Sacroiliitis – inflammation of the sacroiliac joint

Sacroiliac joint dysfunction is an umbrella term used to describe pain in the sacroiliac joint (SIJ). This is usually due to impaired mobility in the joint (i.e. hyper- or hypo-mobility) or improper alignment of the articulating surfaces. SIJ dysfunction is the source of pain in 15-30% of people with mechanical low back pain.

SIJ dysfunction is a condition that is difficult to diagnose and often overlooked by doctors and physical therapists.

• The joint may be hyper- or hypomobile, which can cause pain.
• The pain is localized directly above the affected joint. Patients usually describe the pain as sharp, dull, aching, stabbing or shooting.
• They may also complain of sharp, stabbing and/or shooting pain that radiates down the back of the thigh, usually not below the knee.
• This pain can mimic radicular pain.
• People often complain of pain when sitting, lying ipsilaterally, or climbing stairs.

Clinically Relevant Anatomy

Pelvic ligaments

The sacroiliac joints are located on either side of the spine, between the two pelvic bones, which attach to the sacrum.

You can read more about KPS here.

• Several structures are involved in the maintenance and movement of the SIJ.
• The ligaments that support the SIJ are the anterior and posterior sacroiliac ligaments, the sacrotuberous ligament, the sacrospinous ligament, and the iliopsoas ligament.
• The SIJs are surrounded by some of the most powerful muscles in the body, but none of them have a direct impact on their mobility.
• The main function of the pelvic girdle is to provide shock absorption to the spine and distribute forces between the upper body and lower extremities.

Etiology

It is often difficult to determine what caused the joint damage.

On March 15-20, a seminar by Georgy Temichev “RehabTeam. Block_1 (Lumbar, Thoracic, Pelvis).” Find out more...

• One of the most common causes of problems in the SIJ is injury. The force from this type of injury can damage the ligaments around the joint. A tear in these ligaments is characterized by too much movement in the joint, and over time this can lead to degenerative arthritis.
• Pain may also be caused by an abnormality of the sacrum, which can be seen on x-rays.
• Pregnant women are more likely to develop SIJ syndrome. Female hormones are released during pregnancy, relaxing the sacroiliac ligaments. This stretching causes changes in the SIJ, making it hypermobile. After the fifth decade of life, the SIJ grows together.

Can the ilium hurt?

The first and most important question: can the ilium hurt, or is it a reflected discomfort? How to determine and which doctor to contact if such a clinical symptom appears?

Let's start with the first question: the ilium can hurt on its own. It consists of dense tissue of bone trabeculae, covered on the outside with periosteum. It contains blood vessels and nerve endings. Therefore, any pathological changes in the bone with a violation of the integrity of the periosteum lead to a person experiencing serious pain. Potential causes include severe bruises with the formation of a hematoma inside the periosteum, cracks and fractures of the bone.

Various deformations can occur directly in the bone structure. This may include osteoporosis, osteomalacia and osteonecrosis. All three conditions differ in that the bone structure disintegrates, areas of rarefied matter form inside it, and calcium is washed out. The bone becomes fragile and susceptible to traumatic destruction even with a small load.

Another common group of reasons why the ilium itself hurts is tumor processes. These can be cavity intraosseous cysts filled with blood and lymph fluid. The inflammatory process that constantly occurs in them provokes swelling of the periosteum tissue and pain. Oncological tumors quickly metastasize to nearby bone structures. Cancer of the bone itself, osteosarcoma, is also not uncommon.

Next, let's look at other potential causes of pain in the ilium area.

Epidemiology

Approximately 90% of the population will suffer or complain of some form of low back pain at some point. It is estimated that 10 to 25% of these patients experience SIJ pain. Most SIJ pathologies affect the adult patient population.

• The posterior sacral branch innervates the SIJ, and when compressed or inflamed, it is a source of intense pain.
• Most people suffering from SIJ pain are adults. This disorder most often occurs in people who lead a sedentary lifestyle.
• In general, obese patients are more likely to suffer from SIJ pain.
• This disorder occurs in both men and women.

