Lasting Relief from Sacroiliac Joint Pain
Dr. Robert Zapf, M.S., D.C., Chiropractor
former Associate Professor at Palmer College of Chiropractic
Our Practice is located in Fairfax VA
Expertise in Conservative Treatment of Sacroiliac Joint Disorders
Pain Relief, Improved Mobility, and Long-Term Wellness
Gentle and Non-Invasive Therapies for Effective SI Joint Pain Relief
Sacroiliac (SI) joint pain can be debilitating, but relief doesn’t always require surgery or aggressive drug treatments. Gentle, non-invasive therapies such as spinal manipulative therapy, targeted exercise, and specialized physical therapy techniques can effectively reduce pain, improve mobility, and enhance overall joint function. These approaches promote natural healing, restore balance, and strengthen the body, making them safe and effective options for managing SI joint dysfunction.
Spinal Manipulative Therapy
Spinal manipulative therapy, involves controlled manual adjustments to the spine and pelvis to restore proper alignment and reduce SI joint pain. These adjustments can help improve mobility, decrease inflammation, and relieve pressure on surrounding nerves. Regular treatments may enhance overall function and provide lasting pain relief.
Exercise
Targeted exercises strengthen the muscles surrounding the SI joint, improving stability and reducing strain on the joint. Stretching exercises enhance flexibility, while core-strengthening routines help support proper posture and movement. A well-structured exercise program can prevent further injury and promote long-term pain management.
Physical Therapy
Physical therapy modalities such as electrical muscle stimulation (EMS), ultrasound, shortwave diathermy, and traction help reduce SI joint pain and inflammation. EMS can ease muscle tension and improve circulation, while ultrasound therapy promotes deep tissue healing. Shortwave diathermy and traction work to enhance mobility and relieve pressure, supporting overall joint function and recovery.
Causes of SI Joint Pain
Sacroiliac (SI) Joint Dysfunction occurs when the SI joints, which connect the spine to the pelvis, become inflamed or misaligned, leading to pain and mobility issues. Common causes include arthritis, pregnancy, trauma, or prolonged repetitive movements that stress the joint.
Symptoms typically include lower back pain, hip discomfort, stiffness, and pain that radiates down the legs. This condition can make standing, walking, or sitting for extended periods difficult. Proper diagnosis and treatment, including spinal manipulative therapy, physical therapy, and lifestyle modifications, can help manage SI joint pain effectively.
Sacroiliac Joint Pain:
First-Line Treatment of Choice
First-line treatment combining spinal manipulative therapy and physical therapy exercise represents the optimal approach for sacroiliac joint dysfunction due to its proven safety, rapid onset of pain relief, and long-term effectiveness. This conservative approach successfully treats over 75% of cases while avoiding the risks and limited effectiveness associated with pharmacological interventions⁵.
First-Line (Noninvasive) Treatment for Sacroiliac Pain
1 / Spinal Manipulative Therapy
Spinal manipulative therapy represents the most effective first-line treatment for sacroiliac joint dysfunction. Research demonstrates that manipulation provides the fastest pain relief among all conservative therapies, with significant improvements observed immediately after treatment and sustained benefits at 30 days¹. Studies show manipulation therapy yields superior results at 6 weeks compared to exercise therapy alone, with notable improvements in both pain and functional movement².
The therapeutic mechanism involves realigning joint mechanics, reducing muscle spasm, and providing immediate analgesic effects through both structural and neurological processes³. High-velocity, low-amplitude manipulation techniques specifically targeting both the sacroiliac joint and lumbar spine produce optimal outcomes for both short-term and long-term pain relief¹.
2 / Physical Therapy and Exercise
Targeted exercise therapy provides complementary benefits with slower onset but longer-lasting pain relief. While manipulation shows superior results at 6 weeks, exercise therapy demonstrates peak effectiveness at 12 weeks with sustained improvements extending to 24 weeks³. Effective exercise programs focus on strengthening the gluteus maximus, deep abdominal muscles, lumbar multifidus, and pelvic stabilizers⁴.
Systematic reviews confirm that physiotherapy interventions, particularly manipulation and exercise, are effective in reducing pain, disability, and pelvic asymmetry associated with sacroiliac joint dysfunction⁴. The combination of stabilization training can produce a 50% reduction in long-term disability⁵.
3 / Limitations of Pharmacological Interventions
NSAIDs and other medications show minimal effectiveness and significant risks. Chronic NSAID use can result in gastroduodenal ulcers, cardiovascular complications, and may actually prolong recovery by masking symptoms rather than addressing underlying dysfunction⁶. Opioids provide only short-term benefit with substantial risk of dependence and are strongly discouraged⁶. Research indicates that over 75% of sacroiliac joint dysfunction cases respond effectively to conservative management without pharmacological intervention⁵.
Second-Line (Minimally Invasive) Treatments for Sacroiliac Pain
Recent research indicates that minimally invasive procedures should be considered only after adequate trials of conservative, first line therapy.
Invasive therapies are not offered at our office. They are presented here as a comparison to non-invasive, conservative therapy.
1 / Steroid Injections
Corticosteroids injected directly into the sacroiliac joint reduce inflammation and provide temporary pain relief. Side effects include immune suppression, fluid retention, and mood changes, with effectiveness typically limited to short-term relief⁷.
2 /Radiofrequency Ablation
This procedure uses high-frequency electrical currents to create controlled lesions in pain-transmitting nerves. Variations include pulsed, thermal, and cooled radiofrequency techniques. Adverse effects are generally mild, including temporary soreness and rarely, transient leg pain⁷.
3 / Platelet-Rich Plasma (PRP) Therapy
Patient-derived platelet-rich plasma is injected to stimulate healing through growth factors. Side effects are minimal, typically limited to mild post-injection pain and stiffness⁷.
4 / Minimally Invasive Fusion
Small titanium implants are inserted through a minimal incision to stabilize the joint. Complications include nerve root impingement (most common), infections, and deep wound issues, with an overall complication rate of approximately 11% and revision rate of 2.56%⁸.
Bibliography
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Kamali F, Shokri E. The effect of two manipulative therapy techniques and their outcome in patients with sacroiliac joint syndrome. Journal of Bodywork and Movement Therapies. 2012;16(1):29-35.
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Akinbo SRA, et al. The effectiveness of physiotherapy interventions for sacroiliac joint dysfunction: A systematic review. Journal of Physical Therapy Science. 2017;29(9):1689-1694.
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Nejati P, et al. Effectiveness of Exercise Therapy and Manipulation on Sacroiliac Joint Dysfunction: A Randomized Controlled Trial. Pain Physician. 2019;22:53-61.
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Akinbo SRA, et al. The effectiveness of physiotherapy interventions for sacroiliac joint dysfunction: A systematic review. PMC. 2017. PMC5599847.
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Sacroiliac Joint Injury. StatPearls. NCBI Bookshelf. Updated July 4, 2023.
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Aranke M, et al. Minimally Invasive and Conservative Interventions for the Treatment of Sacroiliac Joint Pain: A Review of Recent Literature. Orthopedic Reviews. 2022;14(3):34098.
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Aranke M, McCrudy G, Rooney K, et al. Minimally Invasive and Conservative Interventions for the Treatment of Sacroiliac Joint Pain: A Review of Recent Literature. Orthopedic Reviews. 2022 May 31;14(3):34098. doi: 10.52965/001c.34098.
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Aranke M, et al. Minimally Invasive and Conservative Interventions for the Treatment of Sacroiliac Joint Pain: A Review of Recent Literature. PMC. 2022. PMC9235436.