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Sacroiliac Joint

Sacroiliac Joint. Sacroiliac Joint Pain.

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Sacroiliac Joint

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  1. Sacroiliac Joint

  2. Sacroiliac Joint Pain • 22% of pregnant women report having some form of pain that originates from the pelvis itself.  Between 5 and 8% of this percentage experience disability and severe pain (Daly, et al).  A common source of pelvic pain during pregnancy includes the Sacroiliac joints. • The pregnant patient often presents with an excess lumbar lordosis as a result of the increased abdominal weight.  Ligaments also become more lax as a result of hormonal changes and the sacroiliac joints often exhibit an asymmetry in the amount of laxity.  With these factors combined there is increased stress at the low back and pelvis, as well as compensations throughout the trunk and extremities.   Orthopedic conditions, pain, and disability can occur as a result of these factors. (Goldsmith, et al).  Other risk factors for pelvic pain in pregnant women are multiparity, obesity, previous cesarean birth, young maternal age, manual labor occupation, and stress (Bjelland et al).

  3. Patient Presentation • Pain occurs in episodes and is aggravated by twisting motions such as turning in bed or within 30 minutes of the SIJ’s being loaded during sitting, standing, walking, or ascending/descending stairs. • Nighttime may be when the pain is worst as a result of loading throughout the day. (Keriakos et al) • The pubic symphysis can also be involved and should be screened for by asking the patient about any pain in the groin area. • Pregnant patients may or may not attribute the mechanism of injury to a traumatic event, such as a fall (Cusi,et al). Pelvic girdle pain is often characterized as being a stabbing or sharp pain on one side that occurs within 1cm inferomedial to one the posterior superior iliac spine.  This is considered to be the Fortin Finger Test.  To meet these criteria for a positive test, the patient must use one finger to directly indicate the area of pain on their body on more than one occasion.  It is suggested to be performed immediately after Patrick’s Test and to be followed by other diagnostic tests (Fortin et al). Pelvic girdle pain can refer to the inner thigh, hip, or groin area and patients may complain of a “clicking” in the pelvis.

  4. Examination • A subjective history including the severity and irritability as well as functional limitations and participation restrictions is necessary.  Be sure to include the nature of the onset of pain. • A body chart of all related symptoms is useful and should be corroborated with palpation of bony structures including the pubic symphysis and SI joints.  There are many tests to help the clinician determine if the pelvis is the true origin of pain.  • A leg length discrepancy, observed dysfunctional active motion at the SI joints, distraction and compression of the sacroialiac joints, posterior pelvic pain provocation test, and hip adductor manual muscle test can help the clinician to rule in sacroiliac dysfunction in the pregnant patient when these tests are positive and assist in ruling out pain referral from the lumbar spin.  Active straight leg raise is contraindicated during pregnancy since it involves active hip flexion in supine. • To determine functional limitations, the patient specific functional scale can be utilized.  

  5. Special Considerations • After the 1st trimester (12 weeks), the supine position should be limited to 1-3 minutes at a time and prone is contraindicated.  Active hip flexion in supine should be avoided as well. • Ultrasound treatment near the trunk is contraindicated and electrical stimulation is a relative contraindication that should be discussed with the physician. **Other questions to consider are bowel & bladder changes, decreased sensation in lower extremities, constitutional symptoms, sudden edema of hands or feet, and pain in lower extremities or lumbar area.

  6. Common Treatments • Muscle energy techniques/strengthening to improve stability of the pelvis, specifically targeting multifidus and transverse abdominus. • Sacroiliac belts which should be placed over the greater trochanters.

  7. References • Bjelland, EK, Eskild, A, Johansen, R, and Eberhard-Gran, M.  Pelvic Girdle Pain in Pregnancy: The Impact of Parity. American Journal of Obstetrics and Gynecology 203(2):146 e1-6, 2010. • Cusi, M.  Paradigm for Assessment and Treatment of SIJ Mechanical Dysfunction. Journal of Bodywork and Movement Therapies (2010) 14,152-161. • Daly, JM, Frame, PS, and Rapoza, PA.  Sacroiliac Subluxation: A Common Treatable cause of Low Back Pain in Pregnancy. Family Practice Research Journal 1991; 11:149-159. • Fortin, JD, Dwyer, AP, West, S, and Pier, J.  Sacroiliac Joint: Pain Referral Maps upon applying a new Injection/Arthrography Technique. Part I: Asymptomatic Volunteers. SPINE Volume 19, Number 13, pp 1475-1482, 1994. • Goldsmith, LT, Weiss, G, and Stienetz, BG. Relaxin and its role in pregnancy. Endocrinology and Metabolism Clinics of North America 1995; 24:171-186. • Keriakos, R, Bhatta, SR, Morris, F, Mason, S, and Buckley, S. Pelvic Girdle Pain and Puerperium. Journal of Obstetetrics and Gynaecology Oct 2011; 31(7); 572-80.

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