What is SI Joint Dysfunction and Causes?

What are the signs and symptoms of SI Joint Dysfunction? 

Sacroiliac joint dysfunction (SI joint dysfunction) occurs when the sacroiliac joints, which connect the lower spine to the pelvis, become inflamed or experience abnormal movement. This can lead to a variety of symptoms that primarily affect the lower back, pelvis, buttocks, and sometimes radiate to the legs. The symptoms can range from mild discomfort to severe, debilitating pain.

Here are the most common symptoms of sacroiliac joint dysfunction:

1. Lower Back Pain

• One of the hallmark symptoms of SI joint dysfunction is pain in the lower back. However, unlike typical lower back pain, which may be centralized around the lumbar spine, the pain from SI joint dysfunction is often felt on one side of the lower back or across the sacrum (the triangular bone at the base of the spine).
• The pain can range from dull and aching to sharp and stabbing. It may be aggravated by activities that stress the sacroiliac joints, such as standing up from a seated position or lifting heavy objects.

2. Buttock Pain

• Pain in the buttocks is another common symptom of SI joint dysfunction. This pain is often felt deep in the buttocks and may be on one or both sides. It can be mistaken for conditions like sciatica or piriformis syndrome because of its location.

3. Pain in the Hips, Groin, or Thighs

• Some people with SI joint dysfunction experience pain radiating from the lower back or pelvis into the hip, groin, or upper thighs. The pain may feel like a dull ache or throbbing and is typically felt on one side of the body.
• Pain in the groin area is less common but can occur due to the interconnected nature of the pelvic structures.

4. Radiating Leg Pain

• SI joint dysfunction can sometimes cause radiating pain down the legs, similar to sciatica, though it rarely travels below the knee. The pain may be described as shooting, tingling, or numbness, and can mimic a nerve impingement, though it originates from the irritated sacroiliac joint rather than a compressed nerve in the lumbar spine.

5. Stiffness and Reduced Mobility

• Many individuals with SI joint dysfunction experience stiffness in the lower back, hips, or pelvis, which can reduce mobility and flexibility. This stiffness is often worse after periods of inactivity, such as after waking up in the morning or after sitting for long periods.
• The stiffness may limit the range of motion in activities like bending forward, sitting cross-legged, or twisting the torso.

6. Pain Worsens with Activity

• Certain movements or positions can aggravate sacroiliac joint dysfunction, such as:
• Prolonged sitting or standing.
• Bending, lifting, or twisting.
• Climbing stairs or walking uphill.
• Getting in and out of a car.
• These activities place stress on the sacroiliac joint, leading to increased pain. The pain may also worsen with high-impact activities, such as running or jumping.

7. Pain Relieved by Rest or Lying Down

• Many individuals find that the pain caused by SI joint dysfunction is relieved by rest, particularly when lying down. Lying on the side or back can help reduce the load on the sacroiliac joint, alleviating pain and discomfort.

8. Instability or Sensation of the Leg Giving Way

• Some people with sacroiliac joint dysfunction report a feeling of instability or that their leg is "giving out" when standing, walking, or climbing stairs. This sensation can occur because the joint is either too loose (hypermobility) or too stiff (hypomobility), which can affect how weight is transferred through the pelvis and legs.

9. Tenderness over the Sacroiliac Joint

• The area over the sacroiliac joint (near the lower back and buttocks) may be tender to the touch. Pressing on this area can elicit pain, indicating irritation or inflammation in the joint. This tenderness is often located on one side of the lower back but can affect both sides in some cases.

10. Difficulty with Sleep

• Individuals with sacroiliac joint dysfunction may have difficulty finding a comfortable sleeping position due to the pain. Lying on the affected side or in certain positions may exacerbate discomfort, leading to disrupted sleep.

11. Pain While Transitioning Between Positions

• SI joint dysfunction can cause pain during transitions between positions, such as:
• Sitting to standing: People may experience pain or stiffness when standing up after sitting for a prolonged period.
• Rolling over in bed: Pain may increase during certain movements, like turning over in bed or repositioning the body.

12. Pain Worsened by Weight-Bearing Activities

• Activities that require weight-bearing on one leg, such as standing on one leg, climbing stairs, or walking, can aggravate the symptoms. This is because the SI joints are crucial for transferring weight between the spine and lower body, and any dysfunction in these joints can make such movements painful.

13. Inflammation

• Inflammation in and around the sacroiliac joint can cause swelling, heat, and pain. Although less common, visible swelling around the sacroiliac area may occur in cases of acute inflammation or injury.

Summary of Symptoms of Sacroiliac Joint Dysfunction:

• Lower back pain, often one-sided.
• Buttock pain.
• Pain that radiates into the hips, groin, or thighs.
• Radiating leg pain, similar to sciatica, usually not extending below the knee.
• Stiffness and reduced range of motion in the lower back, pelvis, and hips.
• Pain that worsens with activity (such as standing, walking, or lifting) and is relieved by rest.
• Feeling of instability or the leg "giving out".
• Tenderness over the sacroiliac joint.
• Difficulty sleeping due to discomfort.
• Pain during position changes, such as from sitting to standing.

