Goal of the Study?
In this comprehensive literature review from the European Spine Journal 1 the authors’ goal was to examine the literature concerning the pathophysical, risk factors, clinical presentation, diagnostic modalities and treatment options for Sacroiliac Joint Dysfunction.
Why are they doing this study?
The Sacroiliac Joint (SIJ) connects the hip bones (iliac crests) to the sacrum, the triangular bone between the lumbar spine and the tailbone (coccyx). The primary function of the SIJ is to absorb shock between the upper body and the pelvis and legs. Age-related changes in the SIJ begin in puberty and continue throughout life. In early adulthood, the joint surfaces are smooth and allow for multi-directional gliding motion but by the third decade, morphological changes restrict motion and begin to resemble osteoarthritic degeneration and include surface irregularities, fissures, chondrocyte clustering and fibrillation.
What did they do?
Over 6,104 articles were initially identified but after removing duplicates and screening for eligible content only 33 articles were included.
What did they find?
- SIJ dysfunction can result from various clinical conditions, including trauma, degenerative arthritis, inflammatory arthropathy, infections and moderate impact exercise. The dysfunction can occur during abnormal lifting, bending forward or lordotic posturing when the line of gravity is displaced relative to the centre of the acetabula. Pain localized to the SIJ region can be broad and include pain from the lumbar spine, SIJ and hip joint as well as visceral pain.
Prevalence and Risk Factors:
- It has been found that 15-30% of all primary Lower Back Pain (LBP) may be the result of SIJ dysfunction. Both genders and all races seemed to be affected equally. SIJ dysfunction is a common cause of LBP in athletes, especially in sports with repetitive or asymmetric loading. Other risk factors include pregnancy, obesity, and a sedentary lifestyle. leg length discrepancy, hypermobility, degenerative joint disease and previous spinal fixation.
- Compared with discogenic LBP, individuals with SIJ dysfunction often present with unilateral pain below L5 and this pain can extend down the posterior thigh to the S1 dermatome. The most common SIJ injury results are from sudden rotational and axial strain. Most athletes will not present acutely following injury but rather experience gradually progressive symptoms following repetitive microtraumas.
- No single provocation test has accurately identified SIJ dysfunction. However, using a combination of three provocation tests such as FABER (Flexion, Abduction, and External Rotation) and Graenslen’s distraction, high thrust and compression tests have shown diagnostic validity. Laboratory tests provide no diagnostic benefit. Definitive evaluation of the SIJ pathology is both diagnostic and therapeutic and involves ultrasound-guided injections of steroid and anesthetic solutions into the joint. Image guidance is crucial due to the complex anatomy of the SIJ and the high likelihood of needle misplacement.
Why do these findings matter?
With the ageing nature of the population, SIJ dysfunction has emerged as an extremely prevalent issue. A better understanding of the pathophysiology, risk factors and associated clinical conditions will help guide diagnostic procedures and improve therapeutic outcomes.
At Dynamic Disc Designs, we have crafted realistic models to help in the greater understanding of the motion and the associated dysfunction that may contribute to problems.