Bones, joints, and muscles

What is sacro-iliac (S-I) joint dysfunction?

By Robert V. Duvall, DPT, MPT, ATC, MGFI
www.losethebackpain.com

The S-I (sacro-iliac) joint is one of the most misunderstood areas of the human body. It has been the source of much controversy in the medical community for many years. Much of the debate relies on the fact that there are few reliable methods of evaluating the S-I joint.

Contrary to disc injuries, which can be evaluated using many types of diagnostic tools, examining the S-I joints has proven to be quite unreliable. Clinicians need to rely mostly on their experience rather than on simple methods used to examine the low back. Most medical professionals do not acknowledge it as a source of pain and dysfunction so patients leave a medical office with an incomplete evaluation and often, with an inaccurate diagnosis.

The S-I (sacro-iliac) joint is comprised of two bones: the sacrum and the ilium. You have two S-I joints (left and right). They are located where the spine meets the pelvis. Look for the two dimples in your low back. These two joints allow for very little movement overall as compared to other, more prominent joints such as the hip or shoulder. The pelvic girdle is generally described as the two S-I joints, the pubic symphysis (pubic bone in front), the two hip joints, and the bottom two vertebrae (L4, L5).

What do you feel?

Patients with S-I joint dysfunction experience pain located at or near the S-I joint on one side or both sides as well as pain located in the low back, buttock, and/or groin area. Another common symptom of an S-I joint dysfunction is sciatica. Sciatica is best described as a sharp, often shooting pain that begins in the buttocks and goes down the back of one leg. S-I joint dysfunction may also cause irritation of the nerves that supply the groin or front of your thigh.

Other symptoms include:

• weakness in one leg or both legs, often characterized by difficulty standing on one leg and raising the other (like marching)
• numbness and tingling in one leg (pins and needles)
• a burning pain located near the "dimples"
• difficulty rising from a chair
• muscle discomfort in the buttock, hip, or low back: over 30 muscles attach to the pelvis from the hip, buttock, thigh, and low back

How does this happen?

S-I joint dysfunction is usually caused by an imbalance in the muscles of the hips and glutes and it can also be caused by a fall or other traumatic event such as a car accident.

A condition known as hypermobility may also predispose an individual to S-I joint dysfunction. Hypermobility is best described as a condition in which the joints have too much mobility. This condition generally affects women more than it does men. Different hormone levels present in women—specifically Relaxin, released to prepare the body for pregnancy—can influence hypermobility. Relaxin basically causes the ligaments to "relax" and to allow for more movement to occur in the pelvic girdle region.

The best treatment options

First of all, thorough evaluation is critical to the success of treating an S-I joint dysfunction. Most dysfunctions can be treated with manual techniques that generally involve mobilizations, manipulations, or muscle energy techniques. These techniques must be applied by a skilled medical professional such as a physical therapist and can prove to be quite helpful when utilized appropriately following a thorough evaluation.

Once appropriate manual techniques have been administered, a comprehensive exercise program must be implemented to address the following areas, specifically muscle imbalances:

• lumbar stabilization program aimed at strengthening abdominals and buttock muscles
• exercises designed to mprove flexibility in lower extremity musculature

Some S-I joint dysfunctions may linger on for months and even years. Remember: if you are engaged in a current treatment plan with little to no improvement, seek other options. If you think you may have an S-I joint dysfunction, the first step is to find a healthcare professional who is skilled and experienced in addressing muscle imbalances.