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1st Mar

2011

Sacroiliac Joint Pain

We know that pelvic girdle pain is common during and after pregnancy, which is believed to often originate in long ligaments in the back of the sacroiliac joint. Sport activities and traumas can also cause such injuries. The pain may stem from excessive stretch of such ligaments, which become weakened and irritated. This in turn causes certain muscles to spontaneously contract, which may create a rotational force on the pelvis and add strain on the sacroiliac ligaments and capsule.

The pain is often felt in the upper buttocks, close to the lower back and often up into the back itself. There may even be pain extending into the groin and inner thigh region. The diagnosis is established primarily by taking a thorough history, and performing clinical tests with proven good reliability. Since the pain typically originates outside of the joint, injections into the joint itself are no longer considered the diagnostic gold standard.

ASYMMETRIC LIGAMENT LAXITY OFTEN SEEN

Recent studies have shown that people with pelvic girdle pain often have asymmetric laxity of the sacroiliac joints, causing the pelvic iliac bone to rotate in an abnormal fashion during weightbearing on the leg of the affected side. Researchers have found individuals with asymmetric laxity of the sacroiliac joints during pregnancy to have a three fold higher risk of developing moderate to severe pelvic pain persisting into the post-partum period, compared to people with symmetric joint laxity during pregnancy.

The pain experienced during pregnancy may persist well beyond the child delivery in some women. A recent Scandinavian research study revealed that one in five
women with pain in the sacroiliac region and public symphysis in front still experienced disabling pain two years after child birth.

TREATMENT AIMED AT STABILIZING THE SACROILIAC JOINT

Orthopedic manual therapy procedures may initially be of great benefit, to reduce protective muscle guarding and minimize or eliminate any pelvic/sacral rotational asymmetry, which may exit. This is accomplished through soft tissue mobilization techniques, and specific joint mobilization-manipulation maneuvers. The pain may initially decrease substantially after such treatment, but the recurrence rate is high unless specific treatment is added to stabilize the lax sacroiliac joint.

One method is the application of a pelvic belt, placed around the pelvic bones. We now know that such a belt can be tightened with only a small force to significantly reduce sacroiliac joint rotation, similar to tensing the laces on a shoe. However, new research has shown that stabilizing deep abdominal muscles become less active while wearing a pelvic belt, and therefore it is crucial to also perform specific stabilization exercise.

A newly published Norwegian high quality study showed that a treatment program which focused on specific stabilizing exercises had a better effect on pain, functional status, health-related quality of life and physical tests, than physical therapy without specific stabilizing exercise.

Another treatment which can benefit in particular some people with substantial sacroiliac joint laxity, and people whose activities or sports require substantial joint stability, is prolotherapy injections, administered by specially trained physicians.

With wishes for continued good health,

Gunnar

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