Synonyms
Hypomobility of the sacroiliac joint Cross-iliac joint blockage, ISG blockage, ISG blockage SIG blockage, SIG blockage, sacroiliac joint blockage, sacroiliac joint blockage, sacroiliac joint blockage
General information
The sacroiliac joint is one of the most therapy-intensive areas of the body affected by pain. 60-80% of the population suffers once in a lifetime from ISG blockage and thus from back pain. A blockage of the ISG can occur at any age and affects men and women equally.
The sacroiliac joint is the point of transition from the uniaxial movement organ of the spine to the biaxial movement organ of the legs. These transition zones are particularly susceptible to functional disorders. Other transition zones where blockages frequently occur are the upper cervical joints, the cervicothoracic transition (transition from the cervical to the thoracic spine) and the thoracolumbar transition (transition from the thoracic to the lumbar spine).
A blockage is a reversible deviation from normal joint function in which joint play (joint-play) is restricted or eliminated within the normal, physiological range of motion of a joint. Causes of a joint blockage are functional or structural changes in the joint surfaces or soft tissue mantle. One or more movement directions of a joint or movement segment can be affected.
A characteristic feature of the blockage is that it always has a free direction of movement. At this point it should be pointed out that only a small selection of therapeutic grips is described here and completeness cannot be guaranteed. Basically one differentiates between mobilization (soft technique) and manipulation (technique with short, fast impulse)
- Mobilization of the sacroiliac joint by the cross handle in prone positionThis technique is well suited for a unilaterally blocked joint (unilateral ISG blockage).
The patient lies on the stomach and the therapist stands on the opposite (untreated) side. The patient’s abdomen should be padded to compensate for the lordosis (normal position of the lumbar spine) of the lumbar spine. During the procedure, one hand of the therapist fixes the lower end of the sacrum, the other hand lies close to the joint and mobilizes the ISG to be treated to the front and side.
- Mobilization of the sacroiliac joint in lateral positionThe goal of this technique is to achieve traction in the ISG.
The patient lies on his side. The therapist tests the joint play by applying pressure to the upper ilium with the forearm. If ISG blockage is diagnosed, the patient can move directly from this position to the treatment.
The pressure on the upper iliac bone causes a gap in the ISG and the blockade is released. If pain occurs during prolonged exercise, this indicates weakness of the ligaments.
- AutomobilizationIn case of an ISG blockade there is also the possibility to remove the malfunction itself. The patient is in a four-footed position on the patient couch.
By lifting and lowering the thigh, which protrudes freely over the edge of the table, the ISG is unblocked.
- Manipulation of the ISG in a cross gripWith this technique the patient lies on his stomach and the therapist stands on the side that cannot be treated. With one hand he fixes the iliac crest to the posterior superior iliac spine and the other hand is on the tip of the sacrum. After a short pre-tension, the therapist gives a short impulse to the front and side.
Before deciding on a technique, it is necessary to examine whether the cause of the discomfort is in the joint or in other areas, e.g. the muscles, as part of a pelvic traction. Infiltrations of the ISG with a local anesthetic in combination with cortisone can also help to improve the symptoms. In order to reduce the pain level, an NSAID such as ibuprofen or Voltaren in combination with a muscle relaxant (e.g. Sirdalud®) should be given for a few days as a supportive measure.
After the treatment, the patient is advised to exercise and to take local warming measures (warm baths, hot water bottles, cherry stone pillows). In general, it should be added that disturbances in the sacroiliac joints are usually secondary. For this reason, causes in the area of the spine and also the hips must be excluded.If the symptoms do not improve after 2-3 treatments, inflammatory, rheumatological and tumor diseases must also be excluded.
As mentioned in the beginning, the ISG has a physiological joint play like any other joint.
This is the sum of the passive movement possibilities a joint can perform and is therefore a basic requirement for normal, healthy joint function. If this joint play is reduced, a blockage exists. In relation to the sacroiliac joint, the cause of a blockage is usually a lifting trauma or, classically, a kick in the nullity, for example when a step is overlooked.