Clinical picture

Symptoms of SIJ syndrome are often difficult to distinguish from other types of low back pain. The most common symptoms include:

• Lower back pain.
• Pain in the hips.
• Discomfort when sitting for long periods of time.
• Local tenderness of the posterior surface of the SIJ (next to the posterior superior iliac spine).
• Pain occurs when there is mechanical stress on the joint, for example, when bending forward.
• No signs of neurological deficits/nerve root tension.
• Aberrant movements of the SIJ.
• The joint may be hyper- or hypomobile, which can cause pain.
• The pain is usually localized directly above the SIJ.
• Patients may complain of sharp, stabbing and/or shooting pain that extends down the back of the thigh, not below the knee.
• The pain may mimic radicular pain and therefore be misdiagnosed as radicular pain.
• Patients often complain of pain when sitting, lying ipsilaterally, or climbing stairs.

Differential diagnosis

SIJ syndrome is a controversial diagnosis, so SIJ pain and injury are commonly overlooked. This condition is often defined as dysfunction (a term that serves as an umbrella term for various conditions).

Differential diagnosis should include:

• Radicular pain.
• Piriformis syndrome.
• Ankylosing spondylitis.
• Lumbar facet syndrome.
• Spondyloatropathy.
• Greater trochanteric bursitis.
• Fracture of the femur.
• Hip overload syndrome.

Diagnostic procedures

To identify SIJ dysfunction, it is necessary to conduct a comprehensive study.

• The hip joints (including range of motion) should be assessed for symptoms. This also includes performing a Trendelenburg test. Palpation over the SIJ often causes discomfort. Differences in leg length may also be a cause of SI joint pain (leg length should be measured in all patients with suspected SI joint dysfunction).

Physical therapists use a variety of orthopedic provocation tests.

• Gaenslen test.
• Sacral trust test.
• Thigh trust test.
• Distraction test.
• FABER test.
• Yeoman test. The patient lies in a prone position with the knee bent 90° degrees. The examiner lifts the bent leg by hyperextending the hip. This test places stress on the posterior structures and anterior sacroiliac ligaments. Pain indicates a positive test.
• Gillette test. The patient is standing. The examiner's thumbs are placed under the posterior superior iliac spine and S2 (fingers parallel to each other). Then the subject should bend one leg at the knee and hip joints 90 degrees. If the VEPO on the side of the bent leg moves upward, then the test is considered positive.
• SIJ compression test. The patient is positioned in a supine position. The examiner applies pressure to the wings of the ilium with both hands. With the arms crossed, the examiner can add lateral compression. Pain is a sign of strain in the anterior sacroiliac ligaments.

Laslett cluster of tests
CT and MRI are often used to confirm the diagnosis. Ultrasound-guided anesthetic injections are a good tool in diagnosing SIJ pathologies.

The role of sacroiliac joint pathology in the development of low back pain

The article discusses the causes of pain in the lower back and one of the most common causes is pathology of the sacroiliac joint. A review of the literature concerning this problem is presented. The main clinical manifestations and principles of diagnosis for damage to the sacroiliac joint are outlined.

Role of pathology the sacroiliac joint in the development of pain in the lower back

In the article the reasons of emergence of pain in the lower part of a back and one of most often meeting reasons - pathology sacroiliac joint are considered. The literature review concerning this problem is submitted. The main clinical manifestations, the principles of diagnostics are stated at defeat sacroiliac joint.

Pain in the lumbosacral region remains one of the most common chronic pain syndromes. The incidence of low back pain ranges from 24% to 56.7% [1]. Complete recovery of patients with chronic back pain is rare due to the limited effectiveness of existing treatment methods, which, in turn, depends on insufficiently studied mechanisms of the formation of chronic pain syndromes and an undifferentiated approach to the development of pain in the lower back.

Low back pain (LBP) can be caused by changes in the spine (vertebral bodies, intervertebral discs, joints, ligaments), muscle damage and disease, damage to the nervous system (spinal cord, roots, peripheral nerves), pathology of the internal abdominal organs , pelvis, mental disorders. It is believed that the most common cause of pain in the lower back is musculoskeletal changes associated with sprains, microtrauma, and excessive overload of the muscles, ligaments, or joints of the spine [2].

