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What is sacroiliac joint dysfunction?
The sacroiliac (SI) joints are where the two halves of the pelvis connect to the spinal column. Sacroiliac joint dysfunction is the term used when describing restriction or fixation of the SI joints.
Restriction in these joints is common, but if left untreated, the restriction may cause a cascade of other issues. For example, restriction can alter gait (walking pattern), which may affect the hips, knees, ankles, or feet.
Alternatively, restriction may cause an imbalance where one half of the pelvis is higher or lower than the other side. This imbalance, known as pelvic obliquity, may cause a mild corrective curve in the spine to keep your head upright. This is known as functional scoliosis, and this may cause pain and tightness in different areas of the spine.
It’s important to know some basic anatomy of the pelvis and the lower portion of the spine in order to understand sacroiliac joint dysfunction.
The weight bearing bone at the base of your spine is called the sacrum. This is a large, triangular shaped bone that sits like a keystone between your pelvic pones. You have two pelvic bones—one on each side. The pelvic bones have three parts, and the upper portion is called the ilium. The sacrum connects to the ilium on each side, hence sacroiliac or SI joint.
With sacroiliac joint dysfunction, the muscles surrounding the SI joints will also be affected. These muscles include, but are not limited to:
- Gluteal muscles: primarily, the gluteus maximus, medius, and minimus will be affected
- Lumbar erector spinae: these muscles run along each side of your spine; they’re responsible for holding you upright and extending your back
- Quadratus lumborum: a square shaped muscle that attaches on the top of the pelvis, on the lower ribs, and along the lumbar (lower back) spine.
Sacroiliac joint dysfunction is the fixation or restriction of the SI joints which will generally be tender or painful on its own. A joint fixation or restriction occurs when the joint capsule becomes hypertonic or goes into spasm.
Along with the SI joint pain, the fixation will cause a disruption in the movement pattern of the pelvis, hips, and lumbar spine. The disrupted movement pattern creates inappropriate tension in the muscles that move the hips and lumbar spine, especially the gluteal muscles and lumbar erector spinae.
With fixation of the SI joints, your hips need to move further or in a different pattern to create the normal range of motion required for walking or maintaining balance in other body positions.
When muscles are doing more work than normal, or when they’re being stretched further than normal, they become irritated. Irritated muscles will present as tight or hypertonic and may develop trigger points which will both be painful.
In addition to a painful, fixated joint and tight, painful muscles, the ligaments that support the SI joints may also become hypertonic. These will become tender or painful as well.
Signs and symptoms
If you’re affected by sacroiliac joint dysfunction, you may experience one or more of the following symptoms:
- Aching pain in the region of the SI joint
- The most obvious symptom is pain along the SI joint line on one or both sides
- Hypertonicity or spasm
- Gluteal muscles or lumbar erector spinae muscles are commonly irritated in sacroiliac joint dysfunction
- These muscles will also feel painful to the touch
- Grabbing pain and/or difficulty changing positions
- Many people describe feeling unable to change positions without experiencing a spasm, often described as a “grabbing” or “gripping” pain sensation
- It is also common to have difficulty standing upright due to tightness and spasm in the SI joint and surrounding muscles
- Referred pain
- SI Joint pain will often cause referred pain in the outer portion of the pelvis
- Referred pain may also be noted upwards towards the flank
- Referred pain is often described as a dull, diffuse ache
Other findings may include:
- More intense pain patterns trying to stand up following prolonged sitting or lying down
- Worsening symptoms during and after gaming
- Relief or improvement of symptoms after warming up or performing light-to-moderate physical activity
Common mechanism(s) of injury
Sacroiliac joint dysfunction in gamers will usually occur due to chronic, poor or awkward posture.
- Slouching or leaning forward:
- Slouching and leaning forward increase pressure on the lower back and strain the muscles surrounding the SI joints
- Sitting upright or with the chair slightly reclined takes pressure off the discs in your back and will help reduce the risk for sacroiliac joint dysfunction
- Sitting with your legs off balance:
- If your legs are not balanced on the seat (e.g. sitting with your legs crossed), there will be uneven strain in the pelvis and on the SI joints
- Keep both thighs flat on the seat!
- Sitting for too long:
- Prolonged static position, even in a “more appropriate” seated posture, may eventually lead to sacroiliac joint dysfunction
- Make sure you take breaks!
The simplest way to prevent sacroiliac joint dysfunction is to monitor your posture. Visit our page on gaming posture to learn the most appropriate way to sit and protect yourself from injuries or ailments.
Since the most common mechanism of injury in gaming is prolonged, static or poor posture, it is also important to take breaks and get moving! Visit our page on how to appropriately break up your routine to protect yourself.
To aid in preventing your muscles from becoming tight or hypertonic, there are a few stretches you can do:
Seated rotation stretch
This stretch is a simple, yet effective stretch for the lumbar erector spinae
- Sit with your legs crossed in front of you
- Rotate your shoulders to the left; with your right hand, grab outside of your left thigh or knee to increase the pressure
- Hold this stretch for 20-30 seconds to a point of mild discomfort
- Repeat on the other side
Perhaps the simplest stretch of them all, this stretch is a passive position to effectively stretch the lumbar erector spinae
- Begin by kneeling down and sitting back on your feet
- Lower your upper body down towards the floor
- You can extend your hands overhead or leave them at your sides
- Gently rest your forehead on the floor in front of you and allow your back to relax
- Hold this position for 20-30 seconds
In addition to stretching, it’s important to make sure the SI joints are moving.
These exercises do not need to be performed with the goal of increasing muscle mass, power, or significant strength. Instead, the goal is to activate these muscles and get the SI joints moving.
An activation exercise for the gluteus medius
- Lie on your side with your knees bent and stacked on each other
- Keep your shoulders square, and separate your top knee by opening your hip
- Be sure not to rotate your trunk or lean backwards
- To increase activation, wrap a resistance band around your knees
- Perform this exercise on both sides, 10 repetitions on each side
- Stand upright
- Take a moderate sized step forwards or backwards with either leg
- With your weight on your front leg, lower bend your knee and hip to lower your body towards the ground
- Your trailing knee should bend and drop straight towards the floor
- Press back upward and return to a neutral starting position
- Repeat with the other leg, and perform 10 repetitions with each leg
As chiropractors, we have a pretty straightforward approach to rehabilitation of sacroiliac joint dysfunction. First, address the issues that cause the problem. Education is always an important factor in recovery. Check your posture!
Next, address the hypertonicity or spasm in the surrounding musculature. In practice, we use manual therapy techniques, stretching techniques, and therapeutic exercises to achieve this goal. Outside of treatment, we prescribe home care exercises and stretches to continue to goals of relieving hypertonicity or spasm.
Lastly, adjust the SI joints to release the restriction and restore movement. In practice, the most common techniques include side posture adjustments or pelvic drop adjustments.
The adjustment itself is often enough to relieve pain and restore movement; however, without addressing the surrounding muscle hypertonicity/spasm or addressing the initial cause of the problem, these adjustments may not provide lasting relief.