The sacroiliac joint (SIJ) is the load-bearing, shock-absorbing union between the spine and pelvis. It is a mechanical link that connects the chain of locomotion to the rest of the body. This irregular, synovial and fibrocartilagenous joint is surrounded by a strong ligamentous-reinforced capsule and is minimally mobile, allowing only about 4 degrees of rotation and up to 1.6 mm of translation (1,2).
Approximately 3-30% of lumbosacral pain is attributable to the SIJ (3,19,20,21,27,31). Sacroiliac joint dysfunction (SIJD) can be divided into two general categories: mechanical and arthritic. “Mechanical” SIJD results from any process that alters normal joint mechanics (i.e. hyper or hypomobility). Common culprits include: leg length inequalities, gait abnormalities, lower extremity joint pain, pes planus, improper shoes, scoliosis, prior lumbar fusion, lumbopelvic myofascial dysfunction, repetitive strenuous activity and trauma- especially a fall onto the buttocks. Atypically formed variant sacroiliac joints show a higher incidence of dysfunction. (37)
Although patients may not always recognize or report a traumatic onset, studies show that over half of mechanical SIJD results from an inciting injury (4). Pregnancy creates a firestorm of sacroiliac joint insult with weight gain, gait changes and postural stressors occurring contemporaneously with hormone-induced ligamentous laxity. The presence of SIJ anatomical variations like an accessory joint, is associated with significantly highr levels of SIJ degeneration. (29)
“Arthritic” SIJD results from either osteoarthritis or from an inflammatory arthropathy including; ankylosing spondylitis, psoriatic arthritis, enteropathic arthritis, and Reiter’s/reactive arthritis which produce sacroiliitis and resulting pain. Morning pain that lasts longfer than 30 minutes and resolves with exercise is characteristic of arthritic SIJD.
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What we do in our office to help this condition:
1. Perform a detailed exam, assessing the alignment of the spine, pelvis, hips, knees, ankles, and small bones of the foot. Improper alignment in any of these areas may be detrimentally affecting the function of the SI joints, and compromising their ability to function normally.
2. As indicated, adjust areas of spinal and extremity subluxations (misalignments), restoring proper nerve system function which facilitates healing.
3. Apply electrical stimulation and heat to the muscles of the low back. Applying an electrical current helps strengthen muscles, block pain signals, and improve blood circulation.
4. Prescribe stretches and exercises in conjunction with chiropractic care to strengthen the muscles of the low back and pelvis.