ISG pain can be categorized based on cause and progression into different categories:

1. Mechanical ISG pain:

- Caused by poor posture, overuse, or trauma.

2. Inflammatory ISG pain:

- Due to inflammatory diseases such as ankylosing spondylitis.

3. Acute ISG pain:

- Sudden onset of symptoms after exertion or injury.

4. Chronic ISG pain:

- Long-lasting pain, often due to degenerative changes.

The causes of SI joint pain are varied and can be mechanical, inflammatory, or traumatic:

• Misalignments:
  • Different leg lengths or scoliosis lead to an asymmetrical load on the SI joint.
• Overload:
  • Intensive physical activity, heavy lifting, or prolonged sitting strain the joint.
• Arthrosis:
  • Degenerative changes in the SI joint due to age-related cartilage wear.
• Inflammatory diseases:
  • Diseases like ankylosing spondylitis or rheumatoid arthritis cause inflammation in the joint.
• Pregnancy:
  • Hormonal changes and the loosening of the ligamentous apparatus lead to increased mobility of the SI joint.
• Traumatic injuries:
  • Falls or direct impacts can affect the SI joint.

The symptoms depend on the cause and severity of the complaints:

- Local pain:

- Pain in the lower back, often on one side, which can radiate to the buttocks or thigh.

- Movement restrictions:

- Difficulties in standing up, walking, or bending the back.

- Tenderness:

- Pain when palpating the SI joint area.

- Stiffness:

- Pronounced stiffness in the pelvic area, especially in the morning or after prolonged periods of rest.

- Gait changes:

- Limping or an unsteady gait to avoid pain.

The diagnosis is based on a combination of medical history, clinical examination, and imaging techniques:

• Medical History:
  • Collection of the medical history, including possible triggers such as injuries or inflammatory diseases.
• Clinical Examination:
  • Tests such as the Lasègue test or the compression test to provoke pain in the SI joint.
• Imaging Techniques:
  • X-ray: Visualization of arthritic changes or misalignments.
  • MRI: Detection of inflammation or soft tissue damage.
  • CT: Precise imaging of the bony structures.

Conservative Therapy

Most SIJ pain can be successfully treated with conservative measures:

• Physiotherapy:
  • Targeted exercises to stabilize the pelvis and strengthen the muscles.
• Medication Therapy:
  • Painkillers and anti-inflammatory drugs (NSAIDs) to relieve symptoms.
• Manual Therapy:
  • Mobilization techniques to restore mobility in the SIJ.
• Injections:
  • Cortisone or hyaluronic acid injections to reduce pain and inflammation.
• Heat or Cold Applications:
  • Application of heat packs or cold compresses depending on the symptoms.

Surgical Therapy

In cases of chronic or therapy-resistant SIJ pain, surgery may be necessary:

• Denervation:
  • Disabling the pain pathways in the SIJ through minimally invasive procedures.
• Arthrodesis:
  • Fusion of the sacroiliac joint in cases of irreversible damage.

To prevent SIJ pain, the following measures are recommended:

1. Ergonomic posture: Avoidance of poor posture through correct sitting and lifting.
2. Regular exercise: Promotion of joint health through sports such as yoga or swimming.
3. Strengthening of the core muscles: Targeted exercises to stabilize the back and pelvis.
4. Avoidance of overexertion: Limiting intense physical activities and heavy lifting tasks.
5. Early treatment: Consult a doctor early at the first signs of discomfort.