|  The
sacroiliac joint has been shown to be the source of
pain in over 20% of people with low back pain.
How
the ACTIVE SI BELT® relieves lower back pain due
to SI joint dysfunction.
Sacroiliac Joint Anatomy, Function,
Diagnosis and Treatment The sacroiliac joint is stabilized primarily
by a network of ligaments, muscular support and proper
spinal alignment. The main function of the ligaments
that support the SI joint is to limit motion in all
planes of movement. The normal sacroiliac joint has
a very small amount of normal motion (about 2-4 mm of
movement in any direction). For women the SI ligaments
are less stiff than men, allowing the mobility necessary
for the purpose of childbirth. Given their location
between the spine and the hip, the sacroiliac joints
are responsible for transferring and absorbing the forces
that are occurring between the spine and lower extremities.
The SI joint is particularly vulnerable to injury because
of its location and the crucial balance between stability
and mobility (2-4 mm of motion) that is required for
normal sacroiliac function.  Injury
to the SI Joint
The largest study to look at how common
injury to the SI joint occurs (Bernard
and Kirkaldy-Willis) found that 22.5% of patients
with reported low back pain had sacroiliac joint pain.
The problem is that the SI joints can withstand only
1/20th of the compression force (lifting) and half the
rotation force (twisting) that the lumbar spine can
withstand during these movements. These are the two
motions that often strain and injure the sacroiliac
joint and thus the mechanism of SI joint injury has
often been described as a combination of vertical compression
and rapid rotation (i.e. carrying a heavy object and
twisting). Arthritis is another cause of SI joint pain
as are the following: leg length discrepancy, gait abnormalities,
prolonged vigorous exercise, scoliosis and spinal fusion
to the sacrum. Lumbar spine surgery has also been reported
to trigger sacroiliac joint pain due to SI ligament
weakening and postsurgical hypermobility. Pregnancy predisposes women to sacroiliac
joint pain via the combination of an exaggerated lordotic
posture (curvature in the lower back), weight gain,
the mechanical trauma of childbirth, and increased ligament
flexibility (laxity) due to increased hormone levels
which predisposes women to sprains of the SI joint ligaments.
Additional causes of sacroiliac joint injury and/or
pain include bracing one's legs in a motor vehicle accident,
falls, athletic injuries, prolonged lifting and bending,
and spinal rotational strain. Diagnosis of Sacroiliac Joint Pain One of the most challenging aspects of
treating sacroiliac joint pain is the complexity of
diagnosis. Literally dozens of physical examination
tests have been advocated as diagnostic aids in patients
with presumed SI joint pain. One method of diagnosing sacroiliac joint
pain that is quick and has been shown to be accurate
is the Fortin
Finger Test. According to Joseph Fortin, DO, and
Frank Falco, MD, by use of the "Fortin Finger Test,"
it is possible to make a rapid and accurate diagnosis
of sacroiliac joint dysfunction.
How to perform the Fortin Finger Test:
- The patient is asked to “point
to the area of your pain with one finger”.
- Repeat at least two times.
Test is positive for SI joint pain if:
- The patient can point to the area
of pain with one finger.
- The patient points precisely to
the sacroiliac joint, immediately inferior (below)
and medial to the posterior superior iliac spine
(PSIS) within 1 cm.
- The patient consistently points to
the same area two times or more.
Treatment of SI Joint Pain
The treatment of SI joint pain is widely
acknowledged to be one of the most challenging problems
confronting doctors and physical therapists. Most treatments
can be divided into two categories: those directed at
correcting the mechanical problem and those aimed at
alleviating symptoms.
Non-invasive treatment: Management of
sacroiliac joint pain should ideally address the underlying
pathology. In other words, SI joint instability is best
treated by SI joint stabilization. Non-surgical stabilization
for sacroiliac joint pain can range from the application
of an SI joint stabilization belt that will reduce rotation
of an unstable SI joint, to exercise-induced pelvic
stabilization programs performed by physical therapists.
In patients with leg length discrepancy, this might
include the use of shoe inserts to more equally distribute
the load exerted on the sacroiliac joints. For SI joint
pain resulting from altered gait mechanics and spine
misalignment, physical therapy and osteopathic or chiropractic
manipulation have been reported to reduce sacroiliac
pain and improve mobility. If your health care provider
feels that your SI joint is hypomobile or too stiff,
sacroiliac joint manipulation and/or mobilization will
often be recommended. How can two treatments for one
joint be so different? Basically, in some cases, the
SI joint is "too stiff" or "locked"
and needs to be more mobile to function correctly. In
other cases, SI joint pain is the result of excessive
mobility and reducing the mobility of the sacroiliac
joint with an SI belt will decrease the pain. Furthermore,
in many patients a combination of SI joint mobilization
and stabilization with an SI belt may be the best treatment.
