Sacroiliac Sprain Treatments & Therapy For Low Back Pain
Sacroiliac sprains (SI sprains) are a common cause of chronic low back pain. The SI joint is incredibly mobile, which allows you to sit, walk, run, flex your thigh to your chest, and extend your leg backwards.
However, body mobility comes at the cost of decreasing its structural support. Very supportive and protected joints have little mobility. Highly mobile joints are more likely to experience strains and sprains because more forces are placed on supporting tendons and ligaments, especially during sports or exercise. Damage to the tissues causes injuries, inflammation and sacroiliac joint dysfunction.
A sacroiliac sprain can either create a mild, dull ache or a sharp, stabbing pain. More severe sprains can cause radiating pain (sciatica) into the butt, hamstring, knee, leg, or even the foot. The condition is usually worse with movement, especially getting up from a seated position; but is relieved with walking a few steps. People describe a pain when sleeping on their side. Most people tell their healthcare provider, “It is sharp right here and radiates down the butt from here,” as the patient points to their SI joint. (If your sciatic pain is different, read about additional diagnoses and causes of sciatica.) Diagnosis does not require an MRI. Your doctor can perform a few clinical orthopedic tests to diagnose sacroiliac joint dysfunction and rule out lower back disc herniations and other severe causes of sciatica.
Sacroiliac sprains are often misdiagnosed as lumbar disc herniations, hip arthritis, muscle spasms, pain syndromes, or muscle strains. Your physician can effectively educate you on the differences and treatment variations for each injury. Proper diagnosis leads to faster and better pain relief. Some of these injuries respond better to anti-inflammatory medication, while others respond very well to injections. Meanwhile, some injuries do not respond to certain medications or injections. Improper diagnosis and treatment fails to improve the SI sprain (which is very common in “self diagnosis” of muscle strains). Very rarely is surgery needed for conditions that affect the SI joint. Its articular surfaces are not usually fractured, nor is the joint likely to become unstable.
Conservative treatment is recommended in all acute and chronic conditions, and most times the SI sprain will resolve without complications. Chronic sacroiliac joint dysfunction might benefit from injections under fluroscopic guidance. The joint injection is frequently performed by pain management clinics and orthopedic surgeons when it is needed for pain relief.
The sacroiliac joint is in your low back off to the side. People often feel a “nub” off the middle of their back along the beltline, which marks the top of the sacroiliac joint. The “nub” is a portion of the ilium bone. The ilium is on the side of the pelvis. The right and left ilium surround the sacrum, which is at the base of your spine. The two ilium and sacrum form the pelvis (also medically called the innominate bone or coxal bone). In common nomenclature, people often refer to the pelvis as their hip bone. The purpose of the bony pelvic ring is to protect the pelvic organs and transition structural forces from the lumbar spine to the femur during movement.
For example, when sitting your hip is flexed forward and your pelvis is tipped to allow you to sit comfortably. As you stand up, the muscles in your low back, hip, and leg contract to extend the hip. The sacroiliac extends backward with the movement and absorbs some of the stress.
During the motion your low back may shift forward and then straighten upwards. All of these complex movements provide shearing forces across the joints, and the SI ligaments and joints absorb some of those forces. Increased stress is absorbed by the sacroiliac joint if twisting or turning is involved.
We did not even consider how long you were sitting. Sitting produces a shear force across the sacroiliac joint because it is resisting your body weight. The sacroiliac joint is constantly under stress. It could be from exercises, bending, squatting, twisting, climbing, or even sitting.
The joint is very unique because a portion of it is very fibrous, or has small ligaments. Those ligaments support the sacroiliac joint as it absorbs the forces with walking, sitting, running, climbing, standing, or twisting.
The small ligaments that connect the ilium to the sacrum can often become injured. Chronic stress creates a low-grade joint sprain. Most times the sprain heals correctly and the symptoms are relieved. Other times the ligaments can heal poorly, leading to an increased risk of future injuries.