Clinical characteristics of muscular-tonic syndromes are described in a number of works [3, 4, 5, 6, 7, 8, 9]. It is believed that not all muscles are equally susceptible to the formation of muscular-tonic syndrome. For example, among the muscles of the pelvic girdle and back, the most susceptible to the formation of chronic tension are the tensor fascia lata, the piriformis muscle, the quadratus lumborum muscle and all spinal extensors [10].

The exact mechanisms of the formation of muscle-tonic syndromes are unknown. Muscular-tonic syndrome can perform a sanogenetic function, limiting the affected area from further damage. Increasing paravertebral muscle activity in response to pain is thought to improve spinal and pelvic stability. V.P. Veselovsky (1977) developed the theory of “myoadaptive” syndromes accompanying both compression and reflex pain syndromes.

With acute tissue damage and associated pain, as a rule, there is a decrease in activation of the deep and increase in activation of the superficial muscles of the back [11]. Long-term changes in the condition of the paravertebral muscles lead to negative consequences in the form of increased load on the bone and ligamentous structures of the spine and pelvis, and impairment of complex movements in the affected segment. Interestingly, changes in muscle condition often persist even if the pain completely resolves, and may contribute to the acceleration of degenerative changes in the structures of the spinal column and the development of repeated episodes of pain in the low back [12]. A relationship has been shown between changes in the activation of the abdominal wall muscles and a decrease in the cross-sectional area of ​​the multifidus muscles with the development of a recurrent episode of back pain [13].

Myofascial pain syndrome (MPPS) is a chronic pain syndrome in which local or segmental pain occurs in various parts of the body. A pathognomonic sign of MFPS are trigger zones (TZ). TZ is an area of ​​local longitudinal compaction located in the direction of the muscle fibers, when irritated (palpation, injection, percussion) causes local soreness and irradiation of pain. The size of the TZ ranges from 2 to 5 mm. Each trigger zone has its own strictly defined area of ​​referred pain of paresthesia. A detailed description of T3 in various muscle groups is given in the work of JG Travell and DGSimons, and the diagnosis of MFPS is made on the basis of clinical data [14].

Despite a significant amount of research devoted to the problem of facet syndrome, this diagnostic category is still ambiguous. This is primarily due to the absence of clear clinical symptoms characteristic of degenerative lesions of the intervertebral joints. The facet joints have been shown to contain a large number of encapsulated and non-encapsulated nerve endings. With degenerative lesions of the facet joints, inflammatory mediators are detected in the cartilage and synovial capsule: prostaglandins, interleukin 1 and 6, tumor necrosis factor alpha [15].

The most well studied features of biomechanics in the lumbar spine are in the spinal motion segment L4-L5, since it is most susceptible to degenerative changes.

It is believed that dysfunction of the sacroiliac joints (SIJ) in 25-30% of cases is the main source of pain in the lumbosacral region [16]. The term “SIJ dysfunction” comes from manual medicine, where it denotes a disorder of biomechanics, manifested by pain and hypomobility of the SIJ without other signs of a specific pathological process. Sometimes, in these cases, the term “SIJ block” is used. SIJ dysfunction is especially common in women during pregnancy, which may be due to relaxation of the ligamentous apparatus that stabilizes the SIJ and a shift of the body’s center of gravity forward, which leads to the formation of compensatory hyperlordosis [17]. There are a large number of factors predisposing to SIJ damage. Many of them are associated with changes in biomechanics against the background of constitutional asymmetry in leg length, the formation of an oblique and twisted pelvis, and changes in the configuration of the lumbar spine. The SIJ suffers from various inflammatory (ankylosing spondylitis), metabolic (gout, pseudogout) and degenerative (osteoarthritis) diseases of the joints, which must be taken into account in the differential diagnosis of their painful dysfunction.

At the same time, according to various authors, there is evidence that the proportion of pain emanating from the sacroiliac joints ranges from 30% to 90% [18, 19]. In the structure of injuries, injuries to the sacroiliac joint account for 18% of all pelvic injuries [18]. Damage to this joint can be an important (and sometimes for a long time the only) symptom of a wide range of therapeutic diseases. According to research by the Russian Center for Manual Therapy, functional blockades of the SIJ occur in almost all people. And neglect to eliminate the blockade of the sacroiliac joint and tension in the sacroiliac ligaments, accompanied by pseudoradicular pain, can lead to chronicity of the process and erroneous laminectomies [20].

