SACROILIAC JOINT PAIN · Chronic low back pain can have a dramatic impact on daily activities as...
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Chronic low back pain can have a dramatic impact on daily activities as well as the ability to work and exercise. The sacroiliac joint (SIJ) is a very common source of low back pain, and many times is misdiagnosed as a problem with the discs or the spine. The first key to understanding SIJ pain is understanding the anatomy. There are two SIJ’s in your body, located on either side of the triangle-shaped bone at the bottom of your spine where it connects to your pelvis. The SIJ’s are a shock absorber for your spine and provide stability for your body as you run, walk, or jump. The most the joint moves in sliding is probably only 2-4 millimeters, and may tilt and rotate two or three degrees. The SI joint is held together by several large, very strong ligaments. The strongest ligaments are in the back of the joint outside of the pelvis. Because the pelvis is a ring, these ligaments work somewhat like the hoops that hold a barrel together. If these ligaments are torn or become lax, the pelvis can become unstable. Muscles of the back and pelvis are functionally connected to the SIJ ligaments therefore their actions can affect joint mobility. HOW DO YOU KNOW IF THE PAIN YOU’RE FEELING IS BEING CAUSED BY A SIJ PROBLEM? There are some common symptoms: ■ Low back pain: usually a dull ache on one side of your lower back that may extend into the thigh or groin. It is usually below the L5, or lowest lumbar vertebrae. ■ Buttock pain: pain can range from an ache to a sharp stabbing pain that extends down one or both legs ■ Low back pain while climbing stairs: activities that require weight transfer to one leg at a time, which require the pelvis to twist may produce SIJ pain. Possibly even feeling that your leg may buckle or give way. ■ Difficulty sitting or lying on one side: often experienced as an ache on one side that causes you to shift weight to one side to relieve the pain in the other. WHAT CAUSES SIJ PAIN? Each joint contains many nerve endings that can cause significant pain if the joint is damaged or loses its ability to move properly. Everyday wear and tear, arthritis, or a single injury can damage these joints, changing their normal movement and creating chronic and sometimes debilitating pain. The SIJ can become painful when the ligaments become too loose or too tight. This can occur as the result of a fall, work injury (repetitive strain), car accident, pregnancy and childbirth, or hip/spine surgery. Underlying biomechanical problems can also cause SIJ pain – such as one leg being longer than the other, uneven movement in the pelvis due to muscle imbalances, or one sided postural habits. HOW IS A DIAGNOSIS MADE? A physiotherapist will help determine whether the SIJ is the source of your pain. Evaluation includes a medical history and physical exam. Your ADVICE HANDOUT SACROI SACROI SACROI ILIAC JOINT PAIN ILIAC JOINT PAIN ILIAC JOINT PAIN therapist will consider all the information you provided, including any history of injury, location of your pain, and problems standing or sleeping. There are specific tests to determine whether the SIJ is the source of pain – performing different movements, assuming certain positions to elicit the pain. Your therapist may manipulate your joints or feel for tenderness over your SIJ. Imaging studies, such as X-ray, CT, or MRI, may be ordered to help in the diagnosis and rule out other spine and hip related problems. A diagnostic SIJ injection may be performed to confirm the cause of pain. WHAT TREATMENTS ARE AVAILABLE FOR SIJ PAIN? Physiotherapy treatment for patients with this condition is vital to hasten the healing process, ensure the best outcome and decrease the likelihood of injury recurrence. Treatment may include: Treatment will also look at addressing any underlying muscle imbalances and postural alignment issues that would affect the SIJ. This may include stretching exercises for shortened tight muscles, as well as strengthening exercises for weak muscles commonly those around the buttocks and abdomen. Your therapist will assess your daily activities and correct any ergonomic problems that could be contributing to your pain, which may also require referral to an occupational therapist. Should you have a leg length discrepancy the therapist will advise on orthotics or inner soles and this too may require a referral. There are other medical treatments available such as SIJ steroid injections, nerve blocks and even surgery which can be discussed with your therapist or doctor in cases where conservative treatment has failed. PREVENTION IS KEY TO AVOIDING RECURRENCE A positive attitude, regular activity, and a prompt return to work or sport are all very important elements of recovery. If regular job duties cannot be performed initially, modified (light or restricted) duty may be prescribed for a limited time. Key points to ensure your pain doesn’t return are: ■ Learn proper lifting techniques ■ Ensure good posture during sitting, standing, moving, and sleeping ■ Regular exercise with stretching /strengthening ■ An ergonomic work area ■ Good nutrition, healthy weight, lean body mass ■ Stress management and relaxation techniques The information contained in this article is intended as general guidance and information only and should not be relied upon as a basis for planning individual medical care or as a substitute for specialist medical advice in each individual case. ©Co-Kinetic 2017 PRODUCED BY: journal TIME-SAVING RESOURCES FOR PHYSICAL AND MANUAL THERAPISTS ■ Joint mobilisation and/or manipulation ■ Spinal and pelvic realignment ■ Dry needling / acupuncture ■ Deep tissue massage / mysofascial release ■ Ultrasound / electrotherapy ■ Neural mobilization ■ Ice or heat treatment ■ Taping
Transcript of SACROILIAC JOINT PAIN · Chronic low back pain can have a dramatic impact on daily activities as...
