Sacroiliac Joint Dysfunction

The sacroiliac joint connects the sacrum, the base of the spine, to the ilium on each side of the pelvis. It is a strong, relatively immobile joint that transfers load between the spine and the lower extremities. It has a small but essential range of motion in multiple planes. When that motion becomes aberrant through hypomobility, hypermobility, or altered joint mechanics, it produces pain in the low back, the buttock, and frequently the posterior thigh and groin. This pain pattern is frequently confused with lumbar disc herniation and lumbar facet syndrome, which is why SI joint dysfunction is so consistently missed by practitioners who do not know how to specifically evaluate the joint.

A 2005 study in Spine found that 15 to 30 percent of chronic low back pain originates from the sacroiliac joint. A 2010 study found that even spine surgeons correctly identified SI joint pain as the primary source in only a minority of cases before the study protocol was established. The most reliable diagnostic approach uses a cluster of provocative tests including the FABER test, the distraction test, the compression test, the thigh thrust, and the Gaenslen maneuver. Three or more positive tests in the cluster strongly predict SI joint origin. Dr. Mammales applies this diagnostic cluster at every initial evaluation for low back pain.

Who Develops SI Joint Dysfunction

Three populations dominate the SI joint dysfunction presentations at Cobblestone. The first is postpartum women, in whom pregnancy-related relaxin-mediated ligamentous laxity produces hypermobility of the joint that does not fully resolve after delivery. The second is equestrian athletes from the Wellington and Acreage communities, in whom the asymmetrical loading of posting trot and the constant vertical impact of riding create a characteristic pelvic rotation pattern that locks the SI joint in a fixed position over months or years of competition. The third is manual laborers and workers who load one side of the pelvis repetitively through their occupation.

Treatment

SI joint manipulation is specific and distinct from lumbar spinal manipulation. The joint requires targeted mobilization in the correct plane of motion for the mechanical dysfunction present. Hypomobile fixations respond to high-velocity low-amplitude thrust at the appropriate joint face angle. Hypermobile joints require stabilization through targeted gluteal and pelvic floor strengthening rather than manipulation. Getting the distinction right is the difference between a treatment that helps and one that makes the problem worse.

Manual therapy addressing the surrounding musculature, particularly the piriformis, gluteus medius, and hip flexor complex, is integrated with the manipulation. For patients with significant joint degeneration, PRP injection into the SI joint administered by Yuleisy Coto, MSN, APRN, FNP-C provides the biological repair component. MLS laser therapy reduces the periarticular inflammation that develops with chronic joint dysfunction. Call (561) 753-2225 or request an evaluation here.