Sacroiliac Pain, Treatment and in Pregnancy

There are many causes of pain in the sacroiliac region, and treatments do not necessarily involve traditional medical interventions.

The Sacroiliac Joint

The sacroiliac joint, or SI joint, is the area in the pelvis between the ilium and the sacrum, held together by ligaments. The ilium supports the sacrum on each side, and the sacrum supports the spinal vertebrae. The SI joint is a synovial, weight-bearing joint. The two SI joints in the human body are shaped like kidney beans, and they “move together as a single unit”. They are stable because of their bony structure and strong ligaments: anterior, interosseous, posterior, sacrotuberous, and sacrospinous. The purposes of the SI joint include shock absorption and torque conversion. It self-locks, to help in the stability of walking, so that weight can transfer from one leg to the other.¹

Disorders in the SI Area

Pain in the SI joints can be caused by sacroiliitis, which can cause low back pain due to the inflammation. Pain may be localized, or it can spread from the lower back to the thighs and buttocks. Disorders in this region are generally termed sacroiliac joint dysfunction (SIJD). Problems are caused where there is too much, too little, or abnormal motions. Mechanical SIJ dysfunction is a “dull…lowback pain”. SIJD can also worsen during certain actions, such as walking steps or moving from sitting to standing. Pain can be on one or both sides of the body, and it can be localized or “referred pain”, into the hip, groin, and sometimes down to the knee, as well as the thigh and buttock. The “nonprovocative” tests for SIJD can include the Gillet Test, supine long sitting test, standing and seated flexion tests, and the prone knee flexion test. There are also “provocative” tests, which are aimed at reproducing the pain in the SI joint.² Some of the causes of SIJD include degenerative arthritis (osteoarthritis), leg length discrepancy, and foot, knee, ankle, and hip pain. Other ways of causing inflammation in the SI joints are rheumatoid arthritis, gout, psoriasis, and ankylosing spondylitis. One of the most common causes of SIJD is pregnancy.³

Pregnancy

Hormonal changes during pregnancy can lead to particular SI joint problems. Even menstruation hormones can trigger lower back pain. Connective tissues during pregnancy relax to prepare the mother for delivery. This changes the SIJs, making them “hypermobile”. Over time and multiple pregnancies, this relaxation and hypermobility can cause permanent structural changes in the SI joints.⁴ Some women may benefit from wearing a sacroiliac belt to “stabilize the sacroiliac joints until the baby is delivered”.⁵

Treatment Options

Medical treatments for SIJD can include injections, NSAIDs, and steroids, such as prednisone. Patients can be referred for physical therapy so that they can learn stretches and exercises. Pilates, yoga, and manual therapy can also be included in treatments. The final option for some patients is surgery to fuse the SI joints.⁶ Chiropractic care approaches SIJD with traditional high-velocity, low-amplitude thrust (HVLA) spinal manipulation. Some patients may require a gentler adjustment: low-velocity, low-amplitude thrust or “spinal mobilization”. Chiropractors will typically adjust the patient on their side. They may also use traction, drop tables, flexion distraction, or the Activator tool. Some patients may benefit from muscle relaxation techniques, heat therapy, massage, electrical stimulation (TENS), ice packs, shoe inserts, and muscle strengthening techniques.⁷ Chiropractic treatment is safe during pregnancy.