Therapy
The therapy of ISG-arthrosis is limited. The damage to the joint caused by the previous course of the disease and especially the worn joint cartilage are not reversible. Initially, the focus is on effective relief of the existing symptoms and, above all, the persistent pain.
To relieve the pain, the application of heat is very useful. Heat can be applied in the form of radiation, plasters, fango packs or even pillows. Massages can help to loosen the surrounding tissue and muscle areas and thus relieve possible tension.
Special physiotherapy can improve the mobility in the ISG and can compensate for possible strain errors and blockages. It is also useful to reduce weight in severely overweight patients. Due to the overweight an increased pressure is exerted, which leads to a strong strain on the ISG and can accelerate the course.
To relieve the pain, so-called non-steroidal anti-inflammatory drugs such as ibuprofen or diclofenac can be used. Another possible therapy option is infiltration, i.e. the injection of locally effective anesthetics. The anesthetics are either injected directly into the joint space of the ISG or into the ligaments surrounding the joint to eliminate the pain receptors located there.
In order to alleviate the painful course of ISG arthrosis, the care of a physiotherapist is particularly useful. Physical activity improves mobility within the ISG and can counteract tension and possible blockages. Through certain physiotherapeutic exercises the joint can be relieved and, above all, a possible malposition can be compensated.
A possible exercise to loosen and stretch the ISG is carried out as follows: The patient stands with one leg on a stool. The hand on the side of the leg that is standing on the stool is placed on the pelvic scoop. With the free hand one should secure oneself to a chair back or even a table.
Then the free leg is swung slightly and loosely. After a few repetitions the side is changed. Another exercise is done in the supine position.
Here the legs are lifted and angled so that the lower and upper thighs are at 90 ° to each other. Then the patient performs a movement similar to riding a bicycle. In order to mobilize and loosen the lower back and especially the ISG, the legs can also be set up and slightly bent in the supine position and the hands placed under the sacrum.
Then you move the pelvis slightly back and forth and go into the lateral movement. There are other simple exercises, but these should be guided by a trained physiotherapist to ensure that they are performed safely and correctly. Surgical treatment of ISG osteoarthritis should always be considered the last choice if conservative measures do not provide sufficient relief of symptoms or if there is instability in the joint.
A stiffening, a so-called arthrodesis, can be carried out in one operation. This is a permanent immobilization of the sacroiliac joint. The surgeon obtains suitable access to the ISG through the skin and muscle layers.
Once the joint capsule has been opened, the damaged joint cartilage is completely removed. In order to connect the bony structures that make up the ISG, screws or pieces of the patient’s own bones that have previously been removed from the patient’s iliac crest are inserted. An operation on this scale involves some complications.
In addition to bleeding, injuries to nerves and muscles, chronic pain can also occur and infections can be triggered.Since a few years there is a new method, which is preferably used to stiffen the ISG (Diana method). With the help of a small skin incision of a few centimeters, three titanium rods are inserted into the joint via a guide wire. These rods provide sufficient stability and grow into the existing bone.
This method is less risky, has a shorter operation duration and good chances of success. After a stiffening of the ISG, one should take it easy for the time being and only partially load the joint until the damaged joint is stable and the inserted nails or titanium rods are firmly anchored. Only when conservative therapy is unsuccessful and the arthrosis continues to progress painfully should surgical stiffening of the joint be considered.
Nowadays, the procedure can be performed in a minimally invasive manner. The sacrum and ilium are screwed together with long screws. The movement of the joint is thereby suspended, which has little effect on the ISG joint.
However, the pain is treated in a long-term and persistent manner. In order to prevent ISG arthrosis, it is advisable to follow a healthy and balanced diet to avoid overweight, which is harmful to the bones and joints. Smoking promotes wear and tear and the breakdown of joint cartilage.
In addition, physical activity and sufficient exercise is good for all joints of the body. Tensions are released and the mobilization and blood circulation of the joints is promoted. Specific exercises for the sacroiliac joint can improve the tension, pain and malpositions caused by ISG arthrosis.
Other recommended sports are swimming or cycling, as they are especially gentle on the joints. Furthermore, one should pay attention to early symptoms and consult a physician, so that treatment and adjustment of the physical load can take place early on, in order to counteract a severe and extremely painful course of ISG-arthrosis.
