The right and left sacroiliac joints are located at the base of the spine, between the sacrum and the adjacent right and left hip bones (iliac bones). Two major ligaments hold each sacroiliac joint together:
- The iliolumbar ligament stretches from each iliac crest to its adjacent fourth and fifth lumbar vertebrae, bilaterally.
- The sacroiliac ligament stretches from the sacrum across to its adjacent iliac spinal process, bilaterally.
Causes of Sacroliac Sprain Injury
- Postural wear-and-tear—by far the most common cause—and
- Traumatic injury (e.g. a vehicular accident, a ski fall, a horse riding accident, a parachute landing fall mishap, a yoga training accident).
Sacroiliac joint ligament sprain injuries are usually bilateral, even though the low back pain may be more pronounced on one side than the other.
The low back pain related to sacroiliac joint ligament sprain is commonly accompanied by misalignment of one or more of the following:
- The sacroiliac joints—usually bilateral
- Other pelvic bones and joints—or
- Lumbar vertebrae
Other Physical Findings
- Restricted mobility
- Difficulty sitting or standing for extended periods—or
- Difficulty walking or twisting.
Other physical findings usually associated with sacroiliac joint sprain and misalignmen include:
- A functionally short leg accompanied by a slight limp and leg abduction weakness—and
- Compensatory scoliosis with its usual pain patterns, including shoulder drop; and back, neck, and head strain.
However, if the misalignment repeatedly reoccurs following treatment, then there is undoubtedly a sacroiliac ligament sprain, which is readily treated by Prolotherapy—the definitive treatment for such an injury. Prolotherapy is directed to sacral and iliac ligament attachments—depending on the patient’s history and findings on examination and X-ray.
Platelet-Rich Plasma (PRP) Therapy would be more appropriate if there is significant ligament or tendon tearing.
Wearing a Sacroiliac Belt may be helpful during initial stages of Prolotherapy treatment to stabilize a lax sacroiliac joint and minimize pain. It helps to maintain reduction of the sacroiliac misalignment, keeping the joint in place between treatments. This is useful, especially, when the dysfunctional joint pain is unbearable during course of Prolotherapy.
Occasionally, the presence of a coexistent anatomically (developmentally) shortened leg needs to be determined and treated with appropriate orthotic prosthetic devices.
If there is evidence of a significant neurological component to the sacroiliac joint dysfunction, appropriate neurological tests and consultations may be necessary, as well.
CAUTION: The pain related to sacroiliac sprain injury can mimic that of neuropathic sciatica caused by degenerative disc disease. Therefore, only a through physical examination and radiological interpretation can differentiate between the various musculoskeletal versus neuropathic causes of such pain—regardless of what an MRI imaging study may show. In the event of a “Perfect Storm” when there is a collision of both severe sprain injury and disc compression producing very acute, severe symptoms, definitive neurological testing and surgical consultation may be required.