Fixing the Foundation: How PT Restores Stability and Relieves SI Joint Dysfunction

Sacroiliac joint dysfunction (SI joint dysfunction) is a common yet often overlooked cause of lower back and pelvic pain. The sacroiliac joints are located at the base of the spine, where the sacrum meets the ilium of the pelvis. They play a critical role in stabilizing the upper body and transferring load between the spine and lower body. When these joints become irritated or dysfunctional, it can lead to significant pain and discomfort. Fortunately, physical therapy can be an effective solution for managing and treating sacroiliac joint dysfunction.

This blog will explore the causes of sacroiliac joint dysfunction, its symptoms, and how physical therapy can help restore mobility and reduce pain.

What is Sacroiliac Joint Dysfunction?

Sacroiliac joint dysfunction occurs when the SI joint becomes either too mobile (hypermobility) or too restricted (hypomobility), leading to inflammation and pain. These joints are essential for providing stability and allowing subtle movement during activities like walking, standing, and bending. Dysfunction can develop due to trauma, pregnancy, repetitive stress, or degenerative changes over time.

Common causes of SI joint dysfunction include:

Injury: Trauma, such as a fall or car accident, can damage the SI joint and lead to dysfunction.

Pregnancy: The hormonal changes during pregnancy cause ligament laxity, which can increase SI joint mobility, leading to instability and pain.

Repetitive Stress: Activities that place continuous stress on the joint, such as running or heavy lifting, can lead to wear and tear over time.

Arthritis: Degenerative changes, such as osteoarthritis, can affect the cartilage within the SI joint, resulting in pain and stiffness.

Leg Length Discrepancy: A difference in leg lengths can create uneven pressure on the SI joints, leading to pain and dysfunction

Poor Posture: Prolonged poor posture, especially while sitting, can place excess strain on the SI joint, contributing to dysfunction.

Symptoms of Sacroiliac Joint Dysfunction

The symptoms of SI joint dysfunction can be similar to other lower back conditions, making it challenging to diagnose. Common symptoms include:

Lower back pain: The most common symptom is pain localized to one or both sides of the lower back, near the dimples of the buttocks.

Buttock pain: Pain may radiate into the buttocks, hips, or even down the back of the thighs.

Pelvic pain: Women, in particular, may experience pain in the pelvic region due to the involvement of the SI joint.

Stiffness: Stiffness or difficulty moving the lower back, especially after prolonged sitting or standing, is a common complaint.

Instability: Some people report a feeling of instability or “giving way” in the pelvis or lower back during movement.

Activities that may aggravate pain or other symptoms of SI Joint Dysfunction :

• Ascending or descending stairs

• Jogging uphill

• Landing after jumping

• Lying on the affected side

• Prolonged sitting, especially in the car

• Prolonged standing

• Shifting weight to the affected side

• Turning in bed

How Physical Therapy Can Help SI Joint Dysfunction

Physical therapy is one of the most effective treatment options for SI joint dysfunction. A skilled physical therapist can help address the root cause of dysfunction, whether it is due to mobility restrictions, instability, or muscle imbalances. Here are several ways physical therapy can provide relief:

1. Pain Relief through Manual Therapy

Manual therapy techniques, such as joint mobilizations, myofascial release, and soft tissue massage, can help relieve pain by reducing muscle tension and improving joint mobility. A physical therapist may also use techniques like muscle energy therapy to realign the SI joint, providing immediate relief from discomfort. These hands-on techniques promote blood flow, reduce inflammation, and help relax overactive muscles around the SI joint.

2. Strengthening Exercises

Strengthening exercises focus on improving the stability of the muscles around the SI joint, particularly in the core, hips, and lower back. Weakness or imbalances in these areas can contribute to SI joint dysfunction by placing excessive stress on the joint. By strengthening key muscles such as the glutes, hip abductors, and transverse abdominis, physical therapy can help create a stable foundation that protects the SI joint from further stress.

3. Stretching and Mobility Work

Stretching exercises are equally important in a physical therapy program for SI joint dysfunction. Tight muscles around the pelvis and lower back, such as the hip flexors, hamstrings, and piriformis, can pull on the SI joint and lead to dysfunction. A physical therapist will prescribe stretches that target these tight areas to improve flexibility and reduce tension on the SI joint.

4. Pelvic Alignment Techniques

In cases where the SI joint is misaligned, a physical therapist may use specific techniques to correct the alignment of the pelvis. Muscle energy techniques, for example, can gently guide the joint back into position by using the patient’s own muscle contractions. These techniques, combined with postural correction exercises, can help improve joint function and prevent future misalignment.

5. Education and Postural Awareness

Physical therapists play an important role in educating patients about proper posture, body mechanics, and movement patterns to prevent SI joint dysfunction from recurring. Patients are taught how to lift, bend, and sit in ways that protect their lower back and pelvis. This awareness helps reduce strain on the SI joint during daily activities.

Conclusion

Sacroiliac joint dysfunction can be a debilitating condition, but physical therapy offers a comprehensive approach to treatment that addresses the underlying causes of pain and dysfunction. By focusing on pain relief, strengthening, mobility, and alignment, physical therapy helps restore balance to the SI joint and allows patients to return to their daily activities pain-free.

If you are struggling with SI joint pain, consider consulting a physical therapist for a personalized treatment plan that targets your specific needs and helps you regain control over your movement and health.

References

1. DePalma MJ, Ketchum JM, Saullo TR. “Etiology of chronic low back pain in patients having undergone lumbar fusion.” Pain Medicine, vol. 12, no. 5, 2011, pp. 732-739. doi:10.1111/j.1526-4637.2011.01098.x.

2. Deyo RA, Mirza SK, Martin BI. “Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002.” Spine, vol. 31, no. 23, 2006, pp. 2724-2727. doi:10.1097/01.brs.0000244618.06877.cd.

3. Cohen SP. “Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment.” Anesth Analg, vol. 101, no. 5, 2005, pp. 1440-1453. doi:10.1213/01.ANE.0000180831.60169.EA.

4. Huijbregts PA, Goubert D. “Sacroiliac Joint Dysfunction: Evidence-based diagnosis and management.” Journal of Manual & Manipulative Therapy, vol. 8, no. 3, 2000, pp. 137-145. doi:10.1080/10669817.2000.10601537.

5. Cusi M. “Sacroiliac joint dysfunction: What is the evidence?” The Journal of Manual & Manipulative Therapy, vol. 18, no. 3, 2010, pp. 139-146. doi:10.1179/106698110X12640740712617.

6. Newman, D. P., & Soto, A. T. (2022). Sacroiliac Joint Dysfunction: Diagnosis and Treatment. American Family Physician, 105(3), 239–245.