Definition
The sacroiliac joint (SIJ) is one of the most complicated and overlooked joints in the body. The SIJ is the junction between the spine and the hips and therefore has a lot of load going through it. The SIJ doesn’t have a large ROM.
SIJ dysfunction involves any condition that irritates or causes pain in the SIJ.
Aetiology (causes)
· Joint misalignment
· Ligament sprain
· Irritation of the joint
· Osteoarthritis or Rheumatoid arthritis.
· Limited mobility or hypermobility
SIJ injuries are often caused by sporting activities that involve lots of movement in different directions such as soccer, rugby and hockey. Any injury that involves hyperextension of the spine can damage the SIJ.
Subjective
History (HX)
· How long have you had this pain/discomfort?
· Was there an accident that caused the pain?
· Have you had treatment before?
· Occupation? Do you sit for long hours during the day?
· Sport or exercise
Objective
Observation
Observations will include leg length, hip alignment, and rotation of pelvis.
Stork Test: Client standing with practitioner behind them kneeling. Place a thumb of each hand onto the clients PSIS’s. Have client stand on one leg and bring the other leg into knee flexion. Notice the movement of the thumb. This is the SIJ movement. Compare to the other side. This test can show the movement of the SIJ’s and detect any restriction.
Palpation
Palpation of the SIJ may cause pain. The soft tissues around this area may also illicit pain and be contracted or tight. These soft tissues will include – piriformis, Gluteus Maximus, medius and minimis, erector spinae, QL’s, Hamstrings, Hip flexors.
Resistive and ROM
Resistive tests of back extension may cause pain in the SIJ.
ROM test may also illicit pain on spine extension as this will jam up the SIJ. There may also be tightness in hip rotation and hip flexion.
Special Tests
Gaenslen’s Test: Client is side lying and brings leg on table up towards their chest, hugging it in. Practitioner stands behind client and stabilizing pelvis with one hand, pulls back top leg at knee into hyperextension. If there is pain in the SIJ then this is seen as a positive Gaenslen’s test.
FABER or Patrick’s test: FABER means Flexion – ABduction – External Rotation. Client has their knee flexed, abducted and externally rotated and foot placed on the opposite distal thigh. The practitioner places one hand on the opposite ASIS and the other on the knee of the bent leg. A slight amount of pressure is placed noting if there is any pain in the SIJ.
Compression Test: Client is side lying. Practitioner places both hands on the Iliac crest and applies a moderate amount of pressure. If pain is felt on the SIJ then this is a positive result.
Compression Test: Client is side lying. Practitioner places both hands on the Iliac crest and applies a moderate amount of pressure. If pain is felt on the SIJ then this is a positive result.
If all or some of these special tests prove positive then it is likely that there is some irritation at the SIJ.
Assessment
Based on findings form subjective and objective measures you will get an idea as to whether it is the SIJ that is the problem.
Treatment / Plan
Remedial massage to increase ROM if SIJ problem is due to restrictions or soft tissue damage. Muscles to work on include Piriformis, Gluteals, ITB/TFL, QL’s, Lumbar Erector Spinae, and Multifidus. Also working on the sacral ligaments to create more ROM.
If it is hypermobility then strengthening exercises will be required from a Physio etc.
Differential Diagnosis
Other conditions that may have the same symptoms include – Lumbar disc problems especially L5/S1, Lumbar facet joint irritation, fractured pelvis, osteoarthritis in the Iliofemoral joint (hip)
Special Needs
With the elderly there may be arthritic changes in the hips so osteoarthritis either of the SIJ or the Iliofemoral joint may be the cause.
For someone who has had a hip replacement you have to be careful with movements of the hip when massaging. No flexion, adduction or internal rotation of the replaced hip as this may dislocate the prosthesis (replaced joint).