Blocking of the ISG often occurs as an accompanying phenomenon in other orthopedic diseases, such as after hip surgery or in the context of spinal diseases. The sacroiliac joint is anatomically closely connected to the hip. Through this joint, the hip bones are in close functional connection with the spine.
In hip diseases, there is a frequent connection to changes in movement and posture in the pelvis and the occurrence of an ISG blockage. A long existing arthrosis of the hip can be such a disease. Likewise, overstretching of the ligaments of the hip, connective tissue weakness and past pregnancies can damage the pelvis, resulting in an ISG blockage.
Broken bones and other traumatic injuries can also cause joint problems. More rarely, the chronic inflammatory disease ankylosing spondylitis is behind an ISG blockage. Apart from the very stressful birth process, changes in the body can also occur during pregnancy, which promote an ISG blockage.
The hormone relaxin plays a major role in this process. As the name suggests, the hormone is released during pregnancy to relax structures in the female body. These include muscles, fasciae and connective tissue in the female pelvis.
By changing the force and tension ratios, the sacroiliac joint can be put under additional strain, resulting in an ISG blockage. The weight load of the growing child also leads to changes in load on the muscular and bony structures in the abdomen and pelvis, which in turn can cause pain. In the majority of cases, the delivery of a pregnant woman is a heavy strain on the woman’s body.
For the ISG joint, there can be special challenges during and after a natural birth. In natural childbirth, the child is pushed through the small pelvis, which, depending on the woman’s anatomy, places a smaller or larger load on the bones of the pelvis and pelvic floor muscles. The birth therefore also places a heavy strain on the ISG joint.
Hormones from pregnancy also loosen the structures of the pelvis to facilitate the birth process. This is also to the detriment of the spine and can trigger an ISG blockage. In the case of a torn pubic symphysis due to childbirth, ISG blockages can also occur some time after delivery.
This is due to repair efforts of the body and changes in the connective tissue structures. The main symptom of ISG blockage is back pain, which is often described as deep-lumbar and usually occurs on one side. An increase in pain after prolonged sitting and an improvement of the symptoms through movement and heat applications are common.
Pain often radiates to the buttocks, groin and lumbar region. A combination with sensations such as tingling and formication is also observed. Knee pain should also make the doctor think about the differential diagnostic possibility of ISG blockage.
The symptoms of ISG blockade belong to the group of pseudoradicular pain syndromes. In principle, radicular pain syndromes can be distinguished from pseudoradicular pain syndromes. Pseudoradicular pain is pain that is not due to root irritation.
Classically, patients report back pain that radiates into the leg, which can affect the front as well as the back of the leg, but usually ends in the knee area. Often the back of the knee is left out of the pain. Sensitivity disorders in the form of tingling and formication can also occur.Since the spinal nerve is not affected in pseudoradicular pain syndromes, the sensitivity disorders cannot be assigned to any dermatomes (the skin area supplied by a spinal nerve).
Radicular pain, such as that caused by a slipped disc in the lumbar spine, causes irritation of the nerve root. Accordingly, the pain and sensory disturbances radiating into the extremity are dermatome related. The second main symptom of ISG blockage besides back pain is groin pain.
From a functional point of view, the doctor should examine the following body regions when groin pain occurs:
- The ISG
- The hip joint
- The lumbar spine (often the segment L3/4)
- The Thoracolumbar Transition
In the case of a severe blockage in the ISG joint, the symptoms can be transmitted and can be felt in the hip, along the leg and in the foot. Initially, the conduction manifests itself as tingling in the toes, this is also called “ant walking”. This is followed by a sensitive numbness, a pain is rather rare.
Pain in the knee is also typical for an ISG blockage. When these symptoms are transmitted, one speaks of so-called pseudo-radicular pain. The name indicates that the symptoms resemble nerve damage to the spinal cord, but no such damage is present.
The nerve is not affected and therefore the prognosis for a cure is better. When the ISG blockade is removed, the symptoms in the leg and foot should also stop. Here there is a significant difference to herniated discs of the lumbar spine, which express themselves with similar symptoms, but affect the nerve itself and can leave permanent damage.
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