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.

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.

Questions

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Media Gallery

Flouroscopically guided sacroiliac joint injection. Contrast seen throughout the joint.

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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, University of Miami, Leonard A Miller School of Medicine

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, Association of Academic Physiatrists, Florida Society of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Coauthor(s)

Robert Gotlin, DO Associate 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 Medical Association, American Osteopathic Association, American Osteopathic College of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Henry T Goitz, MD Clinical Professor of Orthopaedic Surgery and Sports Medicine, Michigan State University College of Human Medicine; Academic Chief of Orthopaedic Sports Medicine, Regional Director of Ambulatory Clinic Site, Sports Medicine Institute, Detroit Medical Center

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Detroit Academy of Orthopaedic Surgeons, International Association for Dance Medicine and Science, International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine, Michigan Orthopaedic Society, Michigan State Medical Society, Mid-America Orthopaedic Association

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 Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, 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

Disclosure: Nothing to disclose.