In this video, Dr. Hölper describes in detail the structure and function of the Ilio sacral joint. He also explains the causes, diagnosis and treatment options for pain in the sacroiliac joint.
The symptoms in the area of the sacroiliac joint are often diagnosed very late. Patients typically complain of pain that radiates from one side of the back into the buttocks and from there can often radiate into the femur and lower leg. In contrast to this, there is a differential diagnosis of deep lumbar back pain, which is usually located centrally on both sides. The sacroiliac joint pain is unilaterally localized in the middle. The sacrum is the static base of the entire spine. The entire spine rests on the sacrum, so to speak, and the lateral boundary of the sacrum on which it rests is formed by the iliac pelvic blades, i. e. the pelvis.
The area between the sacrum in the middle and the two lateral sacral blades is called the sacroiliac joint. In adolescent age, the mobility, the rotational mobility in the sacroiliac joint is about 2-3 degrees maximum and in the course of time, up to the age of 60/70 the mobility decreases further and further, so that one can assume that at the higher age of this sacroiliac joint increasingly stiffens. Complaints in the area of the sacroiliac joint are often caused by incorrect loading, reduced mobility or a weakness of the surrounding muscles, i. e. the deep back muscles, abdominal muscles and hip muscles, which is particularly noticeable because the joint itself is only held by ligaments and cannot be stabilized directly by muscles, i. e. if you want to stabilise the sacroiliac joint, you cannot do so by exercising specific muscles in the area, but you have to train the larger muscle groups. If weaknesses occur in this area, in time significant ailments may occur. If there is suspicion of a sacroiliac joint syndrome, this should be further investigated in diagnostic terms.
First of all, the clinical examination is in the foreground. There are some special tests to substantiate the suspicion that pathological changes in the area of the sacroiliac joint and the surrounding structures, i. e. the hip joint and the lumbar spine, can be excluded. The main diagnoses are osteoarthritis of the hip joint, a herniated disc or a narrowing of the spinal canal. In addition, tumorous and inflammatory changes in the sacroiliac joint should be ruled out. Once we have confirmed an Iliosacral Joint Syndrome, there are different treatment options.
We should primarily exploit all conservative, i. e. non-operative procedures. This includes, on the one hand, manual therapy, then, as an important pillar, the muscular structure of the indirectly supporting muscles, i. e. the deep back muscles, the surrounding oblique and straight abdominal muscles and the hip muscles. In case of severe pain, it is also possible to anesthetize the sacroiliac joint syndrome by inserting a needle into the sacroiliac joint and injecting anaesthetic and anti-inflammatory drugs. In most cases, these procedures can be used to achieve a very good and long-term relief of the symptoms. In addition, there is also the possibility of a pelvic compression belt, which the patient should wear for a period of six months, to further alleviate the symptoms.
From this the patients realize that with a sacroiliac joint syndrome do not have to reckon with a lack of pain within days or weeks, but that the treatment of this pain is very protracted. If all non-surgical measures fail, the last step is to offer the patient a surgical treatment of the sacroiliac joint. Surgically, the sacroiliac joint can be widened slightly and fixed in this position. Over a period of several months, the sacroiliac joint heals and in most cases the symptoms gradually decrease. In the area of the first few weeks around the operation, the patient should not fully stress the sacroiliac joint, i. e. he should mobilize himself with crutches, which can then be omitted after 6 weeks and finally it can be assumed that after 3 months a most extensive healing in the sacroiliac joint is achieved.