Ep. 34 Sacroiliac Joint (SIJ) Dysfunction
Episode Summary:
Justine and Dan delve deep into the complexities of pelvic dysfunction, focusing specifically on sacroiliac joint (SIJ) instability. This episode covers everything from symptoms, affected populations, and conservative management techniques involving movement and exercises, to more advanced procedural treatments. Tune in to learn about the importance of proper diagnosis, the different causes, get insights into useful tools like SIJ belts, and hear recommendations for both clinicians and patients on developing effective pain management strategies for this type of chronic pelvic pain.
Episode Overview
Hey everyone. If you’re here, you’re probably looking for answers about SIJ (sacroiliac joint) pain. Let’s talk through exactly how we approach figuring out where your pain is coming from and walk you through treatment—step by step—from basics all the way to the more intensive options.
Starting Point: Diagnosing SIJ Pain Together
Dan: When someone comes in with lower back pain, I don’t make assumptions. There are five big causes we look at: facet joints, SI joints (that’s our focus today), hips, nerves, and what I call “do-its” (the other tricky stuff).
Here’s how we work through it, together:
If your pain is worse in your legs than your back: We’re probably looking at a nerve issue first.
If your pain is mostly in your back: We split the back into zones and start narrowing things down.
Justine: Diagnosis isn't a one-and-done; it’s more like detective work. We’ll talk with you about exactly where your pain shows up, how it feels, and when it flares. For SIJ pain, you might notice it just off midline, maybe more on one side, and often it gets worse when standing or sitting for extended periods, or moving in certain ways.
Dan: Especially with hypermobile patients, this process gets complicated. You might have more instability around your SI joints, making everything more unpredictable.
Working Through SIJ Pain: Step-by-Step Treatment Options
Justine: Once we’ve zeroed in on SIJ dysfunction, here’s how we get started—always aiming for the least invasive solutions first.
Conservative Options
Education & Support: First, we make sure you understand what the SI joint does and why yours might be acting up. Understanding why your body is doing what it is goes a long way.
Physical Therapy: MET exercises, guided movement, manual therapy, sometimes taping techniques to add support. Improving motor patterning by prioritizing hip mobility and differentiation so you can increase movement when you’ve become more inhibited or lost function is key to take pressure of and better support the SIJ area.
Targeted Exercises: Gentle strengthening and stability routines for your core and pelvis that progressively add resistance so your muscles can overcome the ligament laxity that can perpetuate this dysfunction. We avoid generic plans—what works for one person may not help the next, especially if you’re hypermobile and need more sensory input to affect the motor output.
Dan: Sometimes all you need is this conservative approach, especially if you catch it early and have good compliance so you stay consistent.
Stepping Up: More Targeted Treatments
Medication: Non-steroidal anti-inflammatories (NSAIDs) can reduce pain and inflammation. For those really struggling, short-term muscle relaxants might be considered.
Injections: For those who aren’t improving, SIJ steroid injections can provide relief and help confirm the diagnosis. It’s both diagnostic and therapeutic.
Last Resort: Invasive Options
Dan: For a small number of people, conservative management and even injections don’t cut it. That’s when we discuss more invasive treatments:
Radiofrequency Ablation: This technique targets nerves around the SIJ to dampen pain signals.
Surgery: SIJ fusion is rare and reserved for the most severe cases—when pain is disabling and other methods have failed.
Justine: We want you to know surgery is not an easy answer, or the lone answer even when very helpful/appropriate. Careful evaluation and a clear understanding of risks and benefits are key, and you will still need to progressively strengthen the area.
Supporting You Beyond the Clinic
Justine: Managing SIJ pain isn’t just about procedures or medications. It’s about helping you navigate your daily life, making realistic adjustments, and staying connected to a supportive care team so you continue making progress.
Dan: We’re here for you, from the first question to the last treatment option. Let’s figure out what works best for your body, together.