The sacroiliac joint (SIJ) is the joint between the pelvis and lower back. There is one on each side, and some people have a dimple in the area. Most people can feel a semi-mobile lumpy spot, which might be alarming if you’re only feeling around because something hurts.
The Role of the SIJ
The SI joints are largely built for stability and shock absorption. They don’t have much mobility, but might still present an issue if they lose the small range of movement that they do have. Conversely, they can be responsible for a lot of back pain in pregnancy. The one time in life that they do need to move is in childbirth, and from the first trimester the body begins to produce the hormone that relaxes their supporting ligaments. This loss of support combined with the pressures of a growing bump make SIJ related lower back pain common in pregnancy.
Symptoms of SIJ Dysfunction
Irritation of these joints can present as a dull ache directly over the area. This might become sharper on jarring movements that ask the joint to utilise its shock absorbing properties. Sitting unevenly can be an irritant, and morning stiffness is not uncommon as we rarely spend all night in perfect balance. Your osteopath will combine your case history with a hands-on examination to work out whether the SIJ is the likely cause of your symptoms.
Sometimes SIJ problems are misdiagnosed as sciatica, as they can follow a referral pattern down the legs. In contrast to sciatica, the pain is more diffuse and less likely to shoot or shock in the “toothache” way that sciatica patients often describe their pain. It may also be quicker to respond to treatment. Referred pain like this does not involve the trapping of a nerve, so once the joint is happy, symptoms tend to cease quickly.
Something More Serious
One thing your osteopath will always consider with SIJ pain is ankylosing spondylitis (AS). This is an inflammatory autoimmune condition where the body attacks joints like the SIJ and places where tendon meets bone (entheses). These attacks produce episodes of inflammation, where pain, swelling, and stiffness are the usual symptoms. When the episode subsides, the body tries to heal. Unfortunately with AS, it tends to lay down new bone over the joint itself, causing a gradual stiffening over years.
The first step if we suspect AS is to refer you back to the GP so they can get you to rheumatology: only a rheumatologist can formally diagnose AS. Medication is available through the specialist to slow disease progression, limiting the number or intensity of flares, and thus the damage done by them. Alongside your rheumatology plan, we can help with managing the pain and symptoms associated. AS patients tend to respond well to little treatment, with more problems coming from over-treating- this might resonate if you notice that pain is worse with very little or too much activity, but the middle zone is just right.
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