Sacroiliac Joint Pain
What Is the Sacroiliac Joint?
The sacroiliac joint is the part of your lower back made up of the sacrum (the bony structure above your tailbone and below your lower vertebrae) and the top part (iliac) of your pelvis. It is the part of the low back just behind your waist. You have right and left sacroiliac joints. Ligaments hold these bones in place.
How Does Sacroiliac Joint Pain Occur?
Some possible causes of sacroiliac pain include:
- Activities that involve twisting, bending, or heavy lifting (for example, swinging a golf club or shoveling)
- A fall or a direct blow to the area
- Imbalance of the muscles around your hip or pelvis from one leg being shorter or longer than the other
- Poor posture
- Ligaments in the sacroiliac joint that are too loose.
What Are the Symptoms?
Symptoms can include:
- Pain in the sacroiliac area of the low back
- Difficulty bending or twisting your low back
- Pain after sitting for a long time
- Stiffness in the low back, hip, or leg
- A feeling of being “out of alignment.”
How Is it Diagnosed?
Your provider will ask about your health history and examine your back, pelvis, hips, and legs. You may need an x-ray, or in some cases a CT scan or an MRI. These tests are done to rule out other causes of pain.
How Is it Treated?
For the first 2 to 3 days you should treat the area with ice packs for 20 to 30 minutes every 4 to 6 hours. You may use a frozen gel pack, crushed ice, or a bag of frozen peas. After icing for a few days, you may start to use moist heat to help loosen up a stiff sacroiliac joint and the muscles of your lower back.
Other Treatments May Include:
- Anti-inflammatory medication, muscle relaxants, or other medication
- Massage to your low back and sacroiliac joint
- Physical therapy
- Mobilization of the sacroiliac joint (A physical therapist, chiropractor, or a physician trained in manipulative medicine may do this. This is done by applying force across the joint, and helping put the joint in better alignment.)
- An insert for your shoe, if your legs are different lengths
- A sacroiliac belt which will help support the joint
- A cortisone injection into the sacroiliac joint to reduce pain and swelling.
When Can I Return to My Sport or Activity?
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your sport or activity will be determined by how soon your sacroiliac joint recovers, not by how many days or weeks it has been since your injury occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better.
It is important that you have fully recovered from your sacroiliac pain before you return to your sport or any strenuous activity. You must be able to have the same range of motion that you had before the injury. You must be able to twist, bend, run and jump without pain.
How Is Sacroiliac Pain Prevented?
Be sure that you have warmed up and have done proper stretching exercises before participating in sports or other activities. Try not to twist when you are lifting heavy objects.
These exercises are designed to gently move your sacroiliac joint. Do not do these exercises if they cause any pain or discomfort. If your pain continues see your health care provider or physical therapist as soon as possible.
- Hamstring stretch on wall: Lie on your back with your buttocks close to a doorway, and extend your legs straight out in front of you along the floor. Raise one leg and rest it against the wall next to the doorframe. Your other leg should extend through the doorway. You should feel a stretch in the back of your thigh. Hold this position for 15 to 30 seconds. Repeat 3 times on each side.
- Quadriceps stretch: Stand an arm’s length away from the wall, facing straight ahead. Brace yourself by placing one hand against the wall. With your other hand, grasp your ankle leg and pull your heel toward your buttocks. Don’t arch or twist your back and keep your knees together. Hold this stretch for 15 to 30 seconds. Repeat 3 times.
- Hip adductor stretch: Lie on your back, bend your knees, and put your feet flat on the floor. Gently spread your knees apart, stretching the muscles on the inside of your thigh. Hold this for 15 to 30 seconds. Repeat 3 times.
- Sitting hip adduction isometrics: Sit with your knees bent 90° with a pillow placed between your knees and your feet flat on the floor. Squeeze the pillow for 5 seconds and then relax. Do 3 sets of 10.
- Gluteal isometrics: Lie on your stomach with your legs straight out behind you. Squeeze your buttock muscles together and hold for 5 seconds. Release. Do 3 sets of 10.
- Lower trunk rotation: Lie on your back with your knees bent and your feet flat on the floor. Tighten your abdominal muscles and push your lower back into the floor. Keeping your shoulders down flat, gently rotate your legs to one side, then the other as far as you can. Repeat 10 to 20 times.
- Single knee to chest stretch: Lie on your back with your legs straight out in front of you. Bring one knee up to your chest and grasp the back of your thigh. Pull your knee toward your chest, stretching your buttock muscle. Hold this position for 15 to 30 seconds and return to the starting position. Repeat 3 times on each side.
- Double knee to chest: Lie on your back with your knees bent and your feet flat on the floor. Tighten your abdominal muscles and push your lower back into the floor. Pull both knees up to your chest. Hold for 5 seconds and repeat 10 to 20 times.