Chronic low back pain can have a dramatic impact on daily activities as well as the ability to work and exercise. The sacroiliac joint (SIJ) is a very common source of low back pain, and many times is misdiagnosed as a problem with the discs or the spine.
The first key to understanding SIJ pain is understanding the anatomy. There are two SIJ’s in your body, located on either side of the triangle-shaped bone at the bottom of your spine where it connects to your pelvis. The SIJ’s are a shock absorber for your spine and provide stability for your body as you run, walk, or jump. The most the joint moves in sliding is probably only 2-4 millimeters, and may tilt and rotate two or three degrees.
The SI joint is held together by several large, very strong ligaments. The strongest ligaments are in the back of the joint outside of the pelvis. Because the pelvis is a ring, these ligaments work somewhat like the hoops that hold a barrel together. If these ligaments are torn or become lax, the pelvis can become unstable. Muscles of the back and pelvis are functionally connected to the SIJ ligaments therefore their actions can affect joint mobility.
HOW DO YOU KNOW IF THE PAIN YOU’RE FEELING IS BEING CAUSED BY A SIJ PROBLEM? There are some common symptoms:■ Low back pain: usually a dull ache on one side of your lower back
that may extend into the thigh or groin. It is usually below the L5, or lowest lumbar vertebrae.
■ Buttock pain: pain can range from an ache to a sharp stabbing pain that extends down one or both legs
■ Low back pain while climbing stairs: activities that require weight transfer to one leg at a time, which require the pelvis to twist may produce SIJ pain. Possibly even feeling that your leg may buckle or give way.
■ Difficulty sitting or lying on one side: often experienced as an ache on one side that causes you to shift weight to one side to relieve the pain in the other.
WHAT CAUSES SIJ PAIN? Each joint contains many nerve endings that can cause significant pain if the joint is damaged or loses its ability to move properly. Everyday wear and tear, arthritis, or a single injury can damage these joints, changing their normal movement and creating chronic and sometimes debilitating pain.
The SIJ can become painful when the ligaments become too loose or too tight. This can occur as the result of a fall, work injury (repetitive strain), car accident, pregnancy and childbirth, or hip/spine surgery. Underlying biomechanical problems can also cause SIJ pain – such as one leg being longer than the other, uneven movement in the pelvis due to muscle imbalances, or one sided postural habits.
HOW IS A DIAGNOSIS MADE? A physiotherapist will help determine whether the SIJ is the source of your pain. Evaluation includes a medical history and physical exam. Your
ADVICE HANDOUT
SACROILIAC JOINT PAIN SACROILIAC JOINT PAIN SACROILIAC JOINT PAIN SACROILIAC JOINT PAIN SACROILIAC JOINT PAIN SACROILIAC JOINT PAIN therapist will consider all the information you provided, including any history of injury, location of your pain, and problems standing or sleeping.
There are specific tests to determine whether the SIJ is the source of pain – performing different movements, assuming certain positions to elicit the pain. Your therapist may manipulate your joints or feel for tenderness over your SIJ.
Imaging studies, such as X-ray, CT, or MRI, may be ordered to help in the diagnosis and rule out other spine and hip related problems. A diagnostic SIJ injection may be performed to confirm the cause of pain.
WHAT TREATMENTS ARE AVAILABLE FOR SIJ PAIN?Physiotherapy treatment for patients with this condition is vital to hasten the healing process, ensure the best outcome and decrease the likelihood of injury recurrence. Treatment may include:
Treatment will also look at addressing any underlying muscle imbalances and postural alignment issues that would affect the SIJ. This may include stretching exercises for shortened tight muscles, as well as strengthening exercises for weak muscles commonly those around the buttocks and abdomen. Your therapist will assess your daily activities and correct any ergonomic problems that could be contributing to your pain, which may also require referral to an occupational therapist. Should you have a leg length discrepancy the therapist will advise on orthotics or inner soles and this too may require a referral.
