Sacroiliac Joint (SIJ) Sprain

Who gets it?
There are two types of causes for an SIJ sprain. Traumatic and atraumatic; meaning that it either came from a traumatic onset or something less obvious or something which may have taken a long time to occur.
Traumatic causes include falls, hip fractures, and repeated heavy lifting.
Atraumatic causes include Osteoarthritis, infection, pregnancy, scoliosis, leg length discrepancy and previous spinal surgery.

Population-wise, young adults exposed to traumatic onset via sport and females who are pregnant are more likely to experience an SIJ sprain along with older adults who experience degenerative changes.

Anatomy
The SIJ also known as the Sacroiliac joints are the two points in the lower spine where the hip bones connect with the spine. The joint itself is the connection of the sacrum (just above the tailbone) and the ilium (the big hip bone). This joint is quite stable and secure, responsible for helping absorb shock and evenly dispersing weight from the upper body into the legs. The joint is a synovial joint meaning that it has fluid within it to allow for smooth movement between the cartilage and is surrounded by tissue to secure all that is within it. It also means that there is a risk of injury.

Function
As mentioned before, the SIJ is mainly responsible for transferring weight from the upper body towards the lower body. It also absorbs shock to help us mobilize ourselves (walk) and other movements such as bending at the hip and picking things up. The amount of movement at the joints is quite limited however, this is to maintain that security and stability which is its main role. Men can obtain around 1.2 degrees of movement on average, and women approximately 2.8 degrees. More movement at this joint can increase the probability of obtaining a sprain.

What is a sprain?
A sprain is a term used to describe a joint that has undergone some form of trauma causing damage to the supporting ligaments. This is different to a strain as only muscles and active structures can be strained. The term sprain is commonly used with ligaments in the ankle and knee, however, it applies to joints which have to stabilize and surrounding ligaments too.

The common presentation of an SIJ sprain includes any of the following:

• Lower back pain
• Pain over the buttock/gluteal region
• Shooting pain in the back of the thigh to around the knee
• Agitation/discomfort sitting for long periods
• Pain on bending forward or picking things up
• Pain climbing up the stairs
• Pain sleeping on the side

As mentioned previously, there are two types of causes. Traumatic and Atraumatic.
The most common is due to repetitive stress such as lifting heavy materials for an extended period. Falling down the stairs or on the buttock is another common cause which is considered traumatic. Around 20% of cases come from pregnancy due to the hormone relaxin being released to allow for the muscles and ligaments to relax around the body and prepare for the birthing experience.

Other atraumatic examples include:

• Spondyloarthropathy
• Enthesopathy
• Osteoarthritis
• Infection
• Previous lumbar fusion
• Pregnancy
• Leg length discrepancy
• Scoliosis

Other traumatic examples include:

• Pelvic ring fractures,
• Soft tissue injury from fall onto the buttock
• Indirect injury from motor vehicle collision and
• Sudden / repeated heavy lifting/strain or torsion

SIJ sprains can be diagnosed through multiple avenues. A physical therapist can diagnose using a range of tests including the following: FABER’s test, Gaenslen’s test, Distraction test, Thigh thrust, Lateral compression, Sacral thrust. These tests, along with a detailed history of how you have experienced your pain allow for a high level of confidence diagnosis.

Other modalities which can be used to provide further information include X-rays to assess for any fractures or degenerative changes. Further, an Ultrasound or MRI can be used to get a clearer picture of the surrounding soft tissue structures.

Often these modalities are avoided and the use of physical assessment is the main form of diagnosis as further scans are mainly used if conservative treatment has failed.

• Poor lifting techniques
• Sitting on the couch awkwardly
• Poor sleeping positions Sleeping
• Rotational movement such as reaching for something in the back seat of the car
• Sport
• Lack of movement

The first call for treatment of an SIJ sprain is conservative therapy. This includes a variety of physical therapy treatments, lifestyle advice, postural advice and if the pain is very extreme, immobilization (rare cases).

The focus of treatment is to reduce pain and then prevent the recurrence of the injury from occurring. This means understanding what has caused the issue. As there are a variety of causes, there are varied treatment programs, however, the management should be tailored to meet individual requirements.

Physical therapy treatment can be performed on the surrounding muscles including the gluteals, hamstrings and quadriceps. Stretching can be applied to the hip flexor muscles and lower back stabilizers such as the quadratus lumborum (QL). As this is a joint injury, hip movements are a commonly used method of treating the area including hip muscle energy techniques (MET) which improve pain and range of motion. Manual therapy can also be employed to treat the SIJ once pain levels have subsided further, which enables a greater range of motion at the joint and has been found to reduce the impact of the injury on one’s life.

Exercises are key to maintaining the progress made with the physical therapist between sessions. Specific and targeted exercises should be provided to enable the body to begin correcting postural changes and pelvis imbalances. This prevents irritation of the joint between treatments and also begins the prevention of the issue returning.

If conservative therapy does not work there are medical options to be explored. These include; intra-articular injections, peri-articular injections or nerve blocks. Finally, if those fail to provide pain relief, surgery can be considered.

Patients should expect to begin experiencing resolution within the first 6 weeks of conservative therapy. This can mean a reduction in pain, improvement in function or other forms of desired improvement. A full resolution of symptoms and function can take up to 3-6 months depending on individual circumstances and risk factors.

Depending on the cause of the sprain, it may be able to be prevented. If this injury has come from a traumatic onset, there are precautions one can take to avoid those situations again which would reduce the chances of it occurring again.

For atraumatic cases, some may be preventable via regular treatment and exercises to ensure the body is aligned in a way that supports the individual needs of the patient. If someone was to experience some of the aforementioned causes, they should book in to see their physical therapist to begin a prevention program, tailored to their needs.

There are many exercises which can be used for SIJ sprains however, the best exercises depend once again on the cause and the individual. There are, however, general exercises that have proven effective in many cases with different causes.

The exercises found to help with SIJ sprains include the following:

• Glute stretching
• Piriformis stretching
• Pillow Squeezes
• Pelvic Tilts
• Glute Bridges
• Hamstring stretching
• Quadricep stretching

For more detailed information about how frequently to complete these exercises, book in with one of the physical therapists at Bodytonic. All of the therapists are trained to prescribe these exercises appropriately.

If you are experiencing any numbness around the inside of the groin and anal region, issues going to the toilet, sexual dysfunction and/or weakness of the legs please contact the emergency services.

If you are not experiencing any of the above symptoms, you do not need to go to the GP or hospital. If your pain levels are making life extremely difficult, consider speaking to the GP for pain medication.

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