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Athletic Training Services Team
Texas Medical Center/San Jacinto
Jeff Collins, LAT
Jace Duke, ATC, LAT
Emery Hill, ATC, LAT
Terry King, LAT
Michelle Leget, ATC, LAT
Scott Tidwell, LAT
Jerry Meins, ATC, LAT
Stephen Melancon, ATC, LAT
Brandon Roberts, ATC, LAT
Bill Wissen, ATC, LAT
Richard Gregoire, ATC, LAT
Layne Schramm, ATC, LAT
Dwight Adsit, ATC, LAT
Paula Douglas, ATC, LAT
Keith Jahn, ATC, LAT
Mike Pace, ATC, LAT
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Sacroiliac Joint Dysfunction
The sacroiliac joint (SI joint) is the anatomic union of the sacrum and the ilium bones forming a nearly anarthrodial articulation. The function of the SI joint is to transfer motion and hold posture erect from the lower limbs to the upper body. Motion at the SI joint is limited to approximately 2-18 degrees and is nearly a fused joint except for near term pregnant females when the hormone, relaxin, softens connective tissue at the SI joint and the pubic symphysis for childbirth.
The joint surfaces are wavy and fit together in much the same way as lego blocks. The structure is held together by several strong ligaments. The strongest of which is located on the back of the joint “outside” the pelvic ring. The ligaments act like hoops that hold a wooden barrel together.
When walking or running, the sacrum "tilts" less than 10 degrees when unweighted during the "swing through" phase of ambulation. Unilaterally, when weight bearing, the SI joint becomes close packed and is nearly motionless. This close packed position transfers force and motion through the SI joint and up the spine for propulsion and change of direction.
Diagnosing SI Joint Dysfunction
Determining a correct diagnosis of SI joint dysfunction is difficult and, often, x-ray, and imaging may be of little value in pinpointing the source of pain. A thorough history and physical examination can determine a proper diagnosis of SI joint pain. Sacroiliitis (inflammation of the SI joint) is generally unilateral pain. Sacroiliac joint dysfunction (SJD) is often the result of abnormal motion at the SI joint. SJD can result from leg length discrepancy, worn shoes, running on uneven surfaces such as streets or roads, and motor vehicle accidents. Occasionally infection can be the source of pain. Infection at the SI Joint can be a serious problem that needs be addressed quickly before damage to the joint occurs.
Following a medical history, a physical exam is performed to assess the integrity of the SI joint. Several special tests can confirm SI joint pain.
Treatment Options for SI Joint Pain
Conservative treatment of SI joint pain consists of pain control and gentle active and passive motion to encourage restoration of normal motion. The use of heat, ice, electrical muscle stimulation and manual therapy all have a place in SI joint pain. Cortizone injections may be used when more conservative measures fail to resolve the discomfort. In some cases hyaluronic acid injections have proven useful in treatment. Surgery is reserved for those cases where all other forms of treatment are exhausted and major trauma to the joint has occurred.
The SI joint should be one of the first areas to be examined when an athlete presents with complaints of low back pain. The nuisance and pain that this area can produce can lead to lost practice and game participation. Simple measures taken early usually produce good outcomes and help keep the athletes on the field.
Sideline Management of the Young Athlete
Written by Christian M. Schupp, M.D., F.A.C.S.M. – Houston Methodist Orthopedics & Sports Medicine
In the May/June Volume of Current Sports Medicine Reports, Dr. Alysia Bedgood and I had the privilege of writing an article discussing the sideline management of common injuries affecting young or skeletally immature athletes. With over 41 million children in competitive sports and approximately 2.6 million of those sustaining injury every year, the ability to differentiate harmless injuries from more severe injuries is vital to all healthcare professionals.
In the current literature, there are many articles on specific injury patterns and types of injuries that occur in sports – but few have addressed sideline management with a specific focus on the injuries affecting young athletes.
Our article reviews the most common injuries that can occur with the young athlete from head to toe in comparison to a skeletally mature or adult athlete. The article also addresses how to approach these injuries from a sideline and sports medicine perspective, thus providing insight for health care professionals to evaluate and treat young athletes – and determine when they can return to sports safely.
In the history of medicine, children were often treated as small adults. As medicine has advanced, physicians have learned that this is far from the truth. In the care of young athletes these differences in treatment are even more amplified. As children develop and grow, changes in muscle, ligament and bone structure result in differences from adult injury patterns that commonly present on the sidelines, in clinics, and in emergency rooms. In the immature athlete, growth plates are the weakest and most commonly injured area of a bone or joint. For example, overuse injuries that may cause tendonitis in an adult result in a growth plate injury in a younger athlete.
Shoulder pain in an older baseball player can be attributed to cartilage or ligament problems – though a higher level of suspicion for growth plate injury, such as Little Leaguer’s shoulder, should be suspected in a younger thrower. Children also commonly have difficulty localizing pain, which makes it important for a health care professional to pay attention to the joints above and below the injured joint. For example, knee pain in an older athlete is usually localized to a variety of structures in and around the knee (meniscus or ligament). However, knee pain in a younger athlete may be radiating pain from the hip, which could indicate a more serious problem such as a hip growth plate that is slipping. For further information, the full article is available online: Sideline Management from Head to Toe of the Skeletally Immature Athlete.
Dr. Schupp is a primary care sports medicine physician at Houston Methodist Orthopedics & Sports Medicine. He serves as team physician to high school and college sports teams, advisor to professional sports groups and is part of the sports medicine faculty for the Houston Methodist Primary Care Sports Medicine Fellowship.