People diagnosed with chronic sacroiliac joint syndrome pain often suffer from repeated sprains to this area with mild to moderate activities. The small stability ligaments around the joint did not heal correctly the first time, and create a weakened area that becomes easily injured in the future. The body then forms a structurally poor “patch of scar tissue” to try and stabilize the joint and surrounding tissue. The body sometimes uses scar tissue like duct tape. Put down a little tape now, and tear it up later to correctly repair the area. Sometimes the body forgets to fix the “duct taped” spot.
When the patch is irritated, it commonly puts more scar tissue down on top of it. Think about a leaking pipe. If you kept wrapping more and more duct tape around a leaking pipe, the tape would get you through the day, but the leak is still a continual source of trouble.
The sacroiliac commonly experiences scar tissue across the fibrous portion of the joint. The scar tissue inflammation continues with prolonged sitting, standing, or bending. People with chronic sacroiliac trouble will say, “every time I ride in a plane for two hours, car for three hours, or bend over to work in the yard I experience an aggravation of pain.”
The sacroiliac pain will calm down after a week, but can be easily aggravated with activity or prolonged sitting. It may also be a little sore to the touch. Diagnosis of sacroiliac joint disease is often considered by your doctor or health care provider based on your description of pain symptoms, timing, activities, and location of joint pain. Chronic lower back pain is becoming more common in our sedentary lifestyles with occasional bouts of exercises on the weekends. Not to mention, most people do not consider a few acute episodes of sacroiliac joint pain worth the time or effort to seek rehabilitative therapy, until sacroiliac joint dysfunction becomes a chronic source of pain.
Acute sacroiliac sprains are usually easy to treat conservatively in the office. In the acute injury phase, with ice, stretching, cold laser, chiropractic manipulations, and physical therapy the joint will heal the pain source during the first episode of pain. Medicine can be given by your primary care provider to decrease pain and inflammation. Ibuprofen and non-prescription NSAIDs are common for acute pain relief. Some patients experience significant symptom relief with a combination of medical, conservative, and alternative medicine.
Chronic cases of sacroiliac joint dysfunction can require more treatment and rehabilitation because chronic cases have a significant amount of scar tissue, muscle spasms guarding the joint, and chronic loss of back, hip, and leg flexibility. The body tried to protect the weak sacroiliac by compensating using other muscles and joints for years.
Quality treatment needs to address those compensations by returning flexibility and strength to appropriate muscles.
The scar tissue patches can be difficult to address. Specialized treatment needs to be performed to break up the scar tissue and peel off the small “patches of duct tape.” By peeling some of the duct tape away, the body’s healing mechanisms return to the area. The body recognizes the bad patches and tears up the scar tissue, replacing it with quality tissue.
Massage is great at addressing the muscle spasms of the big muscles around the sacroiliac. It is also good at breaking up scar tissue in the larger muscle groups. However, massage therapy is not very good at breaking up scar tissue in ligaments and around joints. Graston Technique utilizes specialized instruments to break up the scar tissue. The instruments slide along the skin and develop tension across the scar tissue patches. The tension and shear forces that are produced break up the scar tissue and trigger healing (read more about Graston Technique or ASTYM here).
Graston Technique combined with other physical therapy treatments provides excellent resolution to chronic sacroiliac sprains. Getting rid of the scar tissue is critical to repairing the tissue and getting rid of the weak spots. All the muscles need to have proper strength and flexibility to support the sacroiliac joint and reduce the risk of future injury.
Your health care provider may also recommend sacroiliac joint injections in conjunction with rehabilitation and chiropractic manipulation therapy. The joint injection helps decrease the pain and inflammation, which enhances the therapy and treatment. Additional treatment options include acupuncture for pain in the low back, combined with active rehabilitation for strength and stability.
In very difficult cases that do not respond to the rehabilitation program, advanced imaging can be used to evaluate the pelvis and low back for herniated discs, ankylosing spondylitis, psoriatic arthritis, or degenerative arthritis that might be slowing your recovery. As previously mentioned, most cases of sacroiliac sprain syndrome will improve with conservative treatment.