sacro iliac joints

[yvonne]

Does anyone have any info on stabilising a very lax sacroiliac joint, damaged it during a miss gearing episode whilst cycling. Also means I cant rock climb doesn't seem to be anyone around that deals with the problem. The physio said they cant do much because i have a huge amount of movement in the joint so the muscles are having a problem holding things together.

Any info would be greatly appreciated Kind regards

[injuryupdate]

Very unusual problem. Sacroiliac joints normally have hardly any movement (except during childbirth) so it is super rare for them to be unstable.

More common to have inflammatory disorders give pain in the sacroiliac joint, which you can diagnose with blood tests.

Buttock (and groin) pain are very hard to diagnose, so the diagnosis in this case may be wrong.

I think pelvis stabilising exercises (start with pilates if your gym has a class) are good for SIJ problems. As a second line, cortisone injections often work well in the SIJ, but if you really do have an unstable one, I would think twice about using them.

[yvonne]

Yep it seems to be the case, and yes I was very unstable during pregnancy(walking frame case) Just seem to have really blown any strength in the ligament, guess I'll just have to keep having my leg pulled regularly to even me up, keep strapped and hope somethng turns up before I retire.

Thankyou again
Yvonne

[injuryupdate]

I am not an expert on sacroiliac problems post-partum, so I don't see much SIJ instability. It probably does occur. The world guru on this is Andre Vleeming, here is a link mentioning his work from Bruce Mitchell and Emma Coulson who work in Melbourne:

http://www.ausport.gov.au/fulltext/1998/acsm/smabs172.htm

I would still think of trying a cortisone injection into the SIJ if nothing else had worked. I organised one for my mother once when she had complained of a few years of buttock/SIJ pain and she reckons it fixed her up beautifully and long-term. She would have had the post-partum SIJ problems after three kids, rather than the athletic variety.

Then again I treat things with injections a lot and many core stability experts would shake their heads with disappoval at my tendency to recommend injections.

[hhh]

There are two types of instability that need to be considered. One is gross instability and the other is a functional instability about the neutral zone. Both are different and require different treatment methods. Given the mechanism of injury and the ability to still participate in activites, I would suggest the problem is functional instability. Most pelvic girdle pain situations are due to non-optimal stability of the pelvic girdle joint. Of note, it is only in recent history that movement at the sacroiliac joint has been recognised, and as a result the importance of the movement is often neglected. Interestingly, 20% of pregnant women suffer from pelvic girdle pain at any one stage

The sacroiliac joint's stability is governed by what is termed form closure - its inherent stable arrangement characterized by a coarse cartilage texture, cartilage covered grooves and risges, a wedge shape of the sacrum and a propellar like shape of the joint surfaces. This leads to the highest coefficient of friction of diarthrodial human joints. This friction can alter according to the loading situation and serves to stabilize the pelvic girdle. The other is termed force closure which refers to the ability of the musculo-fascial system to contract to prevent shear forces at the joint. A defiency in form closure will require compensation in force closure.

The other important issue is that it sounds like a chronic pain situation has arisen which alters lumbopelvic stabilization strategies, ie: it reduces the ability of force closure mechanisms even further.

There is insufficent evidence available to present strong recommnedations for or against any perticular treatment modality for pelvic girdle pain. Recommendations for treatment should preferably be based on evidence obtained from systematic reviews or RCT's. However, a few CCT's and RCT's have been conducted. Until more evidence becomes available concerning optimal treatment, the following reccomendations are made based on the theoretical and clinical studies combined with expert knowledge. Communicate the condition in a way that the patient understands and acknowledges their specific problem. The purpose of this information is to reduce fear and to enable patients to become active in their own treatment and rehabilitation. It is essential that the information and treatment are consistent across professions in order to preclude uneccessary anxiety about the condition.

