SI joint pain refers to pain within 2cm of the posterior superior iliac spines and has a common well-described pain referral pattern into the buttock known as the Fortin area. A painful SI joint may have several causes. Specific diseases that affect the sacroiliac joint are for example sacroiliitis or Bechterew’s disease.
Otherwise, it’s a consequence of direct trauma such as missing a step or unexpectedly stepping into a hole in the ground or during pregnancy and postpartum due to increased elasticity of ligaments and loosening of the pelvis, which may lead to irritation.
But don’t mistake “irritation” with movement dysfunction as in hyper or hypomobility because we simply cannot define this even by highly sophisticated laboratory measurements as has been shown by Kibsgard et al in 2014. SI Joint movement is simply too minimal to be palpated or assessed using special tests. And even if we try to, the reliability of these tests is poor. However, we ARE able to test for nociception. Click the info icon in the top right corner to learn more.
But where does that leave us for treatment if we narrow it down to a painful SI joint during history taking and assessment? Let’s consider the fact that the SI joint is held together via form and force closure. Form: Via the configuration of the interfacing joint surfaces, the ridged articular surfaces, as well as the dense layer of ligaments surrounding it. And Force closure: via the rectus femoris, glutes, hamstrings, and iliopsoas. We should also mention that the Lats and erector spinae can exert force on the SI joint through the thoracolumbar fascia.
So for our intervention, we can load a sensitized SI joint if we target the aforementioned muscles in an effort to decrease nociception. Here are a couple of examples:
Clamshell Side-Plank (Progression: Quadruped)
Side planks (Progression: Straight Legs, further progression: Upper leg abduction)
Bridging (Progression: Bridging with leg lifts)
When selecting exercises don’t disregard what your patient tells you about when they experience problems. For example, standing up from a chair or walking may give you clues that extension is problematic and you could see if either loading into extension or rather flexion improves their symptoms.
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