Sacroiliac Joint Syndrome and Chiropractic Treatment

The sacroiliac (SI) joints are located on either side of the spine just below waist height. Looking from behind onto somebody’s back you can see two dimples on either side just below the waist, which is where the SI joints are located.

The joints are between the two pelvic (iliac) bones, which join on to the sacrum, forming the two sacroiliac or SI joints. Inside the joint is a system of ridges and grooves. The sacral side has a concave groove and the iliac side has a convex groove, which limits the movement.

The joints also have a complex system of ligaments, which further strengthen the joints. The main function of the sacroiliac joints is to transmit forces between the upper body and the lower limbs. They are designed to withstand large stresses.

Women tend to be affected more often than men since they tend to have more flexibility of their ligaments. The SI joints tend to lose their flexibility and we are less likely to sprain our SI joints as we get older.

Until recently the main anatomical textbook in medicine did not recognise that these joints moved. The Gray’s Anatomy, since some years now, state that the sacroiliac joints do move, which has been a great help in making medical doctors accept that sacroiliac joints can benefit from chiropractic treatment.

Causes of SI Sprain

Repetitive microtrauma: it means many small repetitive injuries, until the proverbial ‘last straw’. That is why people often hurt themselves doing very trivial activities such as bending to pick up a pen, and they feel pain before they even get to lift the pen. These activities can be things that you have done a hundred times before.

Muscular imbalance or weakness in the muscles surrounding the sacroiliac joints: these problems develop over a long period of time giving little or no symptoms until it is too late.

Trauma such as a fall or road traffic accidents.

Prolonged bending or lifting.

Pregnancy: Hormones released in the last trimester to increase the laxity of the pelvic ligaments can make them more vulnerable to injury.

Problems with the hip, knee and feet: These can all put increased pressure on the sacroiliac joint, which can become painful over time due to repetitive strain.

Signs and Symptoms of SI Joint Sprain

Pain on one or both sides over the joints and into the buttocks. Pain can also be felt in the back of the leg, the front of the thigh and groin. Pain often occurs after lifting or twisting, or can develop over a period of time. Pain is worse when sitting and bending forward. Increased weight bearing such as standing on one leg increases the pain. Lying down eases the pain.

In most cases, there is no loss of strength, pins and needles or numbness. The chiropractor is usually able to make a diagnosis based on the history and the signs and symptoms of the condition. Sometimes, especially if the problem is long-standing, if you have reached a certain age or if there is anything in your medical history to indicate it, we may take an x-ray of the pelvis. You cannot diagnose a sacroiliac joint sprain on an x-ray, CT or MRI scans alone. The diagnosis is made on the clinical findings – but the x-ray may help to rule out other causes and in some cases help the chiropractor determine which type of chiropractic treatment is most appropriate.

It can help to rule out underlying inflammatory conditions, sacroiliitis, such as Ankylosing spondylitis.

Chiropractic Treatment of a Sacroiliac Sprain

The initial healing time for a damaged ligament and muscles is between 4-6 weeks, but it can take months before they have healed properly. Chiropractic treatment will normally help you get comfortable quicker, but it is important to remember that the ligaments might not be fully healed even though the pain has subsided.

There are three phases of the treatment, each having specific goals which should be reached before moving to the next. The aim of the initial phase, acute stage, is to decrease pain and inflammation. The aim of the second phase, stabilisation stage, is to allow the problem to stabilise properly. Rehabilitation exercises will be introduced as the treatment continues.

When you reach the third stage, referred to as the maintenance stage, you should be pain-free and able to do your normal activities of daily living and go back to live your life normally. You can read in more detail about chiropractic treatment here.

Why does the pain recur?

If you suffer recurrent episodes of low back pain it is usually a sign of what chiropractors would refer to as a ‘functional instability’. When you get a joint or ligament sprain the healing creates scar tissue as part of the normal healing process. Scar tissue is less elastic and breaks more easily.

It has also been shown that injuries leave the deeper spinal muscles weakened permanently, even after the pain has gone. The only way to make the muscle recover is to do specific core muscle exercises.

What can I do to stop my low back pain recurring?

There are many different treatments available. Recent research shows that chiropractic spinal manipulation in combination with exercises is the most effective treatment for both acute and chronic SI joint pain. Chiropractors advocate dealing with the underlying neurological, mechanical and muscular problems. Just relying on taking painkillers and rest does not deal with these causes, so even if the pain goes away with rest, it is bound to come back due to the remaining underlying weakness.

For each new episode of pain, you have become more at risk of having another episode. Research has shown that after four episodes of pain you are more likely to suffer chronic and long-term pain.

Factors Affecting Recovery

• The severity of the injury.
• The number of previous episodes- previous injuries can leave the joint weak and prone to re-injury and longer healing time.
• Age- joint ‘wear and tear’ or arthritis can affect the long-term improvement of your condition. However, this does not mean that there is nothing that can be done.
• Poor posture, fitness levels and core stability can prolong back pain. These factors will all be addressed as part of your treatment.
• The time between the injury and seeking treatment- in general, the quicker you seek treatment the quicker you will recover.

For the best response to treatment follow your chiropractors advice as closely as possible.

What should you do?

These are all risk factors for developing back pain:

• Poor fitness levels and spinal stability (core muscle strength)
• Poor posture
• Previous episodes of back pain
• Pain for more than 8 days

So, the longer you have put up with the pain the more likely you are to become a chronic and recurrent sufferer. The general recommendation is to make sure you get the problem diagnosed properly, have a chiropractor evaluate your core stability, have treatment if necessary and do the right type of exercise to help your problem.