Sacroiliac joint syndrome

Complaints of the sacro-iliac joint

Iliosacral joint pain - Sacroiliac joint syndrome

What are SIJ complaints and how are they caused?

The pain is caused by disorders of the sacroiliac joint (joint of the sacrum and ilium). There are actually two joints, which together form the connection between the sacral bone and iliac bone. This can be an inflammation of the joint, joint wear, or a disorder of the joint function or position. The discomfort may radiate into the pelvis or the buttocks, and also into the upper and lower leg. Once the cause of the pain is identified, the discomfort can generally be well treated. Pain in the lower region of the spine, for example, after sitting or standing for a long time, often originates in the iliosacral joint. 

Common SIJ diseases include:

  • SIJ syndrome
  • Arthrosis of the sacroiliac joint (SIJ arthrosis)
  • Instability of the sacroiliac joint (SIJ instability)
  • Instability of the pelvic girdle
  • Sacroiliac joint blockage
  • Symphysis diastasis and loosening

Risk factors and causes

Disorders

  • Sustained levels of incorrect weight distribution and excessive physical strain caused by sports or occupational activities
  • Jerky incorrect movements, such as a misjudged step
  • Shortening or hardening of certain muscles (e.g. iliopsoas muscle)
  • Physical deformities such as scoliosis or shortening of the leg
  • Incorrect weight distribution and excessive physical strain due to the forward tilting of the pelvis as a result of arthrosis of the hip joint
  • Loosening of the annular ligaments of the pelvis due to hormonal changes during pregnancy

Inflammation

  • SIJ inflammation
  • Inflammation of the bowel (such as Crohn’s disease)

Bone fractures

  • Accidents
  • Fatigue failure
  • Insufficiency fractures in the event of osteoporosis

Treatment options for SIJ syndrome

The treatment depends on the cause of the disorder. Therefore, there are different therapeutic approaches. Usually the complaints are treated conservatively (without surgery). Patients can prevent a recurrence of the disorder by doing special exercises.

Physiotherapy

Manual therapy involves stretching and mobilising the joints and the corresponding muscles and ligaments. This improves joint function. Depending on the diagnosis and stage of the disorder, the doctor can, if necessary, prescribe other physiotherapeutic treatments (such as electrotherapy (TENS), magnetic field therapy or acupuncture). 

Bandages and orthoses

Special medical aids (for example the Lumbamed sacro pelvic orthosis from medi) support conservative therapy. The pelvis and SIJ can be stabilised and relieved by circular compression. Individually adjustable massage pads promote blood flow and relax the pain points in the SIJ region. The circular compression and pressure of the pads can be infinitely varied by pull straps. 

Heat treatment

A heating pad, hot water bottle, hot bath or simply, a warm towel can relieve acute SIJ pain.

Medication

Ibuprofen or Diclofenac are anti-inflammatory and pain-relieving drugs that doctors can administer if necessary. In any case, consult the doctor in charge.

Drug ointments

The affected area can be massaged several times a day with ointments that are anti-inflammatory or promote blood flow. This promotes recovery.

Injections

If necessary, the doctor may give a local anaesthetic mixed with a cortisone preparation in order to soothe irritation. However, this form of therapy is used only for very severe, persistent pain – and only after consulting with the doctor in charge.

SIJ therapy exercises

So that you are soon up and mobile again, medi provides three stretch exercises and three strengthening exercises for supporting sacroiliac joint therapy. Please discuss in advance with your doctor or therapist, whether these exercises are suitable for you and may be integrated into your therapy plan. 

Stretching exercises

Lower body twisting

Lower body twisting: Exercise to stretch the lower and lateral back and buttock muscles

Starting position:

  • Lie on your back on a firm surface.
  • Straighten your right leg, bend your left leg, lay your left foot on your right knee.
  • Lay your outstretched left arm on the floor, place your right hand on your left thigh.

Exercise:

  • Now move the bent leg over the straight one.
  • As you do so, twist your body from the chest down to the right.
  • Your left arm remains the floor, your chest does not twist, your head looks in the opposite direction.
  • You will feel the stretch in the lower/lateral back muscles and in your bottom.

Please note:

  • arm stays on the floor
  • head turns to the opposite side

Hip tilt

Hip tilt: Exercise to stretch the groin region and the hip flexors

Starting position:

  • Stand on a firm surface with your legs slightly apart.
  • Hold your arms straight out in front of you.

Exercise:

  • Keep your upper body and legs straight and tilt or push your pelvis forwards.
  • You will feel the stretch in your groin.
  • You can increase the stretch in your groin region by keeping your legs straight and turning your pelvis (not your upper body!) slightly further to the left or the right.

Please note:

  • pelvis tilts / is pushed forwards

Leg pulls

Leg pulls: Exercise to stretch the buttock muscles

Starting position:

  • Lie on your back on a firm surface, lay your arms down next to your body.
  • Press your lower back down against the floor.
  • Bend your right knee to an angle of about 90°.
  • Bend your left knee and lay your ankle on the right leg below the knee.

Exercise:

  • Now hold your right leg below the kneecap.
  • Pass your left hand between both legs and grasp it with your right hand around the right leg.
  • Now pull your right calf towards your face.
  • You will feel the stretch in your buttock muscles.

Please note:

  • press your lower back against the floor

Strengthening exercises

Trunk bends

Trunk bends: Exercise to strengthen the lower back muscles

Starting position:

  • Stand on a firm surface with your feet slightly apart and knees slightly bent.
  • Grasp both ends of the exerciser firmly, holding one end in each hand.
  • Now stand with both feet on the exerciser.
  • Lean your upper body forwards with your back straight.
  • Stretch the exerciser with modified tension.
  • Keep your arms straight.

Exercise:

  • Pull the exerciser vertically upwards.
  • Keep your back straight and only straighten up your upper body.
  • Keep your legs in the starting position, do not move them.

Please note:

  • keep your back straight
  • tense your abdominal muscles!
  • knees slightly bent
  • arms held out straight

Leg raises

Leg raises: Exercise to strengthen the buttock muscles

Starting position:

  • Kneel down on a firm surface.
  • Keep your knees together.
  • Lean your upper body forwards, keeping your back straight, and support yourself on your elbows.
  • Grasp both ends of the exerciser firmly, holding one end in each hand.
  • Stretch the exerciser around one foot with modified tension.

Exercise:

  • Stretch your leg diagonally backwards against the tension of the exerciser until your leg, back and neck are in a straight line.
  • Then bring your leg back to the starting position.

Please note:

  • tense your abdominal muscles!
  • do not bend your upper body forwards or backwards
  • keep your knees slightly bent

Leg lifts

Leg lifts: Exercise to strengthen the lower abdominal muscles and the hip flexors

Starting position:

  • Lie on your back on a firm surface.
  • Bend your knees to about 90° with your legs slightly apart.
  • Press your lower back down against the floor.
  • Lay your arms on the floor by your body.
  • Rest your head on the floor.

Exercise:

  • Lift your legs up until the angle between your upper body and thighs is about 90°.
  • The angle at the knee remains unchanged.
  • Keep your lower back pressed against the floor.

Please note:

  • press your lower back against the floor
  • perhaps lay a pillow under your head

More information about Lumbamed sacro

Diagnosis & treatment

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Types, causes and treatment of back pain

Back pain

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