According to N. Bellmany et al. (1983), diseases and conditions accompanied by damage to the SIJ include:

1. Structural abnormalities: congenital joint abnormalities, pelvic asymmetry, different leg lengths.

2. Inflammatory diseases: ankylosing spondylitis, Reiter's disease, inflammatory bowel diseases, juvenile rheumatoid and psoriatic arthritis, familial Mediterranean fever, Behçet's disease, Whipple's disease.

3. Degenerative diseases: osteoarthritis.

4. Joint infection: pyogenic, tuberculosis, brucellosis.

5. Other diseases and conditions: pregnancy, alkaptonuria, Gaucher's disease, condensing osteitis of the ilium, Paget's disease.

There are various theories of nutation (displacement) of the sacrum. Farabeuf's theory states that the tilt of the sacrum occurs around an axis established by the axial ligament. Angular displacement occurs and the promontory moves downward and forward along an arc centered posterior to the joint surface. Another version of Bonner's theory: the tilt of the sacrum occurs around an axis that passes through Bonner's tubercle to the auricular articular surface of the sacrum. According to Weisel's research, a theory of pure linear displacement is obtained: the sacrum slides along the axis of the lower part of the auricular articular surface. This may mean a linear movement of the sacrum in the same direction as the movement of the promontory and sacrum.

The number of theories suggests how difficult it is to analyze low-amplitude mobility and raises the possibility that different people may have different types of mobility. These theories are not just abstract in nature, but are also applied in practice, since the movements of the pelvic girdle are of great physiological importance in the birth act [21].

Pain associated with dysfunction of the SIJ can be noted in the sacral region, radiating to the groin, thigh, and dermatome area S1. Its intensity, as a rule, decreases after walking and increases after static loads. The pain is usually more intense in the morning and decreases in the evening. X-ray and laboratory tests in this case do not reveal any deviations from the norm [22]. Neuroorthopedic examination techniques are used to diagnose SIJ dysfunction. Diagnostic yield and specificity are increased when multiple neuroorthopedic tests are used. It is believed that diagnostic specificity is increased by the injection of a local anesthetic into the SIJ under radiological control. A 75-90% reduction in pain intensity during the duration of the anesthetic according to VAS is considered sufficient to diagnose SIJ dysfunction as the cause of low back pain [23].

Norets I.P. was the first to identify two types of meniscoid tissue in the lumen of the joint space of the sacroiliac joint and thereby explained the mechanism of the occurrence of a functional block in this joint due to entrapment of the meniscoids [24]. They also gave radiological criteria for the functional block of the SIJ, proved the high information content of the spine test and the modified test of the phenomenon of advancing the posterior superior spine are highly informative indicators of the functional block of the sacroiliac joint.

Lumbo-sacralgia was studied in the work of Akhmetsafin A.N. [25]. The author concludes that the study of pathobiomechanics in patients with lumbosacralgia allows us to identify various clinical variants of pathobiomechanical changes in the spine and pelvic ring, especially the sacroiliac joints. Clinical and neurological manifestations of arthrogenic (iliosacral and sacro-iliac) lumbosacralgia are reflex-muscular in nature and are accompanied by distinct static-locomotor disturbances. The use of neuromuscular methods of manual therapy against the background of drug-physioprocedural therapy makes it possible to increase the effectiveness of treatment in the acute phase by 1.5 times, which is confirmed by rheovasographic, thermal imaging, electroneuromyographic and x-ray research methods. Neuromuscular techniques of manual therapy for the treatment of patients with lumbosacralgia are a highly effective, safe and economical method of treatment, easily implemented into everyday clinical practice for widespread use.

The work of Khadzhiev G.V. is devoted to the clinical and pathogenetic diagnosis of pelvic-sacral neuropathies. [26]. As a result of a comprehensive study, the author determines the predominance of changes in the biomechanics of the spine (flexion type of disorders - 50%), in the biomechanics of the sacrum (sacro-iliac distortions - 59.75%) and mixed pelvis (31.65%) and rotational type (37.05). %).

