressure felt in the lower spine.
Sacroiliac joint dysfunction (SIJD) can present as low back pain on one side of the body that worsens with prolonged sitting or standing or specific mechanical motions. Sacroiliac joint dysfunction is found in 10 to 25% of people with low back pain. SIJD symptoms include sharp, stabbing, or dull pain on one side of the pelvis, low back, groin, or tailbone; pain that radiates down to the knee; muscle tightness and tenderness in the hip and buttock region; and numbness or tingling in the hips, groins, and legs.
Sacroiliac joint dysfunction often originates from nerve irritation, misalignment of the joint, micro-tears in ligaments that provide stability, or degenerative conditions of the back. SIJD can result from a variety of factors: arthritis, a single injury like a fall or car accident, or repeated irritation and muscle imbalances from overuse. SIJD may occur due to one side of the joint either becoming too stiff or too loose or because of pregnancy and childbirth that cause laxity in joints, muscles, and ligaments.
Physical Therapy for Sacroiliac Joint Dysfunction
Physical therapy and therapeutic exercise are essential components of sacroiliac joint dysfunction treatment. The physical therapist conducts a thorough medical history review and a complete physical examination, observing how the patient walks, steps, squats, and balances as well as assessing mobility and strength of the spine, pelvis, and hip. The aim of SIJD rehabilitation is to return the SIJ to a normal, neutral mid-range position; restore optimal alignment of the lumbar spine, hip joint, and SIJ; and optimize functional stability of the lumbopelvic region by restoring normal function of muscles that support the SIJ, hip, and low back.
Research has shown that physical therapy interventions are effective in reducing pain and disability associated with SIJD and restoring normal pelvic symmetry in those with SIJD. Manual therapy and therapeutic exercise were shown to be particularly beneficial for SIJD.
Physical therapy treatment for sacroiliac joint dysfunction includes:
Manual therapy to restore normal movement in tissues and normal position and mobility in the SI joint as well as spine and leg.
Core strengthening and stabilization in the trunk, low back, and pelvic regions. Temporary use of a SI belt may be used to provide external stability until the patient’s core strength is improved.
Modification of daily activities that may create or worsen symptoms, such as repetitive twisting and asymmetrical motion
Body mechanic instruction to maintain optimal alignment and posture
Strengthening exercises to balance the strength of muscles that stabilize the SI joint and address muscles that are weakened due to chronic SIJ pain, specifically targeting muscles of the pelvis, groin, low back, hamstring, thigh, and core.
Stretching exercises to lengthen muscles that may be stiff and limit internal rotation of the hip and relax tense muscles and ligaments that limit natural motion in the joint.
Balance and gait training
