Sacroiliac joint pain
Section snippets
Anatomy and biomechanics
A good understanding of the anatomy and biomechanics of the hip, pelvis, and lumbar spine and their relationships to each other is essential in devising a comprehensive treatment program. The pelvis serves as the central base through which forces are transmitted both directly and indirectly. Inherently, the joints of the pelvis are stable joints. Repetitive or high injury loads can lead to ligamentous, bony, and muscle overuse syndromes. Adaptive patterns may occur in the pelvis as a result of
History and presentation
Patients with posterior pelvic pain as a diagnosis may present with a wide variety of complaints. Gluteal pain near or surrounding the posterior superior iliac spine is the most common region as described by Fortin and Colleagues.12, 13 Other symptoms include groin pain, pain radiating into the lower extremity, numbness, and clicking or popping in the posterior pelvis. Pain and/or clicking with transitional activities such as getting up from a chair or in and out of a car may also be noted.
Acute phase (1–3 days)
Acute injury is often associated with a direct trauma such as a fall or marked increase in intensity, frequency, or duration of a specific activity. Often, SIJ pain presents as a progressive problem with fluctuations in symptoms. The patient may only experience symptoms during certain activities including sports or exercise. In the acute setting taking anti-inflammatory medications and icing the areas are helpful. Relative rest after an acute injury assists with pain management. This includes
Conclusion
Sacroiliac joint pain should be considered in the differential diagnosis of patients with low back pain, posterior pelvic pain, and groin pain. Unfortunately the diagnosis and treatment of SIJ pain and dysfunction can be difficult. The healthcare provider needs to have a good understanding of the integrated biomechanics of the spine, pelvis, and hips to guide both the evaluation and the treatment. Care should be taken not to miss concomitant instigating problems outside the SIJ, including
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Cited by (35)
Diagnosis and management of sacrococcygeal pain
2020, BJA EducationCitation Excerpt :Advanced imaging modalities and provocative tests will aid diagnosis but may not be as useful as dynamic radiographs. MRI and technetium Tc-99m will demonstrate inflammation associated with hypermobility and exclude other underlying pathologies.12 Fluoroscopic or ultrasound-guided injection of local anaesthetic and steroid techniques can both aid diagnosis and be therapeutic.17
Musculoskeletal Approach to Pelvic Pain
2017, Physical Medicine and Rehabilitation Clinics of North AmericaPhysical and Neurologic Examination
2016, Benzel's Spine Surgery: Techniques, Complication Avoidance and Management: Volume 1-2, Fourth EditionApplication of cooled radiofrequency ablation in management of chronic joint pain
2014, Techniques in Regional Anesthesia and Pain ManagementCitation Excerpt :The data obtained from history and physical examination have been shown to be less reliable in diagnosing this pain condition; more clinicians advocate use of diagnostic injections for confirmation even though its validity is still unproven.2,3 Different treatment modalities have been proposed for pain derived from SI joint, including conservative management,2,3,8-12 alternative medicine,2,3,13-19 addressing psychosocial issues,3,20,21 intraarticular injection,2,3,22-27 radiofrequency denervation,2,3,28–34 as well as more novel invasive procedures.2,3,35,36 Effectiveness of these treatment modalities has not been consistently satisfactory.2,3
Effect of the pelvic compression belt on the hip extensor activation patterns of sacroiliac joint pain patients during one-leg standing: A pilot study
2013, Manual TherapyCitation Excerpt :Therefore, disruption of these mechanisms has been frequently hypothesized to lead to pain or dysfunction during load transfer through the lumbopelvic region (Snijders et al., 1998; Mens et al., 1999). Weight bearing on the symptomatic side during standing or walking may aggravate the symptoms of SIJP (Slipman et al., 2001); this probably occurs due to asymmetrical shear loading through the lower extremities or the pelvis (Prather and Hunt, 2004; Zelle et al., 2005). Moreover, one-leg standing on the symptomatic side contributes to the forward rotation of the ilium with resulting flexion at the contralateral hip (Hu et al., 2010), which may be a potential factor to make the SIJ unstable during load transfer (Hungerford et al., 2004).