Aching lower back & buttock Pain - Sacroiliac Joint dysfunction
The Sacroiliac joints are two joints situated in our very lower back that join the pelvic to the lower spine. The purpose of the sacroiliac joints is to correctly transfer the weight bearing load of the spine to the pelvis and down into the legs thus allowing us to maintain good balance when walking, bending forward or standing. Sacroiliac joint dysfunction can occur suddenly or gradually. It occurs suddenly as a result of trauma to the joint from a fall on one side of our pelvis or from a car accident. Abnormal movement occurs between the two bones of the sacroiliac joint causing stress to the overlying ligaments and muscle tendons and to the correlated cartilage surfaces of the adjoining bones within the joint. This brings about immediate tenderness and aching pain and often sharp shooting pain into the lower back, buttock and down the back of the leg and into the ankle joint.
Alternatively Sacroiliac joint can occur gradually over a number of months. Poor posture, injuries to other pelvic muscles such as the hamstrings or hip muscles can lead to huge tightness in the area causing unequal pulling on the joint. For example tight hamstring muscles can pull pelvis downwards causing friction and irritation within the joint.
Signs & Symptoms
Dull achy pain & tenderness at the base of the lower back
Pain can refer into the buttock, groin and hip region.
Pain can also be referred down the back of the leg into the hamstring
In some cases there can be deep tenderness in the lower abdomen (belly region) due to a tight hip flexor muscle called illiacus. This symptom is known as Baer’s sacroiliac point.
Pain can refer into the calf muscle, ankle and toes due to sciatic nerve impingement
Lower back stiffness in the morning time
Leg length difference couple with tight pelvic muscles.
Pain increases with:
moving from a seated to standing position
Climbing stairs or walking uphill and descending stairs or walking downhill
Pain can increase when sitting or standing for a prolonged period of time
Treatment & Management
If the sacroiliac injury is acute as a result of a fall, appropriate rest is necessary for the initial stages until the inflammatory response subsides. When patients attend my clinic with a sacroiliac joint dysfunction, the common treatment plan is to slowly release the tightened muscles of the hip, gluteal and lumbar region. This has the effect of releasing the sacroiliac joint back into its neutral position. In some cases where there is greater misalignment within the joint mobilizations are necessary in order to correct the alignment of the joint. Exercises to strengthen this region with the spine in a neutral position are essential.
Next week I will discuss further painful shoulder injuries.
Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy and is based in Thurles.
Contact Number: 086 3275 753
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