Evaluation and treatment of sacroiliac joint pain based on its mechanism of occurrence

Abstract

Although the pathogenesis of sacroiliac joint disorders is not clear, it is assumed that the pelvic intrinsic muscles (transversus abdominis and pelvic floor muscles) that functionally stabilize the sacroiliac joint, become less active than the pelvic extrinsic muscles, resulting in impaired functional stability, which make stress on the posterior sacroiliac ligament as a structural stability system. Symptoms include pain induced by movements or postures that place stress on the pelvic ring, pain induced when stress is applied to the pelvic ring, and tenderness of the posterior sacroiliac ligament. In our investigations, we have observed that the lower extremity positional perception during active straight leg raising is decreased, and that ankle dorsiflexion power is normal in the supine knee extension position, however it is weakened in the knee flexion position. When these symptoms are present, sacroiliac joint disorder is suspected, block injections into the posterior sacroiliac ligament are attempted, and if symptoms are relieved, even temporarily, a diagnosis of sacroiliac joint disorder is made. Various treatment modalities are used, but we find it useful to educate the patient the contraction pattern of the transversus abdominis muscle alone using ultrasound imaging, and to learn motor control in which the transversus abdominis muscle contracts prior to the pelvic extrinsic muscles before any movements.