The key component is to compose and start an indiviual training program, emphasizing and starting with activation and control of the local deep lumbar musculature. Gradually include the training of more superficial muscles in dynamic exercises to improve mobility, strength and endurance capacity. Adequate adice is required with respect to patient activities of daily living, including lifting technique, avoiding sudden jolts and jarring, standing one leg etc. A pelvic belt should only be fitted for symptomatic relief and only in short periods. Exercises should be performed daily and 12 weeks is the typical time frame required.

There are many experts in this field, with a significant proportion in Australia and Scandinavia including Vleeming, Britt Stuge (who recently completed an RCT on the conidtion, showing postive long term results from individualised stabilisation programs), Peter O-Sullivan, Barbara Hungerford, Jan Paul van Wingerden, Helen Elden (who completed an RCT showing positive results with accupuncture) etc.

If you would like to learn more (injuryupdate) I have just completed a paper related to the afore-mentioned topic that you may wish to read, review and potentially co-author. If you are interested let me know and I can email you the paper for your consideration

[sydunisportsmed]

In all seriousness hhh (with none of my usual sarcasm) it sounds like you understand this area in a lot more detail than I do. I'm a bit busy with writing up epidemiology and tendon injury papers at the moment.

If you have done a systematic review of the literature, which it sounds as though you may have, send it to one of the journals that is particularly focussed on this sort of stuff (e.g. Scan J Med Sci Sport, or JOSPT). If it is more a personal perspective then I'm sure that Sport Health or Sportslink would publish it without review.

Also, with the names you have mentioned above being a good starting point, please start a few threads on "Core stability specialists in Melbourne...Sydney etc." I've done quite a few threads listing some of the top surgical specialists, but obviously most lumbopelvic problems need conservative and not surgical treatment.

I think that physios don't specialise nearly as much as they should (neither do sports physicians for that matter). Whereas, in the big cities, 80% of orthopaedic surgeons are subspecialised to an extent, probably only 5% of sports physiotherapists are. There are a few specialist physio hand therapists, but core stability/lumbopelvic specialists is an emerging branch that is worth highlighting.

I am following this mentality myself by trying to specialise (in clinical practice) in muscle and tendon injuries, but I suppose I have to keep up with what is going on in the core stability area, as I might have to refer on quite a few of the groin and hamstring tendinopathies that need extra management if my injections, load management and eccentric strengthening hasn't worked.

(injuryupdate writing from the sydneyuni clinic today)

[hhh]

That's OK, Prof. Nicola Mafulli has agreed to review the paper. He said he hadn't had a medline publication for 4 days so was very interested.

In terms of specialisation, I think physios have sports docs covered. Just have a look at "The McKenzie Institute" or "The Chek Institute".

Perhaps that's what you need at this stage of your career? Have you given it any thought?

[injuryupdate]

I agree that sports docs don't specialise nearly enough currently, but I am sure it will happen in the future.

I have visions of specialising in muscle and tendon injuries, which is going against the grain having a specialty based on pathology type rather than region. However, the surgeons tend to pick up the regional referrals and I think tendinopathy and chronic muscle strain problems are a great area to work in because they are currently falling between the cracks.

To be honest, 30% or more of my workload at the moment is Achilles tendinopathy, probably because this is the most common tendinopathy and it is the one area where everyone is running scared of using cortisone.

Jill Cook has managed to specialise in tendinopathy but 80% of her workload is patellar tendinopathy I think. However, vast majority of physios, if they specialise in sports, will treat the whole body, and most often there is very little service differentiation between 4-5 physios working in the same practice.

[yvonne]

Hi no I am not active in sport any more as , as soon as I do anything I get an upslip and rotation. The joint will not stay in place despite strapping and exercise. even if I lift anything I am at risk of my leg/hip literally sliding upwards, the physio doesnt know what to do anymore and wonders how I managed to hold myself together in the firt place LOL.



