Physiotherapy in North America for Lower Back

Q: If you sprain a ligament holding the sacroiliac joint, does it ever heal properly?

A: The sacroiliac joint (SIJ) formed by the sacrum wedged between the spine and the hip is the subject of ongoing controversy and debate. Some experts refuse to believe the sacroiliac joint is a true synovial joint that moves. They base this opinion on the fact that there is very little sacroiliac motion that can be detected or directly measured.

But most agree that not only does the sacroiliac joint move, it can generate pain that is felt in the low back or buttock area. Studies to that effect report between 14 and 40 per cent of all cases of back pain are really caused by a problem in the sacroiliac joint.

Like all synovial joints, the sacroiliac joint can be subjected to change over time. Along with aging comes osteoarthritis of the SI joint. Other causes of sacroiliac-induced pain include the presence of other low-back problems, spinal fusion surgery, pregnancy, infection, or tumors.

There are ligaments holding the sacroiliac joint together and providing the support needed for proper alignment and movement. A sprained ligament is painful in the acute phase. But like other areas of the body, when healing occurs, pain may persist leading physicians and patients to believe the problem is still in the ligament.

It is more likely the case that there have been dynamic changes within the joint because of the lack of ligamentous support. Force and load on the sacroiliac joint can occur without proper stabilization normally provided by the ligaments. The joint may not be able to adapt. Postural changes develop to compound the problem.

So, in the end, the ligament heals but the joint doesn't fully recover normal alignment, movement, or function. Treatment may be needed to restore one or all of these components.

Conservative (nonoperative) care can include manual therapy provided by an osteopathic physician, chiropractor, or physical therapist. The use of muscle energy techniques, strain-counterstrain, and mobilization or manipulation of the joint are often used by these professionals.

When the sacroiliac joint is extremely painful and unstable despite conservative care, then surgery may be an option. The most common surgical procedures performed on the sacroiliac joint include cutting the nerve(s) to the joint and fusion of the joint (referred to as arthrodesis).

Reference: John G. Stark. The Diagnosis and Treatment of Sacroiliac Joint Abnormalities. In Current Orthopaedic Practice. July/August 2010. Vol. 21. No. 4. Pp. 336-347.