Adopt evidence-based solutions for treating sacroiliac joint dysfunction.
Adopt evidence-based solutions for treating sacroiliac joint dysfunction.The sacroiliac joint is frequently undervalued in it’s influence on musculoskeletal health. A widespread condition, sacroiliac joint dysfunction (SJD) warrants attention separate from chiropractic treatment of low-back pain caused by conditions such as disc lesions and sciatica.1-6
With approximately 80 percent of the population suffering from low-back pain at some point, SJD may represent up to 15 to 25 percent of those cases.3 In addition, SJD has shown to be a source of back pain in more than 30 percent of children.7
Located below the lumbar spine and just above the tailbone (coccyx), the sacroiliac (SI) joints are the largest joints at the base of the spine, connecting the bony sacrum to the pelvis on either side. SJD is a broad term applied to pain in the SI joint region, and it is quite common, affecting between 20 to 50 percent of the general population.8
Because SJD symptoms can manifest elsewhere in the body, the condition may be difficult to diagnose. For example: Pain in the lower back, buttocks, groin, and lower extremities may be caused by SJD. A 2013 study found that the condition might be associated with an increased incidence of neck pain, while a separate study found a correlation to tension and pain in the jaw muscles and joints.9-10
There are two categories of SJD:
- Primary: Occurs suddenly due to trauma, lifting, slipping, or sudden unexpected
- Secondary: Caused by faulty posture aggravated by a patient’s job or Pressure can build up on SI joint(s) for years before any obvious discomfort is noticed.
SJD can be painful and debilitating, but it is rarely life-threatening and in most cases surgery shouldn’t be necessary. Whether facing a primary or secondary form of the condition, most patients with SJD will respond favorably to chiropractic care.
Who it affects
SJD is most frequently caused by minor trauma—rotation of the joint during lifting may cause tears in small ligaments surrounding the joint, for example. Less commonly, serious conditions such as fracture, dislocation, infection, and inflammatory arthritis may be to blame.
The groups particularly at risk include athletes, runners, arthritic patients, the elderly, and pregnant women. Patients with leg-length inequality, excessive pronation, or other abnormalities in gait are also susceptible.1, 11-12
In pregnant women, hormone-induced relaxation of the pelvic ligaments, weight gain, and increased curvature of the lumbar spine are risk factors in the later months of pregnancy and immediately postpartum.13
What to look for
Your patients may complain of tightness of the iliopsoas, rectus femoris, adductors, and hamstring muscles, or weakness in the gluteal, lower abdominal, and hamstring areas. A shortened iliopsoas muscle leads to an anteriorly rotated ilium, which in turn lengthens the hamstring and gluteal muscles, undermining their ability to stabilize the SI joint.
X-rays may help with diagnosis
Your physical examination should stress the joint in various positions and movements. Look for excessive pronation, pelvic unleveling, and leg-length inequality.
Body imbalance, as the foot on one side is likely pronating more than the other foot, can lead to a number of problems, including SJD, knee pain, hip pain, lumbosacral or SI involvement, and cervical problems. (Pronation is a normal part of the walking cycle, but excessive asymmetrical pronation can have serious health consequences.)
Effective solutions
Tell your patients their first step is to stop any activity that induces pain. SJD can be managed conservatively with a combination of chiropractic adjustments, therapeutic exercise, and custom orthotics when necessary. Custom orthotics can help treat underlying biomechanical abnormalities by stabilizing the joint, allowing patients to more comfortably and safely engage in rehab.
- Manipulation of the SI joint is a logical place to start. A 2004 study found that a short regimen of either mechanical force; manually-assisted; or high-velocity, low-amplitude chiropractic adjustments were equally beneficial in relieving pain and disability in patients with SI joint syndrome.14 Some patients respond better to different approaches, so you may want to employ various manipulations. Myofascial release, trigger point therapy, and acupressure may also be effective.
- Therapeutic exercise can help correct muscular imbalances and relieve stress on the joint. Your patients may also benefit from strengthening exercises targeting the core stabilizer muscles of the spine and those focused on SI-joint stability.
- Custom orthotics or shoe lifts address anatomic or functional leg-length discrepancies and other lower extremity components. These will also help to properly distribute weight borne by the lower back and SI joints for immediate pain relief.
- Supports for the low back and pelvic area such as a cervical support pillow help promote comfort and proper alignment of the spine during sleep.
- Electrical nerve stimulation, ultrasound, heat, cryotherapy, and stretching can be used individually or in combination as part of a targeted physical therapy program.7,15
An ounce of prevention is worth a pound of cure. To prevent their condition from returning, encourage your patients to keep their bodies in good physical condition by maintaining a healthy weight, eating plenty of nutritious foods, and wearing custom-made orthotics to ensure the biomechanics of the body are working properly.
Mark Charrette, DC, is a 1980 summa cum laude graduate of Palmer College of Chiropractic. He is a frequent guest speaker at chiropractic colleges worldwide and has taught more than 1,400 seminars on extremity adjusting, biomechanics, and spinal adjusting techniques. Charrette can be reached at drmarkcharrette@gmail.com.
References
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3 American Chiropractic Association. “Sacroiliac Pain Demystified.” https://www.acatoday.org/content_css.cfm?CID=2704. Published August 2008. Accessed August 2015.
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12 Gemmell HA. The sacroiliac joint. Success Express. 1988;12(1):56-59.
13 Sipko T, Grygier D, Barczyk K, Eliasz G. The occurrence of strain symptoms in the lumbosacral region and pelvis during pregnancy and after childbirth. J Manipulative Physiol Ther. 2010;33(5):370-7.
14 Shearar KA, Colloca CJ, White HL. A randomized clinical trial of manual versus mechanical force manipulation in the treatment of sacroiliac joint syndrome. J Manipulative Physiol Ther. 2005;28(7):493-501.
15 Voloshin AS, Burger CP. Interaction of Orthotic Devices and Heel Generated Force Waves. Ninth Intl. Congress on Applied Mechanics. Canada, 1983.