There are two types of instability that need to be considered. One is gross instability and the other is a functional instability about the neutral zone. Both are different and require different treatment methods. Given the mechanism of injury and the ability to still participate in activites, I would suggest the problem is functional instability. Most pelvic girdle pain situations are due to non-optimal stability of the pelvic girdle joint. Of note, it is only in recent history that movement at the sacroiliac joint has been recognised, and as a result the importance of the movement is often neglected. Interestingly, 20% of pregnant women suffer from pelvic girdle pain at any one stage

The sacroiliac joint's stability is governed by what is termed form closure - its inherent stable arrangement characterized by a coarse cartilage texture, cartilage covered grooves and risges, a wedge shape of the sacrum and a propellar like shape of the joint surfaces. This leads to the highest coefficient of friction of diarthrodial human joints. This friction can alter according to the loading situation and serves to stabilize the pelvic girdle. The other is termed force closure which refers to the ability of the musculo-fascial system to contract to prevent shear forces at the joint. A defiency in form closure will require compensation in force closure.

The other important issue is that it sounds like a chronic pain situation has arisen which alters lumbopelvic stabilization strategies, ie: it reduces the ability of force closure mechanisms even further.

There is insufficent evidence available to present strong recommnedations for or against any perticular treatment modality for pelvic girdle pain. Recommendations for treatment should preferably be based on evidence obtained from systematic reviews or RCT's. However, a few CCT's and RCT's have been conducted. Until more evidence becomes available concerning optimal treatment, the following reccomendations are made based on the theoretical and clinical studies combined with expert knowledge. Communicate the condition in a way that the patient understands and acknowledges their specific problem. The purpose of this information is to reduce fear and to enable patients to become active in their own treatment and rehabilitation. It is essential that the information and treatment are consistent across professions in order to preclude uneccessary anxiety about the condition.

The key component is to compose and start an indiviual training program, emphasizing and starting with activation and control of the local deep lumbar musculature. Gradually include the training of more superficial muscles in dynamic exercises to improve mobility, strength and endurance capacity. Adequate adice is required with respect to patient activities of daily living, including lifting technique, avoiding sudden jolts and jarring, standing one leg etc. A pelvic belt should only be fitted for symptomatic relief and only in short periods. Exercises should be performed daily and 12 weeks is the typical time frame required.

There are many experts in this field, with a significant proportion in Australia and Scandinavia including Vleeming, Britt Stuge (who recently completed an RCT on the conidtion, showing postive long term results from individualised stabilisation programs), Peter O-Sullivan, Barbara Hungerford, Jan Paul van Wingerden, Helen Elden (who completed an RCT showing positive results with accupuncture) etc.

If you would like to learn more (injuryupdate) I have just completed a paper related to the afore-mentioned topic that you may wish to read, review and potentially co-author. If you are interested let me know and I can email you the paper for your consideration

[yvonne]

[Sorry i wanted to say yes please send me the paper, I will try anything. I am missing mount Arapilies and never got to do Mt Buffalo, I am just waiting patiently for answeres.

[rachel]

Can anyone recommend a specialist who I can see in Australia about SIJ instabity. I have had this problem for 4 years now and it is agony!

Alternatively does anyone know contact details for Andre Vleeming?

Thanks

[rachel]

How do I contact these specialists that you talk about?


There are two types of instability that need to be considered. One is gross instability and the other is a functional instability about the neutral zone. Both are different and require different treatment methods. Given the mechanism of injury and the ability to still participate in activites, I would suggest the problem is functional instability. Most pelvic girdle pain situations are due to non-optimal stability of the pelvic girdle joint. Of note, it is only in recent history that movement at the sacroiliac joint has been recognised, and as a result the importance of the movement is often neglected. Interestingly, 20% of pregnant women suffer from pelvic girdle pain at any one stage

The sacroiliac joint's stability is governed by what is termed form closure - its inherent stable arrangement characterized by a coarse cartilage texture, cartilage covered grooves and risges, a wedge shape of the sacrum and a propellar like shape of the joint surfaces. This leads to the highest coefficient of friction of diarthrodial human joints. This friction can alter according to the loading situation and serves to stabilize the pelvic girdle. The other is termed force closure which refers to the ability of the musculo-fascial system to contract to prevent shear forces at the joint. A defiency in form closure will require compensation in force closure.

