Runners often complain of low back and buttock pain. While there are several reasons this could occur, sacroiliac joint pain and dysfunction is one cause, and it often requires some level of medical intervention. SI joint pain and dysfunction is an ailment that commonly affects runners and other athletes as well as some people who do not identify as either.
The two SI joints are in a person’s pelvis, part of the stable ring structure that also includes the symphysis pubis. Several muscles including the hamstrings, abdominals, hip flexors and gluteal muscles attach to the SI joints. This joint is different from other joints because it only allows for about two degrees of rotation and less than one millimeter of movement backward and forward, but it is a joint nonetheless. The SI joint connects a part of the spine called the sacrum to the pelvis, and as a result it absorbs a lot of stress between these two bones, which can lead to pain especially if there is an underlying problem.
The SI joint absorbs stress experienced in the legs during running and transfers it to the spine. If the muscles are weak or not working optimally, the SI joint takes the brunt of the load. Tightened ligaments often due to arthritis or hormone changes commonly caused by pregnancy can put the SI joint at greater risk of dysfunction.
To properly diagnose SI joint dysfunction, your doctor will have to do an examination. Symptoms are usually described as increased pain after running, standing from a seated position, walking up stairs or using other exercise equipment that stretches the muscles connected to the SI joint. Diagnoses often includes several types of imaging including x-ray, CT, a special type of CT called a SPECT and MRI, as well as fluoroscopically guided injections and sometimes lab work.
SI joint dysfunction isn’t always the cause of SI joint pain. Other potential causes of SI joint pain include sacral stress fracture, lumbar disk herniation, piriformis syndrome (a rare diagnosis that involves irritation or compression of the sciatic nerve) and ankylosing spondylitis (chronic, dull pain felt in the back, hip, and butt that often results in morning stiffness but subsides with exercise).
If SI joint dysfunction is the cause of pain, an individualized treatment plan will be developed that includes both rest as well as modified activity. The goal is to rehabilitate the affected muscles by targeting the underlying cause of dysfunction and pain. In some cases, runners can change their approach to running to reduce or eliminate pain. A biomechanical evaluation of the runner can be done to assess whether or not this is the problem. Sometimes improper training, weak muscles or imbalanced muscles can be to blame. Overtraining can also be to blame. Manual therapy performed by a sports osteopath, chiropractor, physical therapist or athletic trainer is sometimes recommended as part of a doctor-prescribed therapy protocol.
In some cases, surgery can be performed to reduce or eliminate SI joint pain. The two most common surgical approaches are SI joint stabilization and joint fusion, both of which are typically done after other therapies have failed. For the latter, SIMPACT Sacroiliac Joint Fusion System has shown positive results in treating SI joint dysfunction. LifeSpine, a company that works tirelessly to address spinal pathology from the occiput to the sacrum, provides the technology.
These individualized rehabilitation programs aim to treat the underlying cause of SI joint pain. By treating the underlying cause, the pain should subside and the runner can return to their routine with little modification. Sometimes bracing will be needed while a person heals. In cases where pain is severe, pain medication or steroid injections may be recommended to keep pain under control while the person rehabilitates, and when the dysfunction is very severe, surgical intervention may be required to eliminate pain and treat dysfunction and its underlying causes.
Those who enter into a SI joint rehabilitation program can usually return to running with minor modifications. The more severe the case is, the more modifications will have to be made and longer rest period a physician may recommend. Many runners can return to running immediately by making modifications, but others with more severe pain may need to rest and rehabilitate for a while. In the latter case, it’s important athletes take time to recover so they aren’t doing permanent damage to their body. Usually, a rehabilitation protocol and possible intervention to treat underlying cause (biomechanics, physical attributes, muscle problems) will result in complete recovery and zero residual pain.
Surgical intervention offers similar results for more severe cases. With the use of the SIMPACT Sacroiliac Joint Fusion System, doctors have reported less post-surgical bleeding and bruising and the procedure takes only twenty minutes with the assistance of SIMPACT.
There are no major risks associated with entering a SI joint rehabilitation program as long as it is curated by a professional and followed closely. Those who overdo it during recovery may cause permanent damage to their muscles or joints. Some pain and soreness is normal during physical therapy. If surgical intervention is needed, the number risks goes up. In addition to risks associated with general anesthesia, surgery always carries a risk of infection. Bleeding and bruising can be reduced with the use of a SI joint fusion system called SIMPACT.
A proper SI joint rehabilitation program targets underlying cause of joint dysfunction and pain leading to complete recovery. The more severe the pain and dysfunction are, the longer rehabilitation will take. In many cases, a person can return to their normal athletic routine after the program and experience no pain while running or after.
If pain is affecting a person’s ability to perform daily activities, a short course of pain medication or cortisone shot(s) may be recommended. These however are not alternatives to the rehabilitation program. Physical therapy (along with rest) is another approach to treating SI joint dysfunction. As with other injuries, bracing and ice/heat therapy can help. Patients may also try an SI joint brace or sacroiliac belt that helps hold the joints tightly together to reduce pain. Adequate sleep and gentle exercise (which are often part of a rehabilitation program for SI joint dysfunction) can help runners recover faster.
Costs associated with treating SI joint dysfunction vary based on the course of treatment needed. In minimal cases, ice/heat therapy and over-the-counter pain medications may suffice. If imaging is required to diagnose SI joint dysfunction that will add to the overall cost of treatment. Steroid shots and physical therapy will also cost more. In some cases treating underlying issues such as one leg being longer than the other may add additional expenses, as well. Surgical intervention is pricier than other treatments. In many causes, insurance will cover part or all of your care.
Kraus, Emily. “Sacroiliac (SI) Joint Pain and Dysfunction in Runners – Dr. Emily Kraus.” Athletebiz. April 30, 2018. Accessed May 01, 2018. https://www.athletebiz.us/blog/sacroiliac-si-joint-pain-and-dysfunction-in-runners-dr-emily-kraus/.
“News.” SImpact. Accessed May 01, 2018. https://www.sijointfixation.com/news.
Highsmith, Jason M. “Treatments for Sacroiliac Joint Dysfunction.” SpineUniverse. Accessed May 01, 2018. https://www.spineuniverse.com/conditions/sacroiliac-joint-dysfunction/treatments-sacroiliac-joint-dysfunction.