Sacroiliac Joint Pain During Pregnancy And Treatment
During pregnancy, there is no shortage of aches and pains, and sometimes it can be difficult to determine what exactly it is that is hurting you and how to address it. One of the most common pains women experience is sacroiliac (SI) joint pain, but often we may not know that’s what it is, and in turn, could try to do things to remedy the pain that could actually make it worse. Here are some tips to help you identify if you might have SI joint pain, as well as what to focus on (and avoid) to help mitigate it.
What is SI Joint Pain
SI joint pain is felt in the backside of your pelvis (around your buttocks), and a tell tale sign is that it’s often felt on one side only. The pain is typically worsened by weight bearing activity, especially on one leg (like stair climbing, doing the elliptical machine, taking an exercise class, or even long periods walking). The pain can range from chronic and dull to sharp and shooting, sometimes radiating down your leg a bit. If you think you may have SI joint pain, speak with your doctor to get a diagnosis.
What Causes SI Joint Pain
The human body has two SI joints (a left and a right) located in the posterior pelvic region between the sacrum and the ilium bones (hence the name “sacroiliac” joint). The SI joints are tasked with keeping your pelvis in neutral alignment.However, during pregnancy, two factors combine to put increased stress on these joints:
- A hormone called relaxin softens the joints and ligaments that provide stiffness to the pelvis. This allows your body to adapt to your growing baby, and provides more mobility for childbirth, but it has the side effect of decreasing your pelvic stability.
- Compounding this decreased stability, the growing belly tends to tip the pelvis forward, making it more difficult for the SI joint to keep the pelvis in neutral alignment
Often these two factors – the softening effect of relaxin + the forward pull from the belly – cause the SI joint to give, stretch, and possibly become hypermobile. This is when you feel the pain. Since the effects of relaxin remain in the body for several months after birth as well, SI joint pain can also occur in the postpartum period.
Treatment and Managing SI Joint Pain
Of all the treatments options available, exercise is the best option to treat this condition. Many women ask what stretches they can do to manage the pain. If this was muscle pain, there could be stretches that could alleviate it. However, we are talking about pain in a joint that is likely caused by hypermobility in that joint. Therefore, the keys to addressing it are to 1) decrease stress on the joint and 2) strengthen the muscles surrounding the joint to provide greater pelvic stability. You can accomplish this by getting your body into neutral alignment and strengthening your glutes, core canister, and lats. Please consult your Physiotherapist for more information on this.
Physical therapy treatment of sacroiliac joint pain should ideally address the underlying muscle and ligament problems. Treatments with a physical therapist will typically focus on restoring normal pelvis and core muscle stability as these muscles are responsible for what is known as Force Closure of the pelvis, which creates a dynamic active compressive force and stabilization of the SI joints. Physical therapy is a therapeutic option that may provide relief for some women.
This treatment along with exercises to improve general spinal stability, improve body mechanics, correct postural problems, strengthen and/or stretch specific muscles to balance the muscle groups that surround, attach to, and support the SI joints, combined with general physical conditioning are considered “best practice.” There is little formal research to support these recommendations as the treatments are highly individualized to the specific patient making it difficult to draw conclusions across a broad range of patients.
An SI belt, a non-elastic strap placed temporarily around the pelvic joints, has also been found to reduce the sensation of abnormal movement and may aid with symptom reduction. Other non-surgical treatment options include injection of medications (steroids) into the joint to decrease inflammation and pain, and radiofrequency ablation (RFA). RFA is a procedure where heat or cold is used to temporarily deaden the sensory nerves over the SI joints in order to decrease their ability to transmit pain signals coming from the SI joint.
If a patient continues to have disabling SI joint pain after 6 months or more of appropriate non-surgical treatment, then the patient may benefit from an iFuse minimally invasive surgical (MIS) procedure to fuse the SI joint. The iFuse procedure, available since 2009, has been shown to provide improvement in pain, disability and quality of life in many high-quality studies including two randomized controlled trials (RCTs). Patients with SI joint pain that began in the peri-partum period that received the iFuse procedure showed significant long-term reduction in pain and marked improvement in physical function and in quality of life.
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