Sacroiliac Joint Injury Follow-up

Updated: Jan 16, 2019
  • Author: Andrew L Sherman, MD, MS; Chief Editor: Sherwin SW Ho, MD  more...
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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.

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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.

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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.

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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).

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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.

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