I am after after some information in regards to bilateral sacroiliitis. What does the condition entail and are there any exercises that can help to correct it?
Bilateral Sacroiliitis is inflammation at the sacroiliac joints. Although it may be indicative of other diseases and syndromes such as Enteropathic Arthritis, Psoriatic Arthritis, or Reiter¹s Syndrome, it's most often associated with Ankylosing Spondylitis. Specifically, Bilateral Sacroiliitis is text-book initial site of involvement of ankylosing spondylitis.
Ankylosing" means stiffening or fusion of a joint, and spondylos means vertebra. Spondylitis is inflammation of the vertebrae.
It's important to understand that it is not within our scope of practice to try to diagnose. It is crucial, however, that we learn to recognize medical red flags that should lead us to refer a client to the appropriate medical professional.
Beware of these signals:
- over three months of repeated episodes of low back pain centered over the sacrum
- the pain may radiate to buttocks, inner thighs and down legs
- pain