Understanding SIJ Dysfunction
Sacroiliac joint dysfunction, or sacroiliitis, is usually caused by abnormal motion or malalignment of the sacroiliac joint. Research shows it's a significant source of pain in 15% to 30% of people with mechanical low back pain. SIJ dysfunction occurs when the joints of the pelvis become stiff or weak, with symptoms typically felt on one side of the back, most often in women. It's a condition that's genuinely difficult to diagnose and is often overlooked by physicians and physiotherapists.
When SIJ Dysfunction Occurs
SIJ dysfunction occurs when one side of the joint becomes too lax, which can happen in women of childbearing years due to hormonal changes, or when one side of the joint becomes stiff, causing a lack of coordination. It can also stem from arthritis, muscle imbalances, or joint injury, and is also common among athletes who are over-trained.
Patients with SIJ dysfunction often feel a sharp, stabbing, or dull pain on one side of the pelvis or low back, in the groin, or in the tailbone, and frequently report the pain radiating down to the knee. Others feel pain when standing (especially after sitting for a long time), turning in bed, or bending. Muscle tightness and tenderness in the hip and buttock region are also common, with pain worsening when standing or walking and easing when sitting or lying down.
Building a Treatment Plan
Physical therapy management begins with a thorough history and assessment to gather the information needed to design a targeted treatment program that restores maximum strength and function. The goal of treatment is a safe return to normal daily living, without pain and discomfort. It's worth seeking a physical therapist who specializes in SIJ dysfunction and manual therapy, since treatment is largely hands-on.
A treatment plan typically includes patient education, pain management, bracing (such as a sacroiliac belt), a body mechanics program, manual therapy, functional training, flexibility exercises, and strengthening exercises.
Strengthening and Stretching
Bridge: this exercise strengthens the muscles of the lower back, buttocks, and hips. Lie on your back with knees bent and palms flat on the floor, lift the hips into the air, and hold for 5 seconds to strengthen the lower abdomen, lower back, and hips. Repeat 10 times.
Hip abduction strengthening: lie on your back with knees slightly bent and a resistance band around the knees. Keeping your back arched, gently push your knees apart to strengthen the outer thigh and buttock, hold for 5 seconds, and repeat for 10 reps.
Poses That Can Help
Yoga is also a good option for managing SIJ dysfunction. Child's pose stretches the hips and thighs and is a great beginner's pose, kneel with toes together and knees hip-width apart, rest your palms on your thighs, then exhale and lower your torso between your knees, extending your arms alongside your torso with palms down and shoulders relaxed toward the ground.
Triangle pose involves twisting, so it should only be performed when the joints are stable and pain-free, and your physical therapist can assist with proper form. Begin standing, step the feet apart to a wide stance, straighten through one leg, and hinge the torso over that leg as the hips shift back, reaching the hand toward the mat in front of the foot while maintaining a long, straight spine. Hold for 10 to 20 seconds, then repeat on the other side.
These are just the common exercises and poses that physical therapists include in a patient's treatment plan, there are many more, and it all depends on what works for your particular condition.