The sacro-iliac joint (SIJ) is a joint at the bottom of your back whereby the spine joins to the pelvis. There is an SIJ on each side of the sacrum where it joins onto the ilium (pelvis bone). It is thought to be a significant contributor to low back pain, particularly in the younger population.
The SIJ does have a bony locking mechanism but is very reliant on strong ligament structures to help support it. As with all soft tissue injures, i.e. injuries to tendons, ligaments, muscles etc, these tissues can be overloaded and produce a painful response. This is common in pregnancy when extra load in front can cause an overload to these ligaments, or a trauma to the area.
There is very little movement in this joint and it is known that as we get older, the movement lessens to a point where the bones fuse and no further movement comes from the joint.
Pain is often localised to the joint and around the dimples in the lower part of the back. Pain can refer into the buttock and back of the thigh. Pain is often worse with movement and activities such as walking, climbing stairs and leaning forward can be sore. Pain is often eased with rest but being in one position for too long can also cause the area to become painful and gentle movement often helps alleviate the pain.
As well as the ligaments, the area is also very dependent on the strength in key articulating muscles such as the glutes, abdominals and the hamstrings. Often, weakness in these muscles can overload the ligaments and lead to soreness.
At your initial assessment, your Physio will give you the opportunity to explain the history and nature of your symptoms and will perform a comprehensive physical examination. Once this is complete, your Physiotherapist will discuss your diagnosis. Having a fast an accurate diagnosis means that the most appropriate and effective treatment can be put in place to achieve better outcomes. Your Physio will discuss your limitations and help you develop a list of personal goals. Regular re-assessment will track your progress towards your goals and allow for any necessary adjustments in your treatment to be made.
Your Physiotherapist will discuss how you can modify some of the activities that are causing your symptoms whilst it settles. They may also suggest an ‘SIJ belt’ that can help alleviate some of the symptoms in the short term, whilst you are working on strengthening the muscles. It is important to say that this is not a long-term solution but may give you some comfort until the muscles have a chance to get stronger. These can often be helpful in the second and third trimester of pregnancy.
Physiotherapy focuses on strengthening the muscles around the joint. Your clinician will give you an individualised exercise programme aimed at strengthening around the trunk and top of your legs. Your Physiotherapist will discuss activities and goals that are important to you so that a clear plan can be made to help you achieve those aims. To ensure you make progress and that your rehabilitation plan remains optimal, we carry out regular re-assessment. Please find the patient resources section of our website where we have created a series of recommended exercise programmes for SIJ pain. We advise consulting with your Physiotherapist prior to trying any of these exercises.
Your Physiotherapist may also implement other treatment modalities such as manual therapy and acupuncture to help with the pain if they think it is appropriate and these can be a very useful adjunct alongside your exercise programme.
As you progress through your recovery journey, you will be provided with ongoing advice and support so that you can effectively self-manage and prevent re-occurrence.