Best treatment for the sacroiliac joint
In our previous blog, we highlighted the importance of the sacroiliac joint as it connects the spine to the pelvis. There are many ways that the sacroiliac joint can be injured and it can often be missed on assessments. Best treatment for the sacroiliac joint focuses on treating the articulation and strengthening the supporting muscles.
Form and force closure
One of the reasons I like talking about the sacroiliac joint is that it allows me to talk about my seafaring days! Form closure and force closure are two key mechanisms that contribute to the stability of the sacroiliac joint and it is sometimes helpful to think of these as a boat returning to port!
Form closure refers to the passive stability or articulation of the sacroiliac joint. This is due to the anatomical structure of the joint, namely, its wedge-shaped sacrum fitting between the two pelvic bones (aka the ‘ilia’). The SI joint has irregular surfaces with ridges and grooves that interlock together1. I like to think of this as a boat docking in the harbour!
Force closure is the dynamic stability of the SIJ. This is achieved through compression of the joint by the muscles, ligaments, and fascia2. So back to my boat analogy – the boat might be ‘docked’ in the harbour but it not secure until it is tied up on the quay side.
So the SIJ needs to dock and articulate optionally as well as the surrounding muscles making this docking secure. Together, form and force closure work to the maintain stability and mobility of the joint.
So what is the best treatment for the sacroiliac joint?
Before we treat the sacroiliac joint we need to perform a comprehensive assessment to provide a firm diagnosis. It is important to screen neighbouring (and more obvious) structures such as the lumbar spine and hips. From an accurate diagnosis, we can then provide a bespoke treatment and rehabilitation plan.
Manual therapy
As we have discussed above, optimum articulation of the sacroiliac joint is imperative to facilitate form closure. There are a number of manual therapy (hands-on) techniques we can use, such as, joint mobilisation, manipulation and soft tissue release.
Pain relief
The importance of pain relief cannot be understated – particularly in the treatment of the sacroiliac joint. There is a phenomena in musculoskeletal medicine called arthrogenic muscle inhibition. This is when pain arising from a joint prevents the muscles from fully contracting. Often we see sacroiliac joint patients (and others) that have been unable get on with an exercise programme because of artrogenic muscle inhibition. Of course manual therapy is pain relieving as well as restoring movement but there are lots of options for pain relief too. Common over the counter medication can be surprisingly effective in the musculoskeletal system and adjunctive treatments like acupuncture can relieve pain. In some cases we may indicate a supportive brace or, if required, an injection may be needed to relieve the pain.
Exercise
Next is the most important part of the treatment – an exercise and rehabilitation programme. This is where we address the force closure by targeting the gluteul, lower back and abdominal (“core”) muscles. The exercise programme will be prescribed with your end goal activities and sports in mind.
Sacroiliac pain can be a difficult condition to treat but it WILL get better. An accurate diagnosis from a comprehensive assessment is where the journey begins. Then we can focus on restoring movement, relieving pain and supporting the joint through a bespoke exercise programme.
Most importantly – be patient! Treatment of the sacroiliac joint can take a little while but we will guide you through the whole journey and back to the sports and activities you love!
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