Magomaev F.M. revealed in his studies that common causes of sacralgia are periarthrosis of the sacroiliac joints, aseptic epiduritis, diseases of the pelvic organs, true spondylolisthesis of the lumbar spine, and tumors of the sacrum [27].

Despite previous controversy, it is now well established that mobility in the sacroiliac joint (SIJ) normally decreases with age [28]. Men have more limited mobility than women, and ankylosis usually develops in old age [29]. Frigerio et al. found that the range of rotation of the pelvic bones relative to the sacrum is several centimeters [30]. However, Weisl noted that the concept of the SIJ rotation axis is controversial [29]. The two opposite surfaces of the SIJ are so uneven that there is a significant spread of rotation centers in the frontal and sagittal planes. For this reason, and also because of the significant forces required to separate the joint surfaces tightly pressed by the surrounding ligaments, Wilder et al. concluded that the CPS functions primarily as a shock absorber [31].

According to Lewit, the SIJ refers to three joints whose movements are not controlled by muscles [31]. However, abnormal muscle tension can contribute to joint misalignment. These joints also include the acromioclavicular and tibiofibular joints. Porterfield presented an excellent illustrated description of a patient with impaired pelvic joint mobility associated with impaired muscle function [32].

The patient develops sudden or gradually increasing pain in the area of ​​one or in rare cases both SIJs. Pain can be felt on both sides, even if one SIJ is displaced, however, as a rule, it is more pronounced on the affected side. Pain is usually triggered by movements that involve bending forward, rotating the pelvic girdle, and rotating the torso, such as during a golf swing, shoveling snow, bending over to pick something up from the floor, or trying to stand up from a soft surface. armchairs. Pain can occur during pregnancy, and can also be caused by a fall or an uncomfortable position during general anesthesia. In some cases, the main symptom of SIJ damage may be excruciating pain in the area of ​​innervation of the sciatic nerve, which sometimes reaches such intensity that the patient does not pay attention to back pain. Typically, pain radiates to the leg, but may also refer to the lower back, lateral thigh, gluteal region, sacrum, iliac crest, and sciatic nerve. Limitation of mobility can reach varying degrees of severity from minor difficulties to complete immobility. The pain may worsen when bending forward, putting on shoes, crossing your legs, getting out of a chair, and turning in bed.

When pressing on the superior or inferior posterior iliac spine, pain always occurs on the affected side. In the absence of such pain, the diagnosis of SIJ lesion is highly doubtful. In addition, TT-related soreness occurs in the muscles surrounding the SIJ, including the lower erector spinae, quadratus lumborum, gluteal, and piriformis muscles. Soreness in these muscles can exceed the pain in the joint itself, which often leads to confusion and misdiagnosis.

With conventional radiography of the lumbar and pelvic spine, changes in the SIJ are extremely rarely detected. On examination, difficulties are usually noted when raising an outstretched leg. In more severe cases, there is restriction on the affected side when pulling the leg towards the stomach. Usually the curvature of the lumbar spine is smoothed, the pelvis on the affected side is curved upward, which leads to protrusion of the lateral parts of the pelvis to the side. With intense pain, the patient hunches over and limps when walking, sparing the leg on the side of the affected SIJ.

Limitation of mobility in the left SIJ is detected with the patient lying on his back, while the doctor stands facing the right half of the patient’s body. The right thigh is maximally abducted and rotated at the knee, the foot is located behind the knee of the other leg. The right knee moves slightly up and down, with the hip used as a lever to rock the left SIJ, in which the patient begins to notice an unpleasant sensation if this joint is truly affected. Sometimes pain also occurs on the side of the swinging limb. Negative results of this test indicate the absence of damage to the SIJ.

Ignoring the pathobiomechanical changes that occur during sacralgia and the absence of methods for their correction in therapeutic measures leads to chronicity of the process.

B.H. Akhmetov, Yu.N. Maksimov

Kazan State Medical Academy

Republican Clinical Hospital for Rehabilitation of the Ministry of Health of the Republic of Tajikistan

Akhmetov Bulat Khakimovich - neurologist, correspondence graduate student of the Department of Neurology and Manual Therapy.

Literature:

1. Schmidt, I.R. Osteocondritis of the spine. Etiology and prevention. - Novosibirsk: Nauka, 1992. - 240 p.

2. Kinkade, S. Evaluation and Treatment of Acute Low Back Pain // American Family Physician. - 2007. - Vol. 75, No. 8. - P. 1181-1188.

