Redmond Physical Therapy Logo

Bike

Redmond Physical Therapy
Symptoms & Pathologies SI Joint

 



Sacroiliac Joint:
SI Joint Dysfunction
Piriformis Syndrome

The sacroiliac joint (SIJ) is the junction at which weight is transferred from the sacrum (tailbone) to the ilium (one of the bones of the pelvis).  As it transfers this weight it also acts as a cushion to modulate the forces from the low back to the legs.  This joint is an important part of the pelvic ring which allows it to accommodate changes in size (ie in pregnancy).  The movements at this joint are very minimal compared to other joints of the body but are essential in everything from stepping off a curb to climbing stairs.  Pain is this joint is referred to as Sacroiliac Joint Dysfunction.

SI Joint Dysfunction:
Many muscles cross the SIJ including muscles of the lumbar spine, hips and abdominal wall.  These muscles act to stabilize this joint and can be strengthened when this joint is unstable.  Women aged 15 to 40 years old injure this joint most commonly although men are not immune.  Females are more prone to injury because the body weight falls behind the axis of support of the hip and this causes strain to the SIJ ligaments.

Pain in the SIJ is common in runners due to the repetitive loading and impact forces through this joint at heel strike.  Prolonged standing on one leg (persistent poor posture), poor muscle extensibility and heavy lifting can all irritate the SIJ.  This leads to pain with negotiating stairs, getting in and out of a car and with torsional movements (ie golfing).  There is usually pinpoint pain at the SI joint (Fortin’s point) which can help in the diagnosis of this condition.

Possible Treatments:

  1. Sacroiliac Joint Belt.  This may offer some approximation of the joint and offer relief when running or with prolonged walking.
  2. Lumbosacral stability/strengthening.  Strengthening via core activation is very useful in reducing symptoms.  This is important in providing compression and, therefore, stability to the SIJ.  A physical therapist can instruct you in exercises.  A scan to rule out the lumbar spine as the source of your pain should be performed.
  3. Muscle Energy Technique (MET).  This encompasses a variety of techniques that are done by a trained professional to ensure proper joint mechanics.  The muscles of the hip, abdomen and pelvis are activated in specific sequences to realign the joint.  Patients can then be taught how to do MET at home.
  4. Soft tissue mobilization.   If a person has a lot of associated muscle hypertonicity (spasm) their symptoms will not resolve until these muscles are relaxed.  Massage or soft tissue mobilization is effective to reduce this tension. This should be followed by proper stretching.

 

Piriformis Syndrome:
Another condition that causes pain in the buttock is called Piriformis Syndrome.  This is also known as periarthritis of the anterior sacroiliac joint.  The piriformis muscle is important in abducting and externally rotating the thigh (moving the thigh away or rotating it away from midline).  The sciatic nerve passes inferior and deep (and sometimes through) the piriformis muscle.  If this muscle is in spasm it can cause pain in the distribution of that nerve.  This would be pain in the gluteal area, posterior thigh and leg and lateral foot.
Runners can have hypertrophy of this muscle which can lead to pain.  This can occur if the hip moves into too much internal rotation due to poor arch support in the shoe during the gait cycle.  This muscle has to control this movement and gets overworked.  It can also become inflamed from direct trauma to the mid-buttock or prolonged sitting (ie truck drivers orbleacher sitting).

Possible Treatments:

  1. Custom foot orthotics to optimize lower extremity alignment and provide adequate arch support.
  2. Stretching and massage to piriformis.
  3. Sport-specific strength training to mimic loading a person would encounter routinely.  A trained physical therapist can offer appropriate exercise training.  These would likely be performed after the individual’s acute symptoms have decreased.
  4. Strengthening of lumbar core and hip muscles.
  5. Ice and other modalities (ultrasound, electrical stimulation) to reduce spasm.

 

Back to top

Back To Injuries

References:
Orthopaedic Physical Therapy Secrets:  Your Physical Therapy Questions Answered by ExpertsYou Trust, 2nd Edition.  Jeffrey D. Placzek, MD, PT, David A. Boyce, PT, EdD, OCS, 2006.

Orthopedic Physical Assessment, 3rd Edition. David J. Magee, 1997.

Management of Common Musculoskeletal Disorders:  Physical Therapy Principles and Methods, 3rd Edition. Darlene Hertling, Randolph M. Kessler, 1996.

http://www.daviddarling.info/images/sacroiliac_joint.jpg

http://emedicine.medscape.com/article/87545-overview

 

Author:  Mandie Majerus, MSPT, OCS, CSCS