The other important issue is that it sounds like a chronic pain situation has arisen which alters lumbopelvic stabilization strategies, ie: it reduces the ability of force closure mechanisms even further.

There is insufficent evidence available to present strong recommnedations for or against any perticular treatment modality for pelvic girdle pain. Recommendations for treatment should preferably be based on evidence obtained from systematic reviews or RCT's. However, a few CCT's and RCT's have been conducted. Until more evidence becomes available concerning optimal treatment, the following reccomendations are made based on the theoretical and clinical studies combined with expert knowledge. Communicate the condition in a way that the patient understands and acknowledges their specific problem. The purpose of this information is to reduce fear and to enable patients to become active in their own treatment and rehabilitation. It is essential that the information and treatment are consistent across professions in order to preclude uneccessary anxiety about the condition.

The key component is to compose and start an indiviual training program, emphasizing and starting with activation and control of the local deep lumbar musculature. Gradually include the training of more superficial muscles in dynamic exercises to improve mobility, strength and endurance capacity. Adequate adice is required with respect to patient activities of daily living, including lifting technique, avoiding sudden jolts and jarring, standing one leg etc. A pelvic belt should only be fitted for symptomatic relief and only in short periods. Exercises should be performed daily and 12 weeks is the typical time frame required.

There are many experts in this field, with a significant proportion in Australia and Scandinavia including Vleeming, Britt Stuge (who recently completed an RCT on the conidtion, showing postive long term results from individualised stabilisation programs), Peter O-Sullivan, Barbara Hungerford, Jan Paul van Wingerden, Helen Elden (who completed an RCT showing positive results with accupuncture) etc.

If you would like to learn more (injuryupdate) I have just completed a paper related to the afore-mentioned topic that you may wish to read, review and potentially co-author. If you are interested let me know and I can email you the paper for your consideration

[hhh]

where are you located

[injuryupdate]

If you are located in Holland then Vleeming is your man.

The other question is what treatment you want to have. Big difference between:
(1) Physio treatment of SIJ - emphasing strengthening etc.
(2) Medical treatment of SIJ - guided cortisone injections and heavy anti-inflammatory drugs

Sometimes you need a combination of (1) and (2).

[Una]

I had SI/lower back trouble for two years. I know its already been stated but core stablility exercises played a huge part in my recovery. As long as i do those exercises i'm okay now. My problem however was probably slightly different, I was initially diagnosed with a sprain to the IlioLumbar ligament which complicated itself via atrophy and and compensation so basically my lumbar area used to spasm to compensate for the lack of stability on the right side. Also underlying problems like tight hamstrings / weak can add to the strain on the joint and lower back. Also, the hard ground playing football used to aggrevate it so i had to change my boots and get orthotic insoles.

However, I do think a lot has to be said for the core strengthening as a key part of treatment and future prevention. As was mentioned in the previous post there are several treatment courses. I was given anti-inflam drugs when it was bad (and because my Anatomy Lecturer/Sports Med doctor liked the idea. Personally,even as a medical student I run away from taking injections or drugs unless really needed but they do work for some people) but i never found them to resolve the issue because i'd just reinjure it when i started back playing. The physio treatment however did, in conjunction with the orthotics.

[injuryupdate]

With SIJ problems it is worth having blood tests at some stage for ESR, CRP and possibly a few other inflammatory markers. If these are all low, treat more as a stability problem with core strengthening. If they are high or borderline high, then anti-inflammatory treatment is more justified.

[Unregistered]

I have tried everything including; physio, osteo, chrio, cortisone, prolotherapy, drugs so was looking into surgery or de nervation in Australia - do you know of anyone?


If you are located in Holland then Vleeming is your man.

The other question is what treatment you want to have. Big difference between:
(1) Physio treatment of SIJ - emphasing strengthening etc.
(2) Medical treatment of SIJ - guided cortisone injections and heavy anti-inflammatory drugs

Sometimes you need a combination of (1) and (2).

