Read our latest case study about Sacro-iliac Pain.
James is a 26 year old Amateur Rugby League winger. He trains twice a week (1 session of strength and conditioning, and one session of endurance), and plays a match at the weekend.
After a hard tackle one match he felt a twinge in his low back. Not wanting to let his teammates down he continued to play. After the match he felt okay and went home. The following morning he woke with stiffness and a dull ache on the right side of his low back and in his right groin. When he bent forwards he felt a pull in the back of his hamstring. His pain was worse with prolonged standing, driving, putting his right shoe on and relieved by lying down. He felt he was limping and that one leg was longer than the other. He was concerned as he had another big match coming up so he spoke to his coach who advised him to see an Osteopath.
Case History and examination.
The Osteopath took a detailed case history of James’ injury and asked about past injuries and falls as James participates in a high impact contact sport, which has the potential for injury. James recalled that he had previously caused himself a minor right hamstring pull 2 weeks previously that seemed to settle on its own over a few days.
The Osteopath gave a full assessment and examination of James’ spine and hip girdle. This included checking his mobility and muscle tension, and nerve tension tests. James had tenderness and tightness in his right buttock muscles, hamstring and low back. It was noticed that his pelvis was out of alignment and that his right leg appeared to be slightly shorter than his left leg, which explained his limp. He was unable to bend forwards fully because his right hamstring was tight (probably linked with his previous pulled hamstring) and was holding the right side of his pelvis locked in position. The shortening of his leg had come from the impact of his hard tackle that has shunted the right side of his pelvis upwards and backwards against the lower spine. The Osteopath diagnosed this condition as a right-sided sacroiliac joint dysfunction.
Osteopathic Treatment and Advice.
These finding’s were explained to James. Unfortunately for James’, he was advised to miss his next match, and over the course of 6 weeks he received 5 sessions of Osteopathic treatment with full recovery of his symptoms. He was given some exercises to help with his tight right hamstring and also some core stability exercises to help maintain stability across his pelvis.
What are the sacroiliac (SI) joints?
The sacroiliac (SI) joints are formed by the connection of the sacrum and the right and left iliac bones. The sacrum is the triangular-shaped bone at the lower spine, below the lumbar spine. While most of the bones (vertebrae) of the spine are mobile, the sacrum is made up of five fused bones that do not move. The iliac bones are the two large bones that make up the pelvis.
The SI joints therefore connect the spine to the pelvis. The sacroiliac joints are weight bearing joints that distribute weight from the spine to the lower extremities through the hip joints. The sacrum and the iliac bones are held together by very strong ligaments, which only allow for a very small amount of movement to occur. The SI joints support the entire weight of the upper body when we are erect, which places a large amount of stress across them. The SI joints act like shock absorbers by helping reduce these stresses on the pelvis and spine.
The SI joints also have strong muscles which cross them at the front and back, as well as the deeper muscles of the pelvic floor and the deeper abdominal muscles (core stability muscles).
What is sacroiliac joint dysfunction?
During normal movement of the spine and hips, stretching or compressive forces are put through the sacroiliac joints and surrounding ligaments. When these forces are sudden, repetitive or excessive, injury to the sacroiliac joint may result.
Sacroiliac joint dysfunction refers to pain in the sacroiliac joint caused by abnormal motion of the sacroiliac joint, either too much motion (hypermobility) or too little motion (hypomobility). This typically results in inflammation of the sacroiliac joint.
Causes of sacroiliac joint dysfunction
Common causes and contributory factors of SI joint dysfunction include:
- Repetitive micro-trauma: low level trauma over a period of time can cause damage that can often build up without being noticed. Pain can then be triggered by fairly innocuous activities such as bending to pick something off the floor.
- Muscular imbalances, weakness (poor core strength) or tightness around the lumbar spine and pelvis: This can develop from not only from sedentary activities, such as sitting in the office or at home watching the TV, but also from repetitive and excessive movements that are experienced during sport or even gardening develop over a long period of time giving little or no symptoms until it is too late.
- Trauma such as a falls or road traffic accidents
- Prolonged sitting, bending, twisting or lifting
- Pregnancy: Hormones released during pregnancy, such as Relaxin, increases the laxity of the pelvic ligaments can make them more vulnerable to injury.
- Problems with the lower limb: biomechanical abnormalities, such as flat feet or leg length differences, can increase pressure on the SI joint, which can cause repetitive strain to the SI ligaments.
- Poor posture
- Excessive or repetitive forces associated with impact sports: examples include running, rugby and golf.
Signs and symptoms of sacroiliac joint dysfunction:
- Pain and tenderness is usually felt on one side of the low back over top of the buttock. Rarely is it felt on both sides.
- Pain can sometimes refer into the buttock back of the leg, front of the thigh and groin.
- Pain can come on suddenly or develop gradually over a period of time.
- Pain is worsened by sitting, bending (e.g. putting on shoes and socks), lifting or twisting.
- Increased weight bearing such as standing on one leg can increase the pain e.g. with walking up and down stairs
- Lying down usually eases the pain.
Diagnosis of sacroiliac joint dysfunction
SI joint dysfunction is a major source of low back pain. Sacro-iliac pain is often under-diagnosed, under-appreciated, and misunderstood. The clinical presentation together with a thorough examination from your Osteopath is usually sufficient to diagnose sacroiliac joint dysfunction. Very occasionally you may need to be referred for further investigations such as an X-ray, MRI, bone scan or CT scan so aid in the diagnosis.
Osteopathic Treatment for sacroiliac joint dysfunction
Osteopathic treatment aims to assist in the bodies natural healing process, speeding up the recovery, and reducing the likelihood of future recurrence.
In the acute phase (when the injury has just happened), Osteopaths will aim to reduce the pain and inflammation. They will also aim to improve the function of other parts of the musculo-skeletal system to reduce the stress on the injured area. Ice-packs can also help within the first 48-72 hours.
After the acute phase, treatment is focused on improving the stability of the area by introducing rehabilitation exercises and lifestyle modifications.
Treatment methods used may include:
- soft tissue massage & stretching
- joint mobilisation & manipulation
- medical acupuncture
- the use of a sacroiliac or lumbar support belts
- correction of any leg length discrepancy
- activity modification advice
- ergonomics advice (your working environment)
- exercises to improve flexibility, strength, posture and core stability
Prognosis of sacroiliac joint dysfunction
Patients can get dramatic pain relief from Osteopathic manipulation, but typically this relief may take 3-6 weeks. The recovery time will vary depending on individual and compliance with advice and exercises.
Other intervention for sacroiliac joint dysfunction
A small percentage of patients with sacroiliac joint dysfunction may require other intervention. This may include the use of anti-inflammatory or pain relieving medication, or investigations such as an X-ray, bone scan, CT scan or MRI, blood tests or assessment from a specialist. A corticosteroid injection into the sacroiliac joint may sometimes be used identify the pain and help to alleviate the symptoms. Those with poor lower limb alignment or flat feet may be referred to a podiatrist for an orthotic prescription (arch supports).
Your Osteopath can advise on appropriate management and can refer to the appropriate medical practitoner where necessary.
It is important we listen to our bodies. If in doubt get checked out! At Cheadle Osteopathy we will work with you to help you achieve your goals and assist in your recover. For further information contact us on 0161 478 1877.
Sacro-iliac Pain Case Study.