Brief overview
- Causes and risk factors: Incorrect posture and weight-bearing, different leg lengths, injuries and traumas, loose ligamentous apparatus, chronic diseases such as osteoarthritis, inflammatory rheumatic diseases, obesity, genetic factors.
- Symptoms: Pain on one side during movement or stress, which may radiate to the buttocks or legs.
- ISG syndrome in pregnancy: The sacroiliac joint is loosened and unstable due to hormonal changes.
- Course of the disease and prognosis: If left untreated, ISG syndrome often leads to chronic back pain. The earlier therapy begins, the better the chances of recovery.
- Examinations and diagnosis: Manual examinations with provocation test, antecedent test or test for pressure pain, exclusion diagnosis with the aid of magnetic resonance imaging (MRI) or X-ray examinations.
What are the causes of an ISG block?
There are various causes and factors that trigger or promote sacroiliac joint blockage (ISG blockage) or ISG syndrome:
Incorrect stress and overload
Responsible for a blockage in the sacroiliac joint or an ISG syndrome are often strong tensile or compressive stresses on the ligamentous apparatus of the sacroiliac joint (ISG). These are caused by incorrect postures, for example during sports or due to legs of different lengths.
The pain receptors of the sacroiliac joint are particularly active in ISG syndrome. Often, individual nerve cords that exit the spinal canal at the sacrum and travel along the ISG are pinched and transmit pain accordingly.
Diseases
Other diseases, in which an inflammation of the bones in the area of the joint (osteoarthritis) or a curvature of the spine (scoliosis) are present or infections as well as cysts, are also among the triggers of an ISG syndrome.
Other possible causes
Other factors that cause ISG syndrome include a genetic predisposition or previous diseases of the ISG, in which the joint was surgically stiffened, for example.
What are the symptoms of ISG blockage?
ISG syndrome is often accompanied by a blockage of the joint. This causes the joint surfaces to tilt, which initially means a mechanical movement disorder in the hip area. Affected persons are restricted in their movement due to this.
Some patients with ISG blockage report abdominal pain, particularly pain in the lower abdomen and groin area, due to tension in the lumbar-iliac muscle (iliopsoas muscle).
In some women, ISG blockage sometimes affects the functionality of the pelvic floor muscles. It tenses, causing the organs in the pelvis, such as the bladder, to shift. Usually this triggers an increased urge to urinate.
How is ISG syndrome treated?
There are a few treatment options when the sacroiliac joint is blocked and ISG syndrome is present. They depend on the actual causes. Often it is an overload or incorrect load, which can already be counteracted by improved posture and temporary rest. Try to avoid or at least minimize triggering factors.
Exercises
With the following exercises, which can also be performed at home, it is possible to release an ISG blockage and relieve corresponding symptoms:
Repeat each side three times.
Leg/hip splay in lateral position:Lie in lateral position with legs extended. Support yourself with your overhead arm by placing your hand on the mat in front of your torso. The lower arm is bent. Now spread the overhead leg by raising it more than shoulder width. The toes of both feet point toward the side of the abdomen. Repeat this movement up to 30 times.
Repeat the movement about 30 times, and then switch sides.
Repeat the exercise for each leg at least three times.
For all exercises, use a support such as a sleeping mat and a head support such as a small bolster. It is recommended to perform the exercises two to three times a day.
Infiltration therapy
In addition to local anesthetics, anti-inflammatory and analgesic glucocorticoids such as cortisone are used.
Mobilization or manipulation
Specially trained physicians or physiotherapists use manual therapy to release existing joint blockages. There are two different procedures for this:
- Mobilization: Careful stretching improves the mobility of the affected joint.
Medication
Pain-relieving drugs such as ibuprofen or diclofenac belong to the so-called non-steroidal anti-inflammatory drugs (NSAIDs) and are used for acute lower back pain only for a very short time and in low doses. Experts do not recommend long-term use of NSAIDs because of possible severe side effects.
