Sacroiliac Joint pain

The Sacroiliac Joint pain is the joint connection between the spine and the pelvis. It is a large diarthrodial joint made up of the sacrum and the innominates on each side. Each innominate is formed by the fusion of the three bones of the pelvis: the ilium, ischium, and pubic bone.

The sacroiliac joint has different functions:

• Load transfer between the spine and the lower extremities

• Shock absorption

• Converts torque from the lower extremities into the rest of the body.

This region is surrounded by and covered with the dorsal sacral nerve, the iliolumbar ligament, the dorsal sacral ligaments, the

Erectors spinae muscles (the long muscles along the spine) fascia, which is part of the Thoracolumbar facia and makes palpating specific structures difficult.

Subgluteal !buttock) space: located between the middle and deep gluteal aponeurosis layers. It contains:

• The Superior/Inferior gluteal nerves

• Blood vessels

• Ischium

• Sacroiliac joint ligaments

• Sciatic nerve

• Piriformis

The Piriformis muscles is innervated by the branches of the L5, S1, and S2 spinal nerves.

The sciatic nerve has a complicated relationship with the piriformis muscle, passing above, below and through the muscle before and after dividing.

Buttock pain can be caused by a referred pain from the lumbar spine in the respective dermatome A study by Eubanks reported significant improvement in buttock pain following facet joint block.

Red Flags are serious pathologies and should be spotted on the first contact.

Spondyloarthropathies  and other inflammatory conditions at the lumbar spine level could possibly refer pain to the buttock area. Patients with Ankylosing spondylitis or Reiter's syndrome may present with inflammatory bowel diseases, such as Diverticulitis or Crohn's disease, prolonged severe morning stiffness, bilateral enthesopathies such as Achilles tendinopathy or Plantar fasciitis.

Gynaecological problems, potential infectious diseases, possible malignancies and patients not responding to physiotherapy management can possibly reflect the presence of serious pathologies.

Sacroiliac joint pain can be treated with manual therapy, Ultrasound therapy, specified exercises plan.

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