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 :Patients may often present with a history of one of the risk factors mentioned above, or a history of an event with ensuing biomechanical dysfunction or a failure to restore biomechanical function secondary to adaptative changes resulting from another pathology that has either resolved or is ongoing. These can include a history of conditions such as lumbar discogenic pain, radiculopathy, hip pathology or facet syndrome.12 The characteristics and distribution of the pain vary from patient to patient.
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 EditionEffects of external pelvic compression on electromyographic activity of the hamstring muscles during unipedal stance in sportsmen with and without hamstring injuries
2015, Manual TherapyCitation Excerpt :However, as participants in the current study did not report symptoms associated with SIJ instability, it is more likely that neurophysiological mechanisms might explain the changes in EMG activity. Application of the PCB may have proprioceptive effects, with or without ligamentous stretch of the SIJ facilitating muscle activity (Prather and Hunt, 2004; Arumugam et al., 2012a; Jung et al., 2013). The PCB might also act as a pseudofascia by compressing the GMa which might increase GMa activity (Arumugam et al., 2012a).
Application 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 :The use of the PCB also allows women with pelvic girdle pain to perform active straight leg raising (ASLR) with fewer difficulties (Mens et al., 2006). Therefore, it is often recommended that patients suffering from SIJP wear the PCB while walking and standing (Prather and Hunt, 2004), and many clinicians have incorporated the use of the PCB into their routine therapy (Liebenson, 2004; Mens et al., 2006). The mechanical action of the PCB may alter the activation pattern of the lumbopelvic muscles, depending on where the PCB is worn (Pel et al., 2008).