[Unregistered]

Am currently located in Australia.


where are you located

[Unregistered]

I have had blood tests which came up clear, it is definately an unstable SIJ. I have done core stability for four years and still to no avail!!


With SIJ problems it is worth having blood tests at some stage for ESR, CRP and possibly a few other inflammatory markers. If these are all low, treat more as a stability problem with core strengthening. If they are high or borderline high, then anti-inflammatory treatment is more justified.

[Unregistered]

Could I have a copy of your paper and also, could you tell me who the specialists are in Australia as I would really like to see someone.

Thanks for your help.


There are two types of instability that need to be considered. One is gross instability and the other is a functional instability about the neutral zone. Both are different and require different treatment methods. Given the mechanism of injury and the ability to still participate in activites, I would suggest the problem is functional instability. Most pelvic girdle pain situations are due to non-optimal stability of the pelvic girdle joint. Of note, it is only in recent history that movement at the sacroiliac joint has been recognised, and as a result the importance of the movement is often neglected. Interestingly, 20% of pregnant women suffer from pelvic girdle pain at any one stage

The sacroiliac joint's stability is governed by what is termed form closure - its inherent stable arrangement characterized by a coarse cartilage texture, cartilage covered grooves and risges, a wedge shape of the sacrum and a propellar like shape of the joint surfaces. This leads to the highest coefficient of friction of diarthrodial human joints. This friction can alter according to the loading situation and serves to stabilize the pelvic girdle. The other is termed force closure which refers to the ability of the musculo-fascial system to contract to prevent shear forces at the joint. A defiency in form closure will require compensation in force closure.

The other important issue is that it sounds like a chronic pain situation has arisen which alters lumbopelvic stabilization strategies, ie: it reduces the ability of force closure mechanisms even further.

There is insufficent evidence available to present strong recommnedations for or against any perticular treatment modality for pelvic girdle pain. Recommendations for treatment should preferably be based on evidence obtained from systematic reviews or RCT's. However, a few CCT's and RCT's have been conducted. Until more evidence becomes available concerning optimal treatment, the following reccomendations are made based on the theoretical and clinical studies combined with expert knowledge. Communicate the condition in a way that the patient understands and acknowledges their specific problem. The purpose of this information is to reduce fear and to enable patients to become active in their own treatment and rehabilitation. It is essential that the information and treatment are consistent across professions in order to preclude uneccessary anxiety about the condition.

The key component is to compose and start an indiviual training program, emphasizing and starting with activation and control of the local deep lumbar musculature. Gradually include the training of more superficial muscles in dynamic exercises to improve mobility, strength and endurance capacity. Adequate adice is required with respect to patient activities of daily living, including lifting technique, avoiding sudden jolts and jarring, standing one leg etc. A pelvic belt should only be fitted for symptomatic relief and only in short periods. Exercises should be performed daily and 12 weeks is the typical time frame required.

There are many experts in this field, with a significant proportion in Australia and Scandinavia including Vleeming, Britt Stuge (who recently completed an RCT on the conidtion, showing postive long term results from individualised stabilisation programs), Peter O-Sullivan, Barbara Hungerford, Jan Paul van Wingerden, Helen Elden (who completed an RCT showing positive results with accupuncture) etc.

If you would like to learn more (injuryupdate) I have just completed a paper related to the afore-mentioned topic that you may wish to read, review and potentially co-author. If you are interested let me know and I can email you the paper for your consideration

[Unregistered]

well i am curretnly off work for damaging my sij... the physio has given me a list of "forced closure" exercises, and a belt that women wear after child birth that hold the unstable joints together until ligaments and muscles take over. other than that taking it easy and the use of crutches has helped dramatically



Mandy

[Unregistered]

Does anyone know of any sacral iliac joint specialists in Melbourne or Sydney?

[Unregistered]

i saw a physio named Leeroy in St Leonards. He does a lot of work on the pelvis. Really helped me out! had my problem for 9 months and saw most of the "specialists" in sydney including sports doc's etc, but none of them helped till him.