 

Several potential causes of sacroiliac joint dysfunction, may include:

1. Joint Hypermobility or Hypomobility

• Hypermobility (Excessive Movement): If the sacroiliac joints move too much, it can lead to instability and irritation in the surrounding tissues. This can result in pain and discomfort. Hypermobility can be caused by injuries, weakened ligaments, or conditions like pregnancy (due to hormone changes that loosen ligaments).
• Hypomobility (Limited Movement): On the other hand, when the sacroiliac joints become stiff or restricted, they can cause pain due to the limited range of motion. This lack of mobility may occur due to arthritis, previous injuries, or conditions that lead to joint degeneration.

2. Trauma or Injury

Direct injury to the sacroiliac joint can trigger dysfunction. This may happen as a result of:

• Falls: A fall directly onto the buttocks or lower back can impact the SI joints and lead to misalignment or inflammation.
• Stepping off curb incorrectly jamming foot hard into ground.
• Car accidents: The impact from an auto accident may injure the sacroiliac joints, especially if there is a sudden jolt or twisting motion involved.
• Sports injuries: Activities that involve rapid twisting or heavy lifting can strain the SI joints, leading to dysfunction.

3. Pregnancy

Pregnancy is a common cause of sacroiliac joint dysfunction due to the hormonal changes that occur during this time. Relaxin, a hormone released during pregnancy, loosens the ligaments in the pelvis to prepare the body for childbirth. This loosening can make the sacroiliac joints less stable and lead to pain or dysfunction. The added weight and altered body mechanics during pregnancy can also contribute to the stress on the SI joints. Standing on one hip more than the other or holding a baby mostly on one hip. 

4. Arthritis

• Osteoarthritis: Degeneration of the sacroiliac joints due to wear and tear over time can lead to osteoarthritis. As the cartilage wears away, the bones in the joint may rub against each other, causing pain, stiffness, and reduced mobility. Osteoarthritis is more common as people age.
• Ankylosing Spondylitis: This is a type of inflammatory arthritis that primarily affects the spine and sacroiliac joints. It causes inflammation in the joints, leading to pain, stiffness, and, over time, possible fusion of the vertebrae or joints, further reducing mobility.

5. Poor Posture and Biomechanics

Chronic poor posture, uneven weight distribution, or abnormal body mechanics can place strain on the sacroiliac joints. Common causes include:

• Leg length discrepancies: If one leg is shorter than the other, it can cause uneven stress on the SI joints.
• Spinal misalignment: Conditions like scoliosis or improper posture can affect how the sacroiliac joints bear weight, leading to dysfunction.
• Repetitive stress: Repeated activities that strain the lower back and pelvis, such as certain occupational tasks or exercises, can over time cause sacroiliac joint dysfunction.

6. Degenerative Joint Disease

Over time, the wear and tear on the sacroiliac joints can lead to degenerative joint disease or degenerative sacroiliitis, where the joints become damaged due to cartilage degradation. This is more likely to occur with age, or if the individual has had previous joint injuries.

7. Inflammatory Conditions

Systemic inflammatory conditions can affect the sacroiliac joints and lead to dysfunction. Examples include:

• Rheumatoid arthritis (RA): An autoimmune disorder that attacks the joints, leading to inflammation and pain, including in the sacroiliac joints.
• Psoriatic arthritis: This is a type of arthritis associated with psoriasis and can also affect the sacroiliac joints, causing pain and stiffness.

8. Infections

In rare cases, an infection in the sacroiliac joint, called septic sacroiliitis, can cause joint dysfunction. This may occur when bacteria enter the joint, usually from an infection elsewhere in the body. Infections in the sacroiliac joints can cause severe pain, fever, and swelling, and typically require immediate medical attention.

9. Previous Surgery

Surgeries involving the lower back, pelvis, or hips can sometimes alter the biomechanics of the sacroiliac joints. For example, after a lumbar spinal fusion or hip replacement surgery, the altered alignment and mechanics may place additional strain on the SI joints, leading to dysfunction.

10. Obesity

Excess weight can place added stress on the sacroiliac joints, which may cause or exacerbate dysfunction. The more weight the joints bear, the greater the strain on the ligaments and cartilage, potentially leading to pain and inflammation.

11. Sedentary Lifestyle or Lack of Exercise

A sedentary lifestyle, particularly one with prolonged sitting or poor physical activity, can weaken the muscles that support the sacroiliac joints. This can lead to instability and improper functioning of the joint. Additionally, poor posture during sitting can contribute to the misalignment of the SI joints.

Conclusion

Sacroiliac joint dysfunction presents a range of symptoms, with the most common being pain in the lower back, buttocks, and hips, often exacerbated by movement or weight-bearing activities. The condition can also lead to stiffness, reduced mobility, and radiating pain, sometimes mimicking sciatica. Proper diagnosis and treatment, including physical therapy, pain management, and in some cases, injections or surgery, can help alleviate symptoms and restore function.

*If you would like to schedule a PT Evaluation and Treatment with Mobile Physical Therapy and Wellness on the Westside of Los Angeles, CA, please call (424) 438-1426 to setup an appointment.