Dysfunction in the sacroiliac joint is thought to cause low back and/or leg pain. The pain can be similar to pain caused by a lumbar disc herniation. This condition is generally more common in young and middle age women.
The anatomical source of sacroiliac joint pain
The sacroiliac joint lies next to the spine and connects the sacrum (the triangular bone at the bottom of the spine) with the pelvis (iliac crest). The joint:
· Is small and very strong
· Transmits all the forces of the upper body to the pelvis (hips) and legs
· Acts as a shock-absorbing structure
· Does not have much motion
While it is not clear how the pain is caused, it is thought that an alteration in the normal joint motion may be the culprit that causes sacroiliac pain. This source of pain can be caused by either:
· Too much movement - hypermobility or instability, or
· Too little movement - hypomobility or fixation. The pain is typically felt on one side of the low back or buttocks, and can radiate down the leg. The pain usually remains above the knee, but at times pain can extend to the ankle or foot.
Background on sacroiliac joint dysfunction
For decades, the sacroiliac joint was suspected to be a cause of low back and leg pain though difficulty in proving it with standard diagnostic tests left many in the medical profession skeptical.
Also, over the last twenty to thirty years, the medical profession has focused more on discogenic pain (such as disc herniation). In fact, to this day sacroiliac joint dysfunction remains difficult to diagnose as no non-invasive diagnostic test has been found to be able to isolate the sacroiliac joint (short of anesthetic injection blocks specifically applied to the joint).
Accurately diagnosing sacroiliac joint dysfunction can be difficult because the symptoms mimic other common conditions, such as disc herniations and radiculopathy (pain along the sciatic nerve that radiates down the leg).
A diagnosis is usually arrived at through physical examination and/or an injection.
Physical Examination to Determine the Source of Pain
In physical examination, the doctor may try to determine if the sacroiliac joint is the cause of pain through movement of the joint. If the movement recreates the patient's pain, and no other cause of pain has been found (such as a disc herniation on an MRI scan), the sacroiliac joint may be the cause of the pain.
There are several orthopedic provocative tests that can be used in attempt to reproduce the symptoms associated with sacroiliac joint dysfunction. As a rule, several positive tests that reproduce pain specifically located at the sacroiliac joint improves the probability of the diagnosis of sacroiliac joint dysfunction.
· The patient may lie face up on an examination table with the leg of the affected side resting on a nearby stool so that the sacroiliac joint lies on the edge of the table. In this position, there is no support for the hip joint and pressing down on the iliac crest (pelvis) may reproduce the patient's pain.
Treatment for sacroiliac joint dysfunction is usually conservative (non-surgical) and focuses on trying to restore normal motion in the joint.
Typical treatments for sacroiliac joint dysfunction include:
· Chiropractic Manipulation
· Physical Therapy
· Water Therapy