The sacroiliac joint (SIJ) is the joint linking your spine to your pelvis, where the sacrum sits between the ilium. The SIJ is a common site for lower back pain, especially when patients report a single sided pain. SIJ pain is often reported following a single event initiating the onset of symptoms.
The SIJ puts up with a lot! It supports the upper body and reduces the transfer of impact from movement. Ligaments of the joint restrict movement and mobility in order to provide the required strength. These ligaments work alongside musculature and fascial attachments including the thoracolumbar fascia, allowing for support and movement.
SIJ injury is thought to be a result of axial loading and rotation. You may be predisposed to SIJ injury if you have a true or apparent leg length discrepancy, gait and biomechanical abnormalities, scoliosis, strains of attaching muscles and even trauma that mildly increases load (for example, jogging). Pregnancy or being overweight with significant central adipose tissue can result in an increased lordotic curve in the lumbar spine, altering how the SIJ accounts for load transmission.
Strength and flexibility training can be appropriate to reducing pain by correcting biomechanical abnormalities. Manual therapy, for example spinal mobilisation or manipulation, can have a temporary benefit for pain and may reduce tension in muscles around the SIJ. However, for long term benefits, strength training has the greatest benefit as it improves lumbopelvic stability and can reduce the likelihood of injury recurrence. Manual therapy may be beneficial at the time of injury to allow for greater movement and reduce pain. However, this should then be used as an opportunity to begin strength and flexibility training to maintain the improvements elicited through manual therapy.
MANUAL THERAPY ALONE IS NOT A CURE FOR INJURY! ANY INJURY!!
Rehabilitation programmes should be initially focused around improving strength and stability of the pelvis and then correcting biomechanical issues. Early rehabilitation will be to strengthen the Gluteus Maximus and reduce tension in muscles of the lower back and anterior hip. This will have a benefit to a lordotic posture, reducing the curve and preventing improper load transfer through the SIJ.
For more information check out our SIJ pain YouTube video here
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