3. Popelyansky, Ya.Yu. Orthopedic neurology. - T. 1, 2. - Kazan, 1997.

4. Veselovsky, V.P. Forms of lumbar ischialgia (clinical and experimental, electrophysiological, biochemical and biophysical justification): dis. ... doctor of medical sciences. - Kazan. — 427 p.

5. Ivanichev, G.A. Myofascial pain. - Kazan, 2007. - 392 p.

6. Khabirov F.A. Guide to clinical spinal neurology. - Kazan: Medicine, 2009. - 518 p.

7. Liev, A.A. Variants and forms of vertebrogenic myofascial lumboischialgic syndromes: abstract. diss. ... doc. honey. Sci. - Kazan, 1995. - 48 p.

8. Parfenov, V.A. Causes, diagnosis and treatment of pain in the lower back // Neurology, neuropsychology, psychosomatics. - 2009. - No. 1. - P. 19-23.

9. Alekseev, V.V. Diagnosis and treatment of back pain (methodological recommendations). - Publishing house, 2010. — 22 s.

10. Popelyansky, Ya.Yu. Diseases of the peripheral nervous system. - M.: Medicine, 1989. - 469 p.

11. Hodges, P. Changes in sensorimotor control in low back pain / Fundamentals of musculoskeletal pain ed. by Graven-Nielsen T. —Seattle: IASP Press, 2008. –– P. 445-453.

12. Green, H. A history of low back injury is a risk factor for recurrent back injuries in varsity athletes / H. Green, J. Cholewiski, MT Galloway // Am. J. Sport Med. - 2010. - Vol. 29. - P. 795-800.

13. Hides, JA Long term effects of specific stabilizing exercises for first episode low back pain / JA Hides, GA Jill // Spine. - 2010. - Vol. 26. - P. 243-248.

14. Simons, DG Myofascial pain and dysfunction // Eur. Spine J. - 2006. - V. 15. - R. 169-191.

15. Cohen, S. Diagnosis and treatment of lumbar zygapophysial facet joint pain // Anesthesiology. - 2007. - Vol. 106. - P. 591-614 (1).

16. Schwarzer, AC The sacroiliac joint in chronic low back pain // Spine. - 2009. - Vol. 20. - P. 31-37 (1).

17. Ostgaard, HC Prevalence of back pain in pregnancy // Spine. - 2010. - Vol. 16. - P. 549-552.

18. Popelyansky, Ya.Yu. Clinical significance of the sacral region as a source of local and reflected manifestations of vertebrogenic pathology / Ya Yu. Popelyansky, M.F. Magomaev // Vertebroneurology. - 2001. - T. 8, No. 1-2. — P. 45-48.

19. Editorial. Back pain what can we offer? // Biol. Med. J. - 1979. - Vol. 1. - P. 706.

20. Sitel, A.B. Manual therapy of spondylogenic diseases. - M., 2008. - 408 p.

21. Kapandzhi, A.I. Spine. Physiology of joints. - M., 2009. - 344 p.

22. DonTigny, R. Anterior dysfunction of the sacroiliac joint as a major factor in the etiology of idiopathic low back pain syndrome // Phys. ther. - 1999. - Vol.70. — P. 250-262.

23. Dreyfuss, PH, Dreyer SJ Lumbar faset joint injections // Spine J. - 2003. - Vol. 3. - P. 50-59.

24. Norets, I.P. Lumbar-pelvic pain syndromes from the perspective of manual medicine and the role of the sacroiliac joints in their genesis / Norets, I.P., Grinberg E.A. // Manual therapy in vertebroneurology: abstracts of conference reports. - Novokuznetsk, 1990. - P. 25-28.

25. Akhmetsafin, A.N. Phenomena of “short” and “long” legs and their connection with the localization of the side of the pain syndrome in lumbosacralgia and sciatica / A.N. Akhmetsafin, E.R. Barantsevich, A.A. Skoromets // Materials of the 7th All-Russian Congress of Neurologists: abstract. report - N. Novgorod, 1995. - No. 461.