[jal]

I injured my back 4 weks ago, probably lifting something but I didn't experience sudden pain, it kind of krept up on me over 24 hours untill it was excruciatingly painful for a wek or more. Now I can go about things normally but I still have the nagging constant ache in the lower right side of the spine and in the hip and groin area, with the odd breathtaking sharp pain. I went to the Dr. today to ask if it took so long for these things to heal and what he thought it was. Sacroilliac joint inflamation was the answer and heat and ibruprophen 400 3x a day to be taken for 3 weeks. I have just read that Ice not heat should be used for inflamation and am unsure what to do. I am 55 and very active even after bilateral hip replacements 2 years ago, and want to do the right thing for this problem, can you help.

[expatient]

Very unusual problem. Sacroiliac joints normally have hardly any movement (except during childbirth) so it is super rare for them to be unstable.
Wrong. That is very common disorder!


More common to have inflammatory disorders give pain in the sacroiliac joint, which you can diagnose with blood tests.
They get inflammated because of joint subluxation and ligament damage.


Buttock (and groin) pain are very hard to diagnose, so the diagnosis in this case may be wrong.
Usually all the other diagnoses are wrong. SIJ disorder is most common cause of back problems.

[Danny]

A message from Jan-Paul re SIJ treatment

Dear sirs,
by accident I came to a page on your discussion forum about SI joint problems.
The name of Andry Vleeming is mentionned as well as mine. We work in a rehab clinic and could help people with SI problems (also in Australia) because of our contacts there.

People can check our website www.spineandjoint.nl of send me an email:
wingerden@spineandjoint.nl

with kind regards,

Jan-Paul van Wingerden

[expatient]

A message from Jan-Paul re SIJ treatment

Dear sirs,
by accident I came to a page on your discussion forum about SI joint problems.
The name of Andry Vleeming is mentionned as well as mine. We work in a rehab clinic and could help people with SI problems (also in Australia) because of our contacts there.

People can check our website www.spineandjoint.nl of send me an email:
wingerden@spineandjoint.nl

with kind regards,

Jan-Paul van Wingerden
Andry Vleeming does not understand SIJ problems. He tells manipulation and mobilisation is not the answer. So how is he going to treat it? With pills?

[Ginger]

Yvonne
As a practicing musculoskeletal physiotherapist it is often my pleasure to treat those with apparent SIJ area pain , over a career of 22 years in the same field , I have seen many hundreds of those who , like you ,have had a diagnosis of SIJ related dysfunction and/or pain. In that time I have not come across a single example of so called SIJ instability. I have certainly had occasion to treat those who felt pain to this area, just never one who had , without trauma, somehow either dislocated or suffered any other instability of this very strong pair of pelvic joints.
Instead , what I see regularly are those, whose sacral pain is in fact referred from further up the spine, a very common condition , sometimes referred to as somatic referred pain. This is common, not related to sij instability and easiliy eliminated by appropriate mobilisation treatments to the upper lumbar spinal facet joints. The effect of these treatments is immedate and , provided there are no unusual conditions affecting the biomechanics of the lumbar spine , lasting.
Interpretations of your SIJ being unstable are misleading at best, downright foolish ( as well as risible ) at worst, particularly when the "treatment", as you have described it, is clearly not working for you.
May I suggest you make a departure from those who seem to have perpetuated the myth of instability and seek guidance from a physiotherapist who is confident using his/her hands , with particular emphasis on mobilisation techniques of the spine.
Cheers

[green36green]

Can anyone please recommend spinal surgeons/back specialists with experience in cortisone injections to the SIJ in Sydney. Trying to find a specialist with specific knowledge in SI problems and how best to relieve pain. Core strengthening and physio not really helping.
Also anyone have views of using a chiropractor for this type of injury. I also have a dislocated coccyx. MAny thanks.

