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Q

I have been through physical therapy for an SI (sacroiliac) joint dysfunction. While in physical therapy (PT) the pain goes away, but within a week or two after ending PT the pain comes back. Why?

 
A

Anatomically speaking, the SI (sacroiliac) joint lies at the junction of the hip bone (the ilium) and lower spine (the sacrum). Therefore, most people describe SI joint pain as low back pain or pain in the back of my hip. This joint does not move much but it is critical in transferring the upper body weight to the lower body. SI joint problems vary considerably, and usually involve either hypermobility (excessive motion) or, not as frequently, hypomobility (decreased motion). If the problem is hypermobility, there is usually a degree of associated weakness in the surrounding musculature which can be strengthened by a program designed by a physical therapist for specific abdominal, hip, pelvis and lumbar exercises and resolve the problem. Many times, the problem returns when the patient returns to weight-bearing exercise which may indicate movement dysfunction. In these cases, despite the increase in muscle strength, there is need for extra stability via an SI belt (available through physical therapists) which may be worn for more intense activities until further muscle strength and endurance is achieved. When the dysfunction is due to hypomobility, symptoms may resolve through mobilization of the joint, and maintained through a specific stretching/range of motion exercise program. Your home exercise program should involve advice on continued progression of strengthening/ stretching of the involved muscle groups with a focus on returning to all activities. Consult a Physical Therapist for further advice and education regarding sacroiliac dysfunction.

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