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Sacroiliac (SI) Dysfunction

By Rick L. DaSo, D.C.

A very common cause of lower back and leg pain is sacroiliac (SI) joint dysfunction. Although sometimes difficult to diagnosis, sacroiliac joint pain may arise from within the SI joint or may be related to other structures involving ligaments, muscles and tendons. When dysfunctional, the SI joint can disrupt proper kinetic (movement) function, causing pain. The SI joint complex can cause low back, buttock, groin, and leg pain. Bending, sitting, twisting, and weight-bearing activities may aggravate the condition. Individuals that sit a lot may aggravate and cause flare up of the SI joint. Also, lifting and bending may cause SI pain.

A differential diagnosis is extremely important in treating lower back pain. SI dysfunction is often misdiagnosed as sciatica since both conditions involve leg pain. A proper history and examination can offer good information to identify the underlying cause of back and leg pain. X-rays and sometimes MRI are necessary to rule out lumbar disc involvement or hip pathology. Once a proper diagnosis is completed, a treatment plan can be implemented.

There is good clinical evidence for a conservative approach for SI dysfunction. Here is what the evidence suggests is most effective:

  • Rest and activity modification to avoid aggravating activities
  • Specific SI joint adjustments to reset joint neurology and function
  • Therapy modalities are used initially (i.e., muscle stimulation, ultrasound, ice, massage therapy) to reduce muscle and soft tissue inflammation
  • Therapeutic exercise to correct muscular imbalance and relieve stress on the pelvis and lumbar spine
  • Addressing functional leg length discrepancies or lower limb pathology that may put undue stress to the pelvis, sacral and lumbar spine (i.e., fallen arches, hip or knee degeneration, etc.) with the use of foot orthotics or arch supports

In severe cases, medical intervention may be warranted. However, joint function is rarely addressed and the probability of recurrence is high. It is recommended to consider proper conservative care after the acute symptoms subside.

Chronic SI dysfunction can lead to muscle inhibition and weakness in the lower back, pelvic and lower extremity musculature. It is common for the pain to come and go. Many will self-medicate and delay proper treatment for months, even years. Once the muscle inhibition and weakness progresses, the pain becomes more frequent, even constant. The longer proper treatment is delayed, the more difficult it is to resolve.

If you are suffering from low back and leg pain, don’t delay proper diagnosis and treatment. Addressing the problem early and understanding how to manage your condition will keep you from unnecessary pain and flare up in the future.