There are other medical treatments available such as SIJ steroid injections, nerve blocks and even surgery which can be discussed with your therapist or doctor in cases where conservative treatment has failed.
PREVENTION IS KEY TO AVOIDING RECURRENCE A positive attitude, regular activity, and a prompt return to work or sport are all very important elements of recovery. If regular job duties cannot be performed initially, modified (light or restricted) duty may be prescribed for a limited time. Key points to ensure your pain doesn’t return are: ■ Learn proper lifting techniques ■ Ensure good posture during sitting, standing, moving, and sleeping ■ Regular exercise with stretching /strengthening ■ An ergonomic work area■ Good nutrition, healthy weight, lean body mass ■ Stress management and relaxation techniques
The information contained in this article is intended as general guidance and information only and should not be relied upon as a basis for planning individual medical care or as a substitute for specialist medical advice in each individual case. ©Co-Kinetic 2017
PRODUCED BY:
journalTIME-SAVING RESOURCES FOR PHYSICAL AND MANUAL THERAPISTS
■ Joint mobilisation and/or manipulation
■ Spinal and pelvic realignment■ Dry needling / acupuncture■ Deep tissue massage /
mysofascial release
■ Ultrasound / electrotherapy ■ Neural mobilization ■ Ice or heat treatment■ Taping
SUPINE BRIDGE BASICLie flat on your back, with your knees bent, squeeze your bottom muscles and lift your body upwards. Keep your arms by your side and use them to help you balance. Make sure you maintain good posture (do not over-arch your lower back) and contract the deep abdominal muscles by squeezing your tummy towards your spine. This exercise helps to strengthen the abdominal, lower back, gluteal and hamstring muscles.
Video:http://youtu.be/fK_xUE3OKIE
EXERCISE HANDOUT
STRETCHING FOR SIJ – PHASE 1
The information contained in this article is intended as general guidance and information only and should not be relied upon as a basis for planning individual medical care or as a substitute for specialist medical advice in each individual case. ©Co-Kinetic 2017
PRODUCED BY:
journalTIME-SAVING RESOURCES FOR PHYSICAL AND MANUAL THERAPISTS
PRODUCED IN ASSOCIATION WITH
YOUR REHABILITATION PROGRAMME This exercise programme has specific exercises to strengthen muscles around your lower back, sacro-iliac joint and pelvis. The exercises will improve your core strength and control as well as stretch and mobilise tight structures. In order to achieve proper rehabilitation of your injury it is important to ensure the exercises are performed with good technique. Poor practice may place potential strain on your back. The following leaflet includes some exercises to help in your rehabilitation.
GUIDANCE FOR STRETCHING EXERCISES This exercise programme has specific stretches to target key muscles.
Hold all the stretches for 20 seconds each and repeat them five times on each side. It is important to stretch the uninjured muscles so that you are well balanced.
PROGRESSION SPEED Your therapist will advise you on the speed you should progress. Progression is not just about being able to do the exercise but to do it correctly, with appropriate control. If at any time you feel pain or discomfort stop the exercises and consult your therapist. .
LUMBAR MOBILISATION LYINGLying down, lengthen one leg to create a shift in your pelvic level. The other leg is drawn upwards at the same time. This will create a side-bend to your lumbar spine. Repeat each side to increase mobility in your lumbar spine (lower back).
Video:http://youtu.be/qiFfbJ5H5v8
SINGLE LEG BACK STRETCHLie flat on your back, and bend your knee towards your chest. Hold this position and feel a gentle stretch in your back. If you get any groin pain while doing this exercise, stop and inform your therapist. Relax, and then repeat as necessary.
Video:http://youtu.be/lka-1VKjrew
SETS REPS
SETS REPS
HORSE-STANCE OPPOSITE LIFTStanding up, place your foot on a chair or Swiss ball. Keep your leg Go on to all fours, and keep good posture. Draw your tummy inwards (towards the ceiling). Lift your hand and opposite knee upwards 1cm and hold this position. Repeat each side. This is a great core stability and core control exercise to work the abdominal muscles.
Video:http://youtu.be/R5ScHb9eIXU
PELVIC TILT LYINGLie flat on your back, and engage your deep core muscles by drawing your belly button inwards (towards your spine slightly), while flattening your spine against the floor, then relax. Repeat as required.
Video:http://youtu.be/44D6Xc2Fkek
SETS REPS
SETS REPS
SETS REPS
