Sacroiliitis
Sacroiliitis is an inflammation of the sacroiliac joint (SI), usually resulting in pain.
It is a painful condition that affects one or both sacroiliac joints
Sacroiliitis can cause pain and stiffness in the buttocks or lower back, and the pain might go down one or both legs.
Sacroiliitis can be hard to diagnose.
It often is overlooked as a source of back or buttock pain.
It can be mistaken for other causes of low back pain.
Clinically Relevant Anatomy
The sacroiliac joint (SI) is one of the largest joints in the body .
The sacroiliac joints are on either side of the sacrum, These joints connect the sacrum to the iliac bone, the largest, the uppermost part of the hip bone.
The sacroiliac joints are located on each side of the spine between the two pelvic bones, which attach to the sacrum which is a bony structure at the base of the spine.
The main function within the pelvic girdle is to provide shock absorption for the spine and to transmit forces between the upper body and the lower limbs.
The SI joint experiences forces of shearing, torsion, rotation, and tension. Ambulation is heavily impacted by the SI joint, as this is the only orthopedic joint connecting the upper body to our lower body.
The joint is a relatively stiff synovial joint filled with synovial fluid.
The bones of the sacrum and ilium are coated in hyaline cartilage at their articular surfaces with dense fibrous tissue connecting the ilium and the sacrum.
SI joints typically only have a few degrees of motion
Causes
Pain from this condition often is due to chronic degenerative causes yet relatively uncommon.
Sacroiliitis can be secondary to rheumatic, infectious, drug-related, or oncologic sources.
Some specific examples of non-degenerative conditions that can lead to sacroiliitis are ankylosing spondylitis, psoriatic arthropathy, Bechet disease, hyperparathyroidism, and various pyogenic sources.
Symptoms
The pain of sacroiliitis most often occurs in the buttocks and lower back. It also can affect the legs, groin and even the feet. The pain can improve with movement. The following can make sacroiliitis pain worse:
Sleeping or sitting for a long time.
Standing a long time.
Having more weight on one leg than the other.
Stair climbing.
Running.
Taking large steps when moving forward.
Stiffness felt in the hips and low back, especially after getting out of bed in the morning or after sitting still for a prolonged period.
MRI of the SIJs and of the spine has revolutionized diagnosis of early sacroiliitis.
With its high contrast resolution, it is able to detect inflammation of the joints in its early stage before structural damage occurs. A 2018 study highlighted the importance of MRI tests as a diagnostic tool for sacroiliitis.
Management
Conservative treatment options with physical therapy and analgesics should be attempted first before interventional strategies.
Medical Management
Pain relievers
Muscle relaxants
Tumor necrosis factor (TNF) inhibitors if associated with ankylosing spondylitis.
Corticosteroid injecton
Denervation
Joint fusion
Physical therapy management
Physical therapy can be very helpful if the pain is due to hypermobility. Therapy can help to stabilize and strengthen lumbopelvic musculature.
If the pain is due to immobility, then physical therapy can help increase mobilization of the SI joint.
Depending on the diagnosis the following techniques may be used.
In the early treatment stages heat, cold or alternating cold with heat are effective in reducing pain.
SI Belt: In the early stage a pelvic belt or girdle during exercise and activities of daily living can be used. These SI belts provide compression and reduce SI mobility in hypermobile patients. The belt should be positioned posteriorly across the sacral base and anteriorly below the superior anterior iliac spines. This belt may also be used when this condition becomes chronic (10-12 weeks)
Flexibility and Stabilization exercises(once acute symptoms are under control)
Flexibility
To maintain SI and lower back flexibility, stretching exercises are principal.
These exercises include side-bends, knee chest pulls, and pelvic-rocks with the aim of stretching the paraspinal muscles, the gluteus muscles and the SI joint.
These must be initiated only after hyperacute symptoms have resolved
Each stretch is performed in sets of 20.
These exercises should never surpass the patient’s level of mild discomfort.
Stabilization
Specific pelvic stabilising exercises like crunches, oblique crunches, planks, bridges, etc will help.
Postural education and training muscles of the trunk and lower extremities, can be useful in patients with sacroiliac joint dysfunctions.
Also see our previous post on core strengthening here
After rehabilitation, low-impact aerobic exercises such as light jogging and water aerobics are designated to prevent recurrence.
If the patient has a leg length discrepancy or an altered gait mechanism, the most reliable treatment would be to correct the underlying defect. Sacroiliitis is also a feature of spondyloarthropathies. In this case, this condition should also be treated.
At Valley Healing Hands, we provide the best physical therapy treatment for Sacroiliitis. Our highly skilled therapists will be right ones to diagnose your complaint using certain special tests and plan your exercise program as per your symptoms. Our patients are completely satisfied with our services. You may learn about what they have to say about us here and also get connected to us here. Our patients love us and you too will!!!
Sources
Sacroiliitis: A Review on Anatomy, Diagnosis, and Treatment, Volume 2022 | Article ID 3283296 | https://doi.org/10.1155/2022/3283296
Sacroiliitis, Early diagnosis is the key, ttps://www.tandfonline.com/doi/full/10.2147/JIR.S149494