Treatment of sacroiliac joint pain
often includes specific exercises directed at the SI
joint that are instructed by a doctor or physical therapist.
The type of exercise will depend on many factors however
a good treatment program will often consist of stretching,
strengthening and stabilization exercise. In summary,
sacroiliac joint care is focused on decreasing pain
through sacroiliac joint stabilization and/or mobilization
which reduces pain and encourages healing of the joint
and surrounding ligaments. Stabilization of the SI joint
is often best achieved with use of a sacroiliac stabilization
belt (SI belt). The SI belt wraps around the hips to
compress the SI joints together thereby effectively
reducing motion in a hypermobile pelvis or sacroiliac
joint.
How to determine if a sacroiliac belt
may help to treat your SI joint pain:
Gait Belt Test (should
be performed by a health professional), supplies needed:
stopwatch or watch with second hand, gait belt or
other flexible belt that can be wrapped around hips.
- Pre-test: record walking time until
1st onset of pain.
- Upon onset of pain, rest until symptoms
subside.
- Place belt around the pelvis and
tighten at a level that is just below the ASIS (you
can feel these bones just above where the hip bends
at the front of each hip).
- While wearing belt, record walking
time until next onset of pain.
- If symptoms take longer to begin
while wearing the gait belt it indicates that a
sacroiliac belt will be a helpful part of the treatment
program.
Adapted from description
of test by Dr. Timothy Flynn, PT, PhD, OCS, FAAOMPT
Additional Treatment Options:
Injections:
- Sacroiliac joint injections with
corticosteroid and novacaine have been shown to
provide good to excellent pain relief lasting from
6 mo to 1 yr.
- There have been reports of significant
SI joint pain relief for patients who have received
a series of 3 intraarticular injections with hyaluronic
acid.
- Prolotherapy is another injection
that has been advocated as a treatment for SI joint
pain. The rationale behind the use of "prolotherapy"
is that the hypermobile sacroiliac ligaments in
a patient with SI joint pain can be strengthened
through injecting a drug that promotes ligament
stiffness.
Surgery:
In patients with
SI joint pain unresponsive to more conservative measures,
some have advocated surgery for SI joint stabilization.
Based on the existing studies the long-term success
rate for SI joint fusion appears to be in the range
of 70%. Unfortunately this means that 30% of patients
who have sacroiliac joint surgery have increased pain
or no change in pain after surgery. As such, surgery
is always the last treatment that should be considered
for SI joint pain.
Summary: SI Joint Pain, Diagnosis and
Treatment with a Sacroiliac Belt
Sacroiliac Joint Anatomy
The pelvic girdle is a ring of bones connected
by three separate joint structures: the Sacroiliac or
SI joints in back and the pubic symphysis in front.
A combination of ligamentous and muscular support together
with proper joint alignment stabilizes the SI joints
and prevents lower back pain during normal function.
Sacroiliac Joint Pain
Numerous factors including acute injury,
poor posture, cumulative trauma, pregnancy, aging, etc.
can create excessive or diminished mobility in either
SI joint; resulting in low back pain due to SI joint
dysfunction or pubic symphysis dysfunction. Sacroiliac
joint dysfunction is typically characterized by pain
in the SI joint, lower back, buttock, thigh, or down
the leg (sciatica). Pubic symphysis dysfunction is a
less common problem, but is often disabling with pelvic
pain, along with symptoms similar to sacroiliac joint
dysfunction.
SI Joint Pain Diagnosis and Treatment
- Numerous methods have been described
for correctly diagnosing and treating SI joint pain.
- The Fortin Finger Test is a rapid and
simple test that has been shown to accurately diagnose
sacroiliac joint pain.
- The Gait Belt Test is a quick
and easy test that can determine if a sacroiliac belt
will be a helpful part of SI joint and low back rehabilitation.
The
ACTIVE SI BELT® is the solution for Sacroiliac Joint
Pain If you have SI joint pain due to sacroiliac
joint instability then the ACTIVE SI BELT® is your
stabilization solution. Click
here to read about how the ACTIVE SI BELT® relieves
lower back pain due to SI joint dysfunction. Additional SI Joint Information We have compiled a list of Articles
and Research for anyone searching for more information
about sacroiliac joint pain and dysfunction.
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