The Sacroiliac Joint
There are many possible causes of pain located in the sacroiliac region, and treatments do not necessarily need to involve traditional medical interventions.
The sacroiliac joint, or SI joint, is the area in the pelvis between the ilium and the sacrum. Ligaments hold it together. 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. These joints are meant to move together as though they were a single unit. They are stable because of their bony structure and presence of the following 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 safely transfer from one leg to the other.1
Disorders in the SI Area
Pain in the SI joints can be caused by sacroiliitis, which becomes a cause of low back pain due to the inflammation. Pain may be localized, or it can spread and encompass the area 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 manifests as a dull pain in the lower back. SIJD can also worsen during certain actions, such as walking steps or moving from a sitting position to standing. Pain can be located on one or both sides of the body. It can be localized or “referred pain”, into the hip, groin, and sometimes even reaching all the way 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 having the patient reproduce 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 through the presence of rheumatoid arthritis, gout, psoriasis, and ankylosing spondylitis. One of the most common causes of SIJD is actually not some other harmful condition but, instead, pregnancy.3
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
Traditional medical treatments for SIJD can include the administration of injections and the prescription of NSAIDs and steroids, such as prednisone. Patients can be referred for physical therapy so that they may learn stretches and exercises to have an important part of their own treatment. Pilates, yoga, and manual therapy can also be included in these more natural treatments. The final option for some patients is surgery to fuse the SI joints. Though there are cases where surgery is the only option, many patients have the opportunity, in the case of injury to the SI joints, to try alternative treatments before turning to surgery. Medications and surgery both carry potentially harmful side effects, and patients who have the chance to try alternative therapies are recommended to explore the safer treatment options first.6
Chiropractic Care for SIJD
Chiropractic care approaches SIJD with traditional high-velocity, low-amplitude thrust (HVLA) spinal manipulation. Some patients, such as children or those who need to be handled more carefully, may require a gentler adjustment: low-velocity, low-amplitude thrust or “spinal mobilization”. Chiropractors will typically adjust the patient while the patient is lying down on their side. They may also use additional tools in the adjustment process, such as traction, drop tables, flexion distraction, or the Activator tool, beyond the usual manual adjustment by hand. Some patients may benefit from the application of muscle relaxation techniques, heat therapy, massage, electrical stimulation (TENS), ice packs, shoe inserts, and muscle strengthening techniques.
The chiropractor might recommend additional exercises and methods of recovery for the patient to try at home, in between visits. This is to maintain the progress that they have made in their treatment. It is not uncommon for chiropractors to work with local massage therapists or physical therapists, who could aid in additional treatment.7 Chiropractic care is a safe method of treatment during pregnancy.