yogabook / pathologie / SI joint blockage

SI joint blockage / SI-syndrome, SI joint pain syndrome)

Definition of

Restricted or impaired function of the SI joint

Cause

1. traumatic (e.g. fall on the buttocks)
2. Poor posture, e.g. habitual or due to leg length discrepancy, relieving posture
3. Muscular imbalances in the rectus femoris, hamstrings, gluteus, subordinate latissimus dorsi and erector spinae muscles
4. the kick into the void during sport
5. Pregnancy (loosening of the ligamentous apparatus, especially in the last trimester due to the hormone relaxin)
6. Inflammatory diseases with sacroileitis, e.g. Bechterew’s disease, Reiter’s disease, psoriatic arthritis
7. Osteoarthritis

Predisposing

1. heavy lifting, overweight, spinal arthrodesis (spondylodesis), changes and operations on the distal musculoskeletal system,
2. Muscular weaknesses in the musculoskeletal system, especially glutes and calves, muscular imbalances

Diagnosis

1. MRI does NOT show the blockage.
2. Tests and signs: Standing Bent Over Test, Spine Test, Mennell, Laslett Cluster, Maigne van der Wurff Cluster, Gänslen Sign, Shimpi Prone SI-Joint Test

Symptoms

1. Usually strictly unilateral, rather dull, profound, mild to moderate, often radiating, pulling pain at the level of the SIPS and lower, often occurs during forward bending or rotational movements, with stronger hip extension and hip flexion
2. Possibly pseudoradicular ischialgiform pain
3. possibly with severe joint dysfunction pain radiating into the groin (presumably excessive traction of the iliopsoas)
4. Possible pain at rest, lumbar back pain and feeling of stiffness, especially after prolonged sitting or walking
5. Exercise, e.g. going for a walk, improves

Therapy

1. Exercise, including walking, warmth
2. PT (mobilization, manipulation),
3. Analgesics, analgesics if necessary, and corticosteroid infiltration therapy for inflammatory processes
4. Unblocking exercise in supine position
5. If a blockage is present: only run while avoiding pain, avoid ascents and descents; resume training slowly
6. Identifying and correcting any muscular imbalances

DD

1. Vertebral/sacral fracture(then spinous process with knocking pain)
2. Disorders of the lumbar spine or hip joint

Asana practice and movement therapy

If there is no more serious underlying disease affecting the sacroiliac joint, the main causes of an SIJ blockage must be sought in the muscles that directly cover the sacroiliac joint and the muscles that exert force on the sacroiliac joint. On the one hand, the gluteus maximus plays a role as the muscle that directly covers the sacroiliac joint, and on the other hand the iliopsoas, as it is a very powerful muscle that also covers the hip joint in addition to the sacroiliac joint. Excessive tension and, above all, side discrepancies must be investigated here. If side discrepancies are found in the two muscles mentioned, the pelvis will tend to twist and the function of the sacroiliac joint will be impaired. Secondarily, pelvic obliquities can also have a detrimental effect on the sacroiliac joint; they create a laterally different load in the joint surfaces of the sacroiliac joints and also influence the above-mentioned muscles.

In acute cases, the main aim is to unblock the sacroiliac joint. This is achieved above all by postures and exercises that have an effect equivalent to traction of the joint, such as jathara parivartanasana, in which the upper leg in adduction pulls the hip bone of the upper leg away from the opposite hip bone on the floor via the gluteus maximus and possibly also via the firm-elastic (ligamentous) or hard-elastic (osseous) limit of adduction in the hip joint. The 3rd hip opening works similarly well if the leg ipsilateral to the affected sacroiliac joint is placed at right angles to the front and even more so if a supporter slowly pushes the contralateral hip bone (i.e. of the extended rear leg) towards the floor.