SI Dysfunction FAQs

• You must first get the SI joint in alignment and do self corrections 3 to 4 times per day to keep it in alignment. So the ligaments will heal.
• You must use some external bracing such as a SI belt or postural taping to help hold the joint in alignment as it heals.
• You must avoid activities that frequently malalign the joint for 6 weeks such as: prolonged walking, stair and hill climbing, twisting and bending activities.

• Sacroiliac Joint Dysfunction can occue as an isolated condition, or associated with other spinal disorders.
• Torsion injuries can cause damage to the disc annulus, facet joints, lamina, pedicle and ligaments, as well as to the sacroiliac joint.
• Facet Joint: Torsion or axial rotation causes the facets to flex and laterally bend towards the side of the rotation crushing the facet articular surfaces on the rotation side and distracting the capsile with tearing or avulsion on the side opposite the rotation.
• Nerve Root: The lateral portion of the facet joint is long and slender, making it easily deformed. Torsion causes facet impingement on the torsion side. Distraction on the opposite side can stretch the nerve root. Therefore, neural arch deformation can cause bilateral nerve root entrapment.
• Disc: Torsion causes annular tears which can weaken the annulus leading to an annular bulge, or herniation, of the nucleolus pulposis. The iliolumbar ligament can become taut due to sub-luxation of the sacroiliac joint. Its fibers are attached to the transverse rocess of L4, and chronic tension can lead to bulging of the disc. It is not uncommon to see an L4 annular bulge on the MRI of a patient who has chronic sacroiliac joint instability.
• Effect on Muscle: Janda, an expert on muscle imbalance, has pointed out that postural muscles become inhibited and weaker as the result of articular dysfunction. With long-standing dysfunction, anatomic changes in the muscle bundles can take place that are irreversible. The piriformis is one of the most adversely affected muscle in chronic sacroilic instability (piriformis syndrome). Pelvic wall muscle spasm, or contracture, may lead to pelvic floor dysfunction. Other muscles affected include the iliopsoas, hamstrings, adductors, gluteus, quadrates lumborum, and the tensor fascia lata.
• Effect on Nerves: Due to long-standing spasm, or secondary fibrosis, the chronically shortened piriformis can entrap neurovascular structures that accompany it through the greater sciatic foramen (superior and inferior gluteal nerves, the sciatic nerve and the pudendal nerve.) The lateral femoral cutaneous nerve passes just medial to the anterior superior iliac spine. It can be injured as it passes form the pelvis to the thigh by changes in anatomic positioning associated with sacroiliac joint subluxation (meralgia paresthetica).
• Pubic Symphysis Instability: With chronic sacroiliac joint instability the cotralateral sacroiliac joint and the pubic symphysis may destablize.

Reports of not being able to maintain any static position such as prolonged sitting, standing, lying or walking. People report they must change positions often.

Distortion of the pelvic ring with associated changes in alignment of the skeleton, so that there appears to be a reorientation from head to toe. This reorientation causes compensatory changes in the soft tissue structures. The malalignment may cause pain in places other than the pelvis such as mid back and/or neck and shoulder pain. Pain may migrate south into the hips or knees.

SI dysfunction is a biomechanical problem and must be corrected by a maneuver that will align the SI joint. This is the basis for healing.

• Pregnancy causing laxity of ligaments – due to hormonal changes,
• Muscle imbalances may cause dysfunction
  • Muscle spasm and an inhibition due to disc derangement
  • Muscle tightness and/or weakness due to other injury or disease
• Dysfunction in the kinetic chain
  • Leg length discrepancy
  • Abnormal gait due to lower limb injury
  • Vertebrae movement dysfunction
  • Restrictions in hip motion
  • Abnormal foot biomechanics

• Stabilize the SI joint dysfunction as the piriformis is a stabilizer of the joint and it will tighten to try to stabilize the joint as long as it is out of alignment.
• Gently stretch the piriformis while the joint is in alignment.
• If the piriformis syndrome persists for 1 month after the SI dysfunction has been stabilized you may need to consider getting a steroid injection in the tendon of the muscle where it connects to the hip. We have found sometimes 3 injections are required to completely resolve the problem.