Many sports therapists, trainers, and physical therapists are only too aware that problems in the hips can mean problems in the back. The reason for this is the involvement of the sacroiliac joint which is located right at the bottom of the back between the sacrum (vertebrae S1-S5) and the ilia (hip bones). Forming the rear part of the pelvic girdle, the sacroiliac joints, along with the pubic symphysis, allow twisting movements on either side of the spine when our legs move. Without this ability the risk of fracture in the pelvis would be extremely high. In assessing lower back pain physicians may sometime neglect to explore the possibility of a sacroiliac joint problem, and the area is difficult to assess without having good knowledge of the complex anatomy of the area.
Sacroiliac joint dysfunction is used to describe injury or pathology in this area, leading to either hyper- or hypomobility. If the joint locks, or begins to be too flexible and mobile, then the surrounding tissues are put under strain, including ligaments such as the iliolumbar, sacrotuberus, sacrospinus, and anterior and posterior sacroiliac ligaments. Both the pubic symphysis and the sacroiliac joints are held together with strong ligaments which can degenerate like other tissues in the body. The pubic symphysis is actually a disc like the intervertebral discs and, as such, is liable to dehydrate, become brittle, and rupture like the discs in the spine. The sacroiliac joint is an arthrodial joint with hyaline articular cartilage, a synovial membrane and capsule. Inflammatory joint diseases can, therefore, affect this joint just as much as the fingers, knees, shoulders, or any other in the body.
Symptoms of Sacroiliac Joint Dysfunction
Problems in the lower back, thigh, buttock, and groin are found in this type of dysfunction and common symptoms include:
● Pain in either the left or right of the lower back, either aching or sharp, restrictive pain
● Pain in the buttock and back of the thigh, often mistaken for sciatica
● Radiating pain in the buttocks and lower back, sometimes into the groin and, in men, the testicles
● Difficulty turning over in bed, getting in or out of the car, and putting on shoes and socks
● Stiffness in the lower back in the morning or after long periods of sitting
● Aching in the lower back at either side after driving long distances
Anyone sustaining an injury to the hip area should ensure that their physician not only examines the lower back but also the sacroiliac joint as this can be damaged and often overlooked. Those engaging repetitive activities where stress is put on the hip joints, such as golfing, should consider the possibility that their lower back pain is connected to that activity rather than necessarily a problem with the spine itself.
What Causes Sacroiliac Joint Dysfunction?
Sacroiliac joint dysfunction is usually due to one of four reasons: trauma, biomechanical problems, hormonal imbalance, or inflammatory joint disease. Trauma may include a sudden fall where a person lands on their buttocks and jolts the hip joints, frequently damaging the ligaments in the process. Biomechanical problems may include such things as a congenital structural abnormality such as one leg being longer than the other, a ‘twisted’ pelvis, muscle tone imbalances, or overpronation. These problems can also be the result of wear and tear over time and are more prevalent in those working in manual jobs or high impact sports. A broken leg may also cause one leg to be longer than the other and, over time, if lifts are not worn in the shoes to balance the posture, one side of the hip joints may become worn and damaged.
Hormonal changes during pregnancy frequently cause lower back pain, in part due to the laxity of the ligaments that occurs as a woman prepares to give birth. As the woman is also carrying extra weight, this relaxation of all the ligaments in the body, particularly the pelvis, can put extra pressure on the spine and cause sacroiliac joint dysfunction. Inflammation of the sacroiliac joint can also occur due to conditions such as Ankylosing spondylitis leading to joint pain and lower back pain.
Treatments for Sacroiliac Joint Dysfunction
The usual treatment for sacroiliac joint dysfunction is simply rest. This allows, in most cases, the joint or ligaments to heal and prevents further exacerbation of the condition. The use of thermotherapy to relax any tense muscles in the lower back and pelvis can help relieve pain, but this is not recommended in cases of trauma where heat may increase inflammation and injury (a cold compress should be applied in this case). If inflammation is present then NSAIDs or anti-inflammatory alternative remedies may be useful, although patients should have the problem checked by a doctor rather than self-diagnosing. Special sacroiliac back belts can also be acquired if the problem is ongoing, allowing for extra support in the hip joint and relieving, in part, the chronic lower back pain.
Obtaining the correct diagnosis is very important when suffering lower back pain as conditions such as Ankylosing Spondylitis are likely to cause symptoms elsewhere in the spine. Similarly, a condition such as rheumatoid arthritis, or a fracture in the area is likely to be treated differently to an acute ligament strain. Massage and physical therapy can be helpful in relieving lower back pain from sacroiliac joint dysfunction, and patients with anatomical issues may be recommended devices that can help correct muscle tone imbalance or equalize leg length. On occasion a steroid injection into the sacroiliac joint may be used to reduce the inflammation, with an analgesic administered simultaneously to relieve pain.
Just as hip dysfunction can cause lower back pain, lower back problems can also cause hip dysfunction making things very difficult for the diagnosing physician. By taking a full medical history, working out the timeline for pain development, and using diagnostic imagery such as MRI and CT scans, and X-rays, a physician should be able to acquire a clearer picture of the condition and advise appropriate treatment for lower back pain.