Is it the hip, is it the back? No – it’s the sacroiliac joint!

Johnny Cassidy

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The sacroiliac joint is essentially links the spine to the pelvis. Often this important weight bearing joint can be missed in assessment and treatment. A few years ago our team attended a training event for the hip at a professional football club and they dedicated most to the day to the sacroiliac joint such was the importance they placed on this joint and its contribution to the hip.

So perhaps you are experience pain and symptoms in your lower back or pelvis that “you just can’t get”? Perhaps you may even have had treatment on your back or hip that was only slightly helpful. Perhaps, just perhaps, your symptoms might be arising from the sacroiliac joint.

So what is the sacroiliac joint?

The sacroiliac joint (SIJ) is a crucial weight-bearing joint that connects the sacrum of the spine to the ilium of the pelvis. Its primary function is to transmit forces from the upper body to the lower limbs, playing a vital role in distributing weight during standing and sitting_¹. Like most of the major joints of the body (e.g. hip, knee, etc), the SIJ is a synovial joint with interlocking surfaces lined with cartilage. Despite being reinforced by strong stabilising ligaments, the SI joint allows for a small amount of movement (typically 2-4 mm) meaning it can be subject to the same injuries and ‘wear and tear’ of any mobile, synovial joint. SI joint pain, also known as sacroiliitis, can arise from various factors.

What can cause pain in the sacroiliac joint?

There are many potential causes of sacroiliac joint pain and dysfunction. I have briefly listed these below but do remember the anatomy and contributory factors make this joint complex.

1. Hypermobility or hypomobility: Too much and too little movement can lead to pain and inflammation.
2. Trauma such as a fall, can injure the joint or damage its supporting ligament. Injuries or falls can damage ligaments, causing joint instability³.
3. Different types of arthritis can cause pain and dysfunction in the SIJ, for example, osteoarthritis (‘wear and tear’), ankylosing spondylitis, and psoriatic arthritis can affect the SI joint⁴.
4. Biomechanical issues: Leg length discrepancies, muscle imbalances, and gait abnormalities can strain the SI joint³.
5. Pregnancy and childbirth: Hormonal changes can cause laxity and instability in the SIJ, the physical stress of labour can injure the joint and poor post-partum recovery can affect the recovery of the SIJ.
6. Obesity: Excess weight increases stress on the joint.
7. Repetitive strain: Certain occupations or sports may cause repeated stress on the SI joint, for example, repetitive sports like running, impact sports like jumping or excessive movement sports like gymnastics.
8. Lumbar spine surgery: Procedures affecting the iliolumbar ligament can also lead to SI joint instability³.

How can my sacroiliac joint get better?

Symptoms of sacroiliac dysfunction can include lower back pain, buttock pain, and sometimes leg pain⁴ and assessment must include all of these areas. Diagnosis can mostly be deduced with comprehensive examination by understanding the complex anatomy and biomechanics of the joint. In some cases imaging may be required.

Treatment for sacroiliac pain and dysfunction includes manual therapy, conditioning exercises and a guided and graded return to physical activity and sport.

Here at The Physios we have a team of specialist and experienced clinicians who are well versed in the treatment and management of sacroiliac joint pain. If you need our help you can book online or give us a call to arrange a consultation with one of our specialists.