Sacroiliac joint: One of the main causes of low back pain
About 15% to 25% of axial back pain is caused by sacroiliac joint pain. Recent studies have shown that history, physical examination, and radiography alone are not sufficient to diagnose sacroiliac joint pain. This article will give some diagnostic methods and exercise programs.
01
Structure and function of sacroiliac joint
The sacroiliac joint is the largest axial joint in the human body with an average surface area of 17.5 square centimeters, and the area of the sacroiliac joint can vary greatly in adults.
The sacroiliac joint is generally described as a large, flexible synovial joint shaped like the auricle. There is no articular sac behind it, and it is covered by a large group of ligamentous structures that connect the sacrum to the ilium. The ligaments are the static stabilizers of the joint.
In addition, a network of muscles, including the gluteus maximus , piriformis and biceps femoris , support the sacroiliac joint to stabilize the pelvic bones.
02
Normal aging of the sacroiliac joint
Since puberty, the sacroiliac joint continues to change with age. Signs of degeneration of this joint can often be detected by X-rays at age 30 to 40.
Around age 60, this joint is apparently limited by stiffness of the joint capsule.
Nerve distribution in the sacroiliac joint The nerve distribution in the sacroiliac joint has been a controversial topic. Some scholars believe that the anterior end of the sacroiliac joint has no nerve tissue.
However, it is generally accepted that the posterior branch of the nerve from the fifth lumbar vertebra (L5) to the third sacral vertebra (S3) is the primary source of nerve supply to the posterior end of the sacroiliac joint.
03
Prevalence rate
Bernard and Kirkaldy-Willis conducted the largest prevalence survey and found that about 22.5% of patients with low back pain also had sacroiliac joint pain.
Sacroiliac joint pain is present in 15% to 25% of patients with low back pain who are carefully examined according to Guideline 7 of the International Association of Spinal Injection.
Causes of sacroiliac joint pain:
The causes can be divided into internal joints and external joints.
Internal joint causes: arthritis and infection.
External joint causes: bone point lesion, fracture, ligament injury and myofascial
pain.
There are two causes of sacroiliac joint injury: axial load and sudden rotation. This injury may result in bursa or synovial fluid destruction, bursa and ligament tightness, insufficient or excessive joint motion, external pressure or shear force, abnormal joint mechanics, microfractures or large fractures, chondromalacia, soft tissue damage and inflammation.
Factors affecting sacroiliac joint pain:
Risk factors that increase stress on the sacroiliac joint include:
- Pregnant
- Real and obvious long and short feet
- Abnormal gait
- Intense exercise for a long time
- Scoliosis and fusion of spine into sacrum
04
Diagnosis and symptoms
One of the most challenging aspects of treating sacroiliac joint pain is the complexity of the diagnosis.
Sacroiliac joint pain is similar to many pathologic conditions, and diagnosis requires examination to rule out other possibilities, such as lumbar disc problems, nerve root compression, joint pain on the spinal surface, primary or secondary myofascial syndrome, and non-spinal structural symptoms.
Inflammation of the sacroiliac joint, including ankylosing spondylitis and Redder's syndrome, is often found in clinical diagnosis. Physical examination should include a thorough neurological examination, straight leg elevation test, and evaluation of
pain and loss of motion from the lower rib cage to the lumbar spine.
The physical examination should also test the hip joint and palpate the soft tissue at the lesion site or the bone pain site at the lumbosacral pelvis. The patient must indicate the most painful location and record it.
The lesion location along the sacroiliac joint line and sacral sulci becomes immediately painful, which is a typical sign. There are numerous signs or tests in the literature for sacroiliac joint pain.
Patrick
The Patrick (above) test and the Gaenslen (below) test are the most common physical examinations.
The reliability of tests such as vigorous sacroiliac joint movements, side-to-side legs and movement has not been fully demonstrated.
Gaenslen
05
Pain implicated patterns
The sensory changes are mainly concentrated in the lower middle of the hip to the anterior superior spine of the iliac, i.e. above the greater trochanter of the femur and above the thigh.
The associated pattern of sacroiliac joint pain was usually hip (94%), lower lumbar (72%), lower leg (28%), groin (14%) and foot (12%).
Scattered pain to the upper lumbar spine (6%) and abdomen (2-6%) is rare.
06
Ways to prevent & relieve pain
1.Knee extension (single/double leg)
Hold the other knee with your hand and lift it up to the back side to feel a stretch. Hold for 8-10 seconds and then slowly lower it. Repeat 6-8 times.
You can also complete the action of holding the knee with your legs (below), hold the knee with your hands and pull it up to the lower back and buttocks, hold it for 8-10 seconds and then slowly lower it, repeat 6-8 times.
2.Supine knee pendulum
Bend your knees about 90 degrees, place your feet flat on the ground, slowly control your knees to swing from side to side with your pelvis, pay attention to the abdomen must be slightly tightened, and complete the action without pain, 10-20 times per set, and repeat 4-6 sets.
- Hip Bridge
Bend your knees and put your feet flat on the ground, pay attention to the knee joint slightly less than 90 degrees, pull in the abdomen to lift the pelvis, use the gluteal muscle to lift the pelvis parallel to the torso, and then slowly lower back.
Pay attention to avoid overexertion of the thigh and lumbar muscles. Exhale while lifting and inhale while breathing below. Repeat 15-20 times for 4-6 sets.
- Cobra Pose
Place your hands on your shoulders and slowly lift your upper body up to avoid pain. Hold for 15-20 seconds, then slowly lower your upper body. Repeat 4-6 sets. (If the back is not strong enough, you can use elbow support)
5.Baby Pose
From a kneeling position, slowly sit your pelvis down on your heels and extend your hands fully toward your head for 15-20 seconds. Repeat 4-6 sets.
6. Bird Dog pose
Support all four feet, then extend the opposite arm and leg (reach a position parallel to the back), pay attention to the abdominal tightening, avoid waist collapse, hold 3-5 seconds, slowly return, repeat the other side to complete the same movement, 6-8 times on each side, repeat 4-6 sets.
If you have sacroiliac joint pain, to avoid aggravating it, it is recommended to stop the following activities: golf, football, weight lifting, cycling, sit-ups.