Additional treatment options
Another way to reduce discomfort caused by ISG syndrome is to stabilize the lower back in the hip area with kinesio tapes. They belong to the alternative therapy methods whose medical effectiveness has not been clinically proven. Therefore, discuss with your attending physician whether such tapes are an option for you.
Operation
ISG blockage in pregnancy
It is estimated that almost every second pregnant woman suffers from pregnancy-related pain in the iliac-cruciate joint (sacroiliac joint), in the region between the lower lumbar spine and the sacrum and/or in the area of the pubic symphysis.
The loosened ligaments and the increased load on the pelvis during pregnancy often trigger ISG syndrome. Because the ligamentous apparatus loses stability and the sacroiliac joint is less able to withstand the pressure loads, the bony joint partners drift apart slightly and shift. As a result, the nerves that exit the spinal canal at the sacrum slip into the joint space and become pinched, depending on the movement. This triggers pain.
In most cases, an ISG blockage slowly recedes on its own after birth, as the ligaments tighten again. Regular exercises as part of postpartum recovery measures help to reduce the symptoms of ISG syndrome. However, in about 20 percent of women, symptoms persist over the long term.
What is ISG syndrome?
In the case of an ISG affection, the joint surfaces slip and tilt – an ISG blockage in the lower back or an ISG syndrome occurs, which is characterized by acute pain in the area. Often, incorrect loading of the joint causes ISG syndrome, and it also occurs more frequently during pregnancy and is characterized primarily by pain.
In the event of severe and permanent incorrect loading, ISG syndrome sometimes also leads to inflammation in the sacroiliac joint, which then causes severe pain in the ISG. In the case of an ISG inflammation, physicians speak of sacroiliitis.
Course of the disease and prognosis
Examinations and diagnosis
Anyone who has pain in the sacroiliac joint should see a doctor. Initially, many patients seek treatment from their primary care physician, who usually refers them to an orthopedic surgeon. If you have pain in the sacroiliac joint, your doctor will ask you the following questions, among others, to find out about your medical history (medical history):
- When did the pain first occur?
- Where exactly is the pain?
- Does the pain radiate, for example into the leg?
- What pre-existing conditions do you suffer from?
- Are there any known hereditary diseases in your family?
- Have you had a fall?
- Do you have a fever?
Physical examination
Your doctor will then examine you physically. Among other things, he or she will perform the following examinations:
- Leading phenomenon: You stand with your back to the doctor, who places his thumbs on both sacroiliac joints. Then you bend forward. In the case of ISG irritation, the thumb on the affected side is pulled into flexion earlier.
- Mennell sign: You lie on your stomach and the doctor fixes the sacroiliac joint with one hand. With the other hand, he lifts your leg. If you feel pain in the joint, the Mennell sign is positive and indicates ISG syndrome.
Further diagnostics
Normally, blood tests are not necessary. However, if you have chronic low back pain before the age of 45, your doctor will draw your blood to have it tested in the laboratory for signs of ankylosing spondylitis.
In addition to an X-ray examination, which ideally will show an ISG blockage on the X-ray, a magnetic resonance imaging (MRI) or computed tomography (CT) scan will detect possible vertebral fractures or dislocations at the ISG.
Exclusion of other diseases
- Bone fractures
- Tumors (for example, cancer of the spine)
- Infections
- Nerve damage (for example, in the case of a herniated disc)
- Bechterew’s disease
- Psychologically induced back pain
- Hip diseases (for example hip joint arthrosis)
Prevention
Since ISG blockage or ISG syndrome is mostly due to incorrect posture and excessive strain, it can be prevented primarily by conscious and correct posture.
Little movement and constant, one-sided lying as well as a lot of sitting usually have an unfavorable effect on the ISG. Therefore, make sure you get enough exercise.
In the case of genetic factors or triggering infections, it is usually almost impossible to prevent ISG syndrome.