eMedicine Specialties > Sports Medicine > Spine

Sacroiliac Joint Injury: Follow-up

Author: Andrew L Sherman, MD, MS, Associate Professor of Clinical Rehabilitation Medicine, Vice Chairman, Chief of Spine and Musculoskeletal Services, Program Director, SCI Fellowship and PMR Residency Programs, Department of Rehabilitation Medicine, Leonard A Miller School of Medicine, University of Miami
Coauthor(s): Robert Gotlin, DO, Assistant Professor, Department of Physical Medicine and Rehabilitation, Albert Einstein College of Medicine; Director of Orthopaedic and Sports Rehabilitation, Department of Orthopedic Surgery, The Continuum Center for Health and Healing, Beth Israel Medical Center
Contributor Information and Disclosures

Updated: Apr 28, 2008

Follow-up

Return to Play

Similar to most conditions of mechanically related low back injury, an athlete's return to competition is a complex issue. In most SIJ injury cases, the athlete does not have a condition that can anatomically worsen with competition. However, pain may be exacerbated by the extreme motion and pelvic stress many athletes experience in their sport. Additionally, SIJ pain often leads to myofascial guarding and muscle imbalances, which, if not addressed before return to play, can lead to secondary injury in another part of the body. For example, a baseball pitcher with an SIJ strain may not be able to generate the support base or hip rotation needed to support the shoulder on overhead throws. Added stress to the shoulder can result in strains and even tears to the intrinsic elbow or shoulder muscles and ligaments.

Complications

Complications arise more from missed alternative causes of back pain than from any mechanical damage to the joint. Systemic conditions (eg, AS, Crohn-related arthritis) can cause future problems. Missed stress fractures to the hip could progress to a complete fracture. Finally, overlooked malignancy is a rare but real possibility.

Other complications can occur in athletes not fully rehabilitated. Muscle imbalances may persist and put the athlete at risk for reinjury or future injury to another structure. Finally, with any back injury, an inherent risk exists that the pain may become chronic. Excessive rest can often lead to adaption of a deconditioned state or sick role. These mechanical spine conditions must be identified early and rehabilitated aggressively to reduce this complication.

Prevention

Prevention of lower back injuries, including those to the SIJ, is multifaceted and relies on patient education concerning the back. Excessive lifting with a rotatory component can injure the SIJ in a manner similar to lumbar disk injuries. Using accessory muscles in forceful activities and training them for these activities can prevent injury. Sport-specific training after rehabilitation and before return to play is most important to prevent future injury.

Related eMedicine topics:
Lumbar Degenerative Disk Disease
Lumbar Disk Problems in the Athlete
Lumbosacral Spine Sprain/Strain Injuries
Mechanical Low Back Pain

Related Medscape topics:
Resource Center Exercise and Sports Medicine
Resource Center Spinal Disorders

Prognosis

Sacroiliac injury has an excellent prognosis for full recovery. While most studies suggest 80% of people with a lower back injury significantly improve within 2 weeks, no scientific studies show any stratification into diagnostic groups (ie, SIJ injury vs disk injury vs piriformis injury).

Education

Patient education is essential to achieving good outcomes. Patients can be informed that their SIJ pain is considered a benign condition, which, in most cases, improves with time and conservative treatments. Encourage them to resume physical activity as soon as possible to prevent deconditioning. Also encourage them to immediately enlist the help of a physical therapist to assist with therapeutic exercise. Home exercise programs are essential to help prevent reinjury and can be provided by a physician, chiropractor, or physical therapist.

Miscellaneous

Medicolegal Pitfalls

  • Legal issues primarily occur when underlying malignant diagnoses are overlooked. Patients with pain that persists unchanged for longer than 1 month should have their diagnosis reconsidered (see Differentials and Other Problems to Be Considered) and should undergo a proper workup.
  • Injured workers often have injuries similar to those of athletes. These patients require a similar aggressive rehabilitation approach to minimize time away from work and to prevent reinjury. Worker's compensation can often interfere and delay the patient recovery. When providing work excuses, patient confidentiality must be protected. In some states, the only information entitled to the employer is whether the work excuse is legitimate and whether the employee has any medical problems that may prevent the employee from doing their job.

Related Medscape topic:
Resource Center Medical Malpractice and Legal Issues

Special Concerns

  • Back pain is less common in pediatric age groups. In such groups, nonmechanical causes (eg, infection, malignancy, spondylolisthesis) must be considered.
  • When pain persists in an adult for more than 1 month, a more aggressive diagnostic workup should be considered.
 


More on Sacroiliac Joint Injury

Overview: Sacroiliac Joint Injury
Differential Diagnoses & Workup: Sacroiliac Joint Injury
Treatment & Medication: Sacroiliac Joint Injury
Follow-up: Sacroiliac Joint Injury
Multimedia: Sacroiliac Joint Injury
References
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References

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Further Reading

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Keywords

sacroiliitis, SIJ injury, lower back pain, low back pain, LBP, back pain, low back injuries, lower back injuries

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Contributor Information and Disclosures

Author

Andrew L Sherman, MD, MS, Associate Professor of Clinical Rehabilitation Medicine, Vice Chairman, Chief of Spine and Musculoskeletal Services, Program Director, SCI Fellowship and PMR Residency Programs, Department of Rehabilitation Medicine, Leonard A Miller School of Medicine, University of Miami
Andrew L Sherman, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Sports Medicine, American Medical Association, American Paraplegia Society, American Spinal Injury Association, and Association of Academic Physiatrists
Disclosure: Nothing to disclose.

Coauthor(s)

Robert Gotlin, DO, Assistant Professor, Department of Physical Medicine and Rehabilitation, Albert Einstein College of Medicine; Director of Orthopaedic and Sports Rehabilitation, Department of Orthopedic Surgery, The Continuum Center for Health and Healing, Beth Israel Medical Center
Robert Gotlin, DO is a member of the following medical societies: American Academy of Pain Management, American Academy of Physical Medicine and Rehabilitation, American Medical Association, American Osteopathic Association, American Osteopathic College of Physical Medicine and Rehabilitation, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Medical Editor

Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Henry T Goitz, MD, Fellowship Director, Sports Medicine, Department of Orthopedic Surgery, Henry Ford Hospital
Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

 
 
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