Sacroiliac sprains are a common injury and a frequent source of chronic low back pain. The sacroiliac joint is a very mobile joint. Its movement allows your pelvis and legs to move in over 180 degrees of motion. Think what happens to your pelvis and leg when you sit, walk, run, flex your thigh to your chest, or kick your leg backwards.
In the body a general rule is that the more mobile a joint is the easier it is to get hurt. While the less mobile a joint is the less likely it is to be injured. Very supportive and protected joints have limited mobility. Highly mobile joints are more likely to experience strains and sprains because the movement strains tendons and ligaments.
People commonly complain of dull or sharp stabbing pain in their low back. The pain feet a little to the side on a small bump. People sometimes refer to this as their hip area, but it is actually a part of their sacroiliac joint.
Severe sacroiliac sprains produce radiating pain from the back into the back of the leg and knee. Very severe sprains can radiate down to the ankle or foot. The pain is always worse with movement, especially getting up from a chair or car seat. People are often uncomfortable sleeping, and feel better sleeping with a pillow between their knees.
Patients are able to point to the sacroiliac joint and say, "It always hurts right here. The pain starts right here and shoot down my leg." After walking a few steps the pain decrees in intensity.
Anatomy and Structure of the Sacroiliac Joint and Pelvis
The pelvis is made up of three bones. The sacrum is at the base of the spine below your belt line. On each side of the sacrum is an ilium bone. The ilium bone on the right and sacrum form the right sacroiliac joint, while the ilium on the left and sacrum form the left sacroiliac.
The sacroiliac joints are just a few inches off center. If you placed your hand in the center of the sacrum and moved to the side you would feel a "bump." This bump is part of the ilium, and helps form part of the sacroiliac joint.
The sacroiliac joint is incredibly mobile. It helps you to flex your knee to your chest or extend your leg behind you. It is flexed during sitting and helps transition the pelvis to a standing position. Walking, running, and jumping transfer an incredible amount of stress and strain through the SI joint.
The joint is unique because of its size, joint angle, and amount of supporting ligaments. The size and angle of the SI joint help transition the forces from the lower legs through the pelvis and back. For example, when running or walking the pelvis being stabilized to the femur (upper leg bone) can develop enough force to propel the leg. The difference between walking and running is the amount of force is increased over a shorter period of time.
The sacroiliac joint has a significant amount of ligaments supporting and protecting the joint. The body is trying to protect the joint against excess movement or forces. These ligaments are often injured in people, and sometimes they do not heal correctly. This poor healing is what leads to chronic sacroiliac pain.
Chronic Sacroiliac Sprains Occur Because of Scar Tissue
The small ligaments that connect the sacrum and ilium are under constant stress from walking, running, squatting, bending, and sitting. Most people do not think of sitting as strenuous, but to the little ligaments of the SI it is very strenuous activity.
Sitting requires the low back and pelvis joints to rock forward, which produces strain across the sacroiliac joint. Your body weight is transitioning across the lumbar spinal to pelvis, which is resistant against the chair. The chair is pushing your ilium upwards as the lumbar spine is pushing the sacrum downward. This produces shear force across the sacroiliac joint. Small injuries in the SI joint can be made worse with sitting. Usually these injuries heal correctly, but sometimes they become problematic.
Small injured ligaments sometimes can not heal because sitting lasts to injure them. The body is trying to repair the fibers, but the stresses of sitting and daily life overwhelm the repaired area and damage it again. Over time small areas of ligaments develop scar tissue that chronically produces pain whenever it is stressed.
People with chronic sacroiliac sprains can describe the process perfectly. Their pain is always in the same area. Sometimes the area is just sore to the touch, other times it produces a painful zone around it. The pain is worse whenever they perform a bending, squatting, or lifting activity. Or if they sit for a certain amount of time in the car or plane. There is usually a set amount of activity that can do without developing pain, and anything above that produces sacroiliac pain. The longer they do it the more pain they develop.
Over time the pain will decrease, but can be quickly aggravated again with sitting. With walking or running this is the first area to get sore.
The chronic sacroiliac pain is a result of scar tissue trying to protect the ligaments. The body places scar tissue in areas to provide a quick patch until it can correctly heal. I like to make the comparison to duct tape. The duct tape is meant to hold a leaky pipe until the weekend when I have time to fix it properly. However, the leak increases before the weekend, so I put down a little more duct tape around the patch. If I get busy and do not fix the duct tape patch this weekend and it starts to leak next week I will probably place more duct tape around it. Soon I will end up with a large duct tape patch.
The duct tape is mean to be a short term solution, but by creating a large patch I create a structurally weak zone. Any extra stress will produce problems in the duct tape first.
In the body, the duct tape is scar tissue. Scar tissue is trying to be a quick patch, but the body is mistaking using it as a long term patch. Every time the scar tissue is under extra stress it goes through an inflammatory process producing pain and more scar tissue to be added.
This is why after two hours of sitting the sacroiliac starts to hurt. Three hours of sitting produces a lot of pain. The scar tissue patch is able to hand an hour and half of sitting but two hours produce some inflammation around the duct tape. Three hours overwhelms the area and you feel more pain. With repeated cycles of injury and more scar tissue, the area gets easier to aggravate, which is why the sacroiliac will tolerate less sitting before becoming painful.
The sacroiliac commonly experiences scar tissue across the SI joint ligaments. The scar tissue keeps getting inflated with prolonged sitting, standing, or bending. This process will continue until the patch is broken down and repair with proper tissue.
Treatment for Chronic Sacroiliac Sprains
Acute sacroiliac sprains are usually easy to treat. With a little ice, stretching, cold laser, chiropractic, and physiotherapy the sacroiliac joint will heal correctly the first time. Unfortunately, chronic cases require a different treatment protocol. If it was an easy sprain it would have healed by now. Chronic cases requiring pulling the "duct tape" off and making the body break down the duct tape and repair with proper tissue.
Chronic cases can have a significant amount of scar tissue, which needs to be addressed. The longer it has been causing you pain and the more severe it is usually indicate more difficult cases to treat. If the body has been compensating for the weak sacroiliac joint and scar tissue by creating muscle spasms and decreasing hip and back flexibility treatment will be more involved and complicated.
There are treatments to help break up the scar tissue patches. Graston Treatment is an effective tool for decreasing scar tissue. It utilized specialized tools to help "stretch and pull" the scar tissue patches. By breaking the scar tissue, it triggers the body's healing mechanisms to repair the area properly. The next treatment helps break up the next layer of scar tissue. Treatment is a process of breaking each layer down until getting to the original problem
Massage therapy and Graston Therapy are often used together. Massage is better and breaking up scar tissue in big muscle groups that surround the sacroiliac joint. Graston Technique is better at breaking up scar tissue in tendons, ligaments, and smaller muscle fibers.
Graston Technique combined with Chiropractic and other physiotherapy treatment provides excellent success rates to chronic sacroiliac sprains. Without getting rid of the scar tissue in the sacroiliac joint it is likely to continue causing chronic problems. With proper treatment the scar tissue can be removed and changed into proper ligament tissue; thereby, getting rid of your sacroiliac pain.