Sacroiliac Joint Dysfunction

  • Sacroiliac Joint Dysfunction is pain originating from sacroiliac joint and/or capsule.
  • Can be referred to as SI Syndrome or SI Lesion
  • Very common: may account for 50% of all cases of lower back pain

Aetiology

Demographics

Frequency
A lifetime prevalence of mechanical lower back pain (about 80%) is very common with sacroiliac joint dysfunction. 
Gender
50-90% of women develop lower back pain during pregnancy
Age
Increased complaint of lower back pain with increased age (especially above 55 years)

SI Syndrome Associated With:

Ligamentous Laxity (Pregnancy/Sprain)
Increased sacroiliac joint movement (common in young patients). Possible direct trauma
Leg Length Discrepancy

SI Lesion: Static Characteristics

Anterior Superior Ilium (Extension) Posterior Inferior Ilium (Flexion)
High iliac crest & PSIS Low iliac crest & PSIS
Long Leg Short Leg
Possible lumber scoliosis to opposite side Possible lumber scoliosis to same side
PSIS less pronounced PSIS more pronounced
ASIS low ASIS high

History, Signs & Symptoms

Symptoms & History

Symptoms of Pain
  • Local pain, however many patients with sacroiliac joint dysfunction also suffer from pain radiating to their buttocks and the back of their thighs (may be confused with sciatica).
  • With a sprain, pain may be sharp and stabbing
  • Relieved by recumbency (decreased weight bearing)
  • Pain may be worse with:
  1. Weight bearing, moving from sitting to standing
  2. Motion, walking
  3. Forward flexion or extension of the pelvis

Physical Exam

Observation & Palpation
  1. Focal SI tenderness increases with joint challenge; muscular spasms – gluteal/low back
  2. Leg Length Discrepancy
  3. Possible guarded gait
  4. Palpatory and/or postural signs of misalignment
  5. Altered SI motion and/or joint play
Orthopaedics Exam
  1. (+) Belt Test, (+) Gaenslen’s Test
  2. (+) Gillette Test for SI Motion
  3. (+) Laguerre/Patrick’s (FABERE)
  4. (+) Hibb’s, (+) Yeoman’s
  5. (+) SI Compression/SI Distraction
  6. (+) Sit-up Leg Length Test
Imaging
  1. Usually negative
  2. May be useful to rule out other conditions
Differential Diagnosis
  1. Reiter’s Syndrome, Psoriatic Arthritis, Ankylosing Spondylitis
  2. SI or Lumber Degenerative Disc Disease
  3. Spondylolysis or Spondylolisthesis

Management

Physical Treatment

  1. Osseous manipulation of mal-positioned/restricted joint – restore motion and alignment
    • Many patients with sacroiliac joint dysfunction show a dramatic reduction in symptoms with manipulation
  2. Avoid stretching of ligaments into already sprained direction
  3. Massage therapy: trigger point therapy, relaxation massage, hydrotherapy

General Treatment

  1. Consider SI support brace (short term use only)
  2. Also consider heel lift orthotics for leg length inequality
  3. Electrotherapy: IFC, TENS reduce edema, decrease pain
  4. Home Care: stretching and exercise
  5. Prevention: patient education
    • Environmental factors: sitting posture, leg-crossing, wallet in back pocket, furniture
    • Aerobic conditioning and core body muscle strength are fundamental