26. Khadzhiev, G.V. Diagnosis and manual therapy of pelvic-sacral neuropathies. Educational manual / G.V. Khadzhiev, Yu.D. Badzgaradze, T.N. Trofimova, N.M. Zhulev. - St. Petersburg: SPbMAPO, 2006.

27. Magomaev, M.F. Painful sacrum. Mechanisms of development, clinical manifestations, treatment // Vertebroneurology. - 2004. - T. 11, No. 1-2. — P. 65-70.

28. Cray, H. Sacroiliac joint pain: Mobility and axes of rotation // Int. Clin. - Vol. 11. - P. 65-76.

29. Weisl, H: The movements of the sacroiliac joint // Acta Anat. - Vol. 23. - P. 80-91.

30. Frigerio, NA Movement of the sacroiliac joint / NA Frigerio, RR Stowe, JW Howe // Clin. Orthop. - Vol. 100. - P. 370-377.

31. Lewit, K. The muscular and acticular factor in movement restriction // Manual Med. - Vol. 2. - P. 101-104.

32. Porterfield, JA The sacroiliac joint, Chapter 23 // Orthopedic and Sport Physical Therapy, edited by JA Could and GJ Davies. — Mosby, St. Louis, 1985. — P. 550-580.

Physical therapy

The goal of the first stage of treatment is to reduce inflammation with ice packs and anti-inflammatory medications.

The second goal is to improve mobility through mobilizations, manipulations, or exercise therapy.

If there are complaints of instability, it may be helpful to use a sacroiliac belt for temporary pelvic support, as well as progressive stabilization training to improve motor control and stability.

If the SIJ is severely inflamed, a sacroiliac belt can also be used.

Postural and ergonomic recommendations will help the patient reduce the risk of re-injury.

Core stability

Exercise is a core component of a SIJ pain management program. Exercises that focus on improving core stability have been shown to be effective in this case.

Stabilization exercises

• In order to concentrate on contracting the local muscles of the lower back (without involving the global muscles), it is necessary to improve proprioception and motor control. It is also necessary to work in an isometric mode with two main stabilizers - the transverse abdominis and multifidus lumbar muscles. These muscles need to be trained at low levels of maximal voluntary isometric contraction. It is important to maintain controlled breathing and neutral lordosis during resistance exercise. The following principles must be followed: inhale and exhale, pull the lower abdomen below the navel carefully and slowly, without moving the upper abdomen, back or pelvis. In addition, the physical therapist may palpate the multifidus muscles. This is necessary to ensure effective muscle activation.

The ilium hurts on the right or left side

The ilium hurts on the right or left - this does not matter for making a diagnosis in principle. The topography of pain can only indicate the location of the focus of pathological changes.

For example, if the right ilium hurts due to damage to the radicular nerve against the background of degenerative dystrophic destruction of the intervertebral disc and a decrease in its height. In this case, the diagnosis will be: lumbosacral osteochondrosis at the protrusion stage. But the fact that the ilium hurts on the right side will mean that the topography of intervertebral disc degeneration is located on this side. Accordingly, when developing a course of manual therapy, the doctor will focus on carefully studying this particular segment.

If the left ilium hurts due to deforming osteoarthritis, then the diagnosis will be made accordingly. The patient’s card will indicate that he has left-sided deforming osteoarthritis of the 1st, 2nd or 3rd degree.

If the left ilium hurts due to damage to the abdominal organs, then the topography of the pathological process is important only in cases where paired organs are affected. These are the ureters, uterine appendages (tubes, ovaries). In case of damage to an area of ​​the large intestine, a diagnosis of inflammation of the common colon, sigmoid, ileum, etc. can be established.

It doesn’t matter whether the ilium hurts on the left side or on the right, making an accurate diagnosis will require detailed diagnosis and exclusion of a number of pathological changes. Therefore, it is important to consult a doctor as soon as possible if symptoms appear at an early stage of the disease. This will allow you to start timely treatment and eliminate the likelihood of complications.

If you experience unpleasant sensations in the pelvic bones, you should contact an orthopedist, neurologist, or vertebrologist. These specialists will be able to understand the potential causes of pain. If necessary, they will prescribe a consultation with an andrologist, gynecologist, gastroenterologist, neurologist and other specialized specialists.