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Sacroiliac Joint Pain or Lower Back Pain?
Sacroiliac joint pain is a common condition that can feel like lower back pain, but the source and cause are quite different. It also requires a specific assessment of the pelvis and the many muscles acting on it. In this blog I explain the distinguishing characteristics of sacroiliac joint pain compared to lower back pain. I also explain the basic treatment principles and the role of ‘motor control’ in rehabilitation and how this applies to the sacroiliac joint.
What is Sacroiliac Joint Pain?
Pain can come from either of the two joints between the sacrum and ilium and the muscles connected to the pelvis. The joint can be twisted causing a deep ache in the hip and buttock area. In some situations the joint can become inflamed if it is too mobile. Some of the muscles attached to the pelvis and hip can go into spasm and become quite achey.
Most patients will describe it as lower back pain because the pattern of pain can be similar. It can be a major cause of pain in the lower back and pelvic area in all age and activity groups. It can be particularly prevalent before and after pregnancy where the ligaments become lax causing the joint to be more unstable. Sacroiliac joint pain is usually felt lower than the lumbar spine and can be palpated over the joint.
Usually muscle testing shows weakness in the muscles that stabilize the sacroiliac joint. This may have been going on for a while and then a specific event pulls the joint out of alignment. In some patients it can be a specific trauma such as a motor vehicle accident or fall on the pelvis.
Apart from pregnancy and trauma being obvious causes, there is not one causal factor that explains pain and weakness in the sacroiliac joint. Each person demonstrates a combination of biomechanical factors that cause misalignment and the underlying muscle weakness. In the more insidious cases, the lack of muscle control is the underlying cause.
Getting the correct diagnosis that distinguishes it from lower back pain is essential for directed treatment. Sacroiliac joint pain is both a mechanical problem of the joint being misaligned and muscle imbalances.
Four Common Symptoms:
- Pain is felt at the back of the hip and pelvis, sometimes coming round to the front of the hip and groin. It is usually present on one side.
- The leg can feel shorter or longer, particularly if there is a significant misalignment.
- Pain can be felt in standing and walking, worse when using stairs.
- Pain can radiate down to the knee, but not usually below.
There are a number of tests in the clinic that can further diagnose a sacroiliac joint problem compared to a lower back issue. Most of the time we are able to find that the joint has been rotated or twisted, and also if the patient has a muscle control problem causing the joint to be unstable. Some tests can localize the pain to the joint whereas lumbar spine tests don’t produce symptoms.
The patient’s history of the problem and clinical tests will narrow it down to either a lower back or sacroiliac joint problem.
What is the Treatment for a Sacroiliac Joint Problem?
- The joint needs to be manually mobilized into the correct alignment.
- Taping or a sacroiliac belt maybe necessary to provide short-term stability.
- The muscles around the hip and pelvis need to be strengthened.
- Motor control patterns need to be retrained so that the muscles work in a stabilizing way. Pilates rehabilitation is ideal for this as it has a unique way of training the stabilizing muscles.
What is Motor Control in Rehabilitation?
Many patients, not surprisingly, seem a bit confused between the concepts of strengthening and motor control. Firstly, motor control is the coordinated pattern of how muscles stabilize a joint. Strengthening refers to an individual exercise for each muscle. Our muscular system is complex with each muscle and groups of them having different functions. The pelvic joints need to be trained just like an sprained ankle. Ankle joints need balancing exercises to retrain the stabilizing role of all the muscles acting on the joint. The pelvis is no different. Individual muscles need to be targeted and then trained to work in groups to stabilize the sacroiliac joint.
- Sacroiliac joint pain has a similar pain pattern to lower back pain but can be differentiated with clinical tests.
- Sometimes manual therapy is helpful in realigning the sacroiliac joint.
- Strengthening and motor control exercises are essential to resolve muscle imbalances that act on the joint.
- Sacroiliac joint conditions can be managed effectively with a gradual exercise program that stabilizes the joint.
About the Author
Damian Wyard trained is a Registered Physiotherapist and Stott Pilates Rehabilitation Instructor with 20 years experience in his field. He is the owner of Pilates4Physio in Toronto. You can reach him privately at firstname.lastname@example.org, or at his Pilates studio www.pilates4physio.ca www.facebook.com/pilates4physio