[unicorn_1]

Hi
I have had pain in my groin,buttocks for the past 2 yrs.Went to every doc in town n vry1 told me that its an adductor muscle problem,even got a corticosone injection.Nothing worked.Finally a doc told me that its an iliolumbar sprain.He told me that the muscles on my left side are very weak.He gave me some back exercises to do along with massage everyday.Though im better but its been 2 months now n i still feel the "sharp pain" wen i jog(which led to the injury in frst place).Plz tell me if som1 has faced this problem b4 n if id ever b able to run again.FYI my mri reports(back+lower abdomen) were clean!!!!!!!

[Yvskie]

i saw a physio named Leeroy in St Leonards. He does a lot of work on the pelvis. Really helped me out! had my problem for 9 months and saw most of the "specialists" in sydney including sports doc's etc, but none of them helped till him.

What is the name of the practice where this physio Leeroy works? Thanks

[chanel05]

Does anyone know who can help me? I suffer from a severe twisted pelvis. When It is twisted I can hardly walk. It is agony.My chiropractor puts it back and then I am instantly better. But, It doesn't hold. I have to have treatment 3 times a week. I have had 14 prolotherapy injections into the SIJ. I have had CT scans, MRIs, x-rays, etc. and all they show is scoliosis (which I am told is causes from the twist in my pelvis). I have had physiotherapy for years, chiropractic treatment and it is getting worse. I am living on pain killers. I can't find anyone who can help. I can't even go for a short walk because my pelvis will twist. I have tried a back brace. To make matters worse, I then broke my pelvis. I have suffered with this for 13 years.The doctors suggest fusing the joint. Is there anyone in Perth, W.A. who can help? Is there anyone in the world who can help? If I have to, I will travel anywhere to be fixed.

[Cristella]

I have had problems with both SIJ's for 5 years now. It feels and sounds like they click and crunch, and produce sharp stabbing pains. This makes it difficult to walk and sit. In the begging it would happen every odd day, now it is chronic pain, every day for most of the day.

This happened after a personal trainer overstretched me during some floor exercises. At first the only relief (and suspected cure) came from corticosteroid injections. About 4 months after the injections, all the pain would come back, to the point where it was hard to walk. Over the years I have had fortnightly physiotherapy sessions, weekly Pilates sessions, as well as 7 corticosteroid injections with probably a lot more to come and tried many NSAIDs. The past 2 years my coccyx has also needed injected to be injected. I also get clicking in my spine, all of this the result of my SIJ dysfunction getting so out of hand it's messed up so many other areas of my body.

I have a wonderful sports medicine doctor in Canberra, so feel free to private message me for his details. He ordered me a bone scan and blood tests. The bone scan revealed reuptake into my sacroiliac joints and ankles, and I tested positive for the HLA B27 gene. I was then diagnosed with seronegative spondyloarthropathy. Basically this is a genetic auto-immune arthritis which tends to start in the SIJ area and then progress into other areas, such as the spine, ankles etc. From there on I was referred to a rheumatologist who basically just prescribed a few new NSAIDS which all failed so then put me onto DMARDs which also has failed.

My physiotherapist tells me a lot of areas in my SIJ/Coccyx are just not moving properly, not moving enough, moving too much, each area does it own little thing. My rheumatologist treats this as purely an immune related disorder (sacroiliitis & seronegative spondyloarthropathy), while my sports medicine and physio threat this as a combined mechanical/immune related problem. The truth is it is both, and I hope once the mechanical part is sorted one day, the immune related problem will clear itself up.

After doing my own research, I am next going to try prolotherapy and hopefully try some of the new biological medicines for this arthritis (if I can even qualify for this medicine). Sacroilliac pain is one of the worst things I believe, so it's good there's people on here who are sharing their experiances and treatment options. Hopefully we can all sort out these annoying SIJs one day!

[leehanna]

I sympathize with you when you have a SI Joint Pain. It is so terrible. My mother has the same problem as you.
Hope my article will supply you with good information :)
http://sijointpain.org/si-joint-treatment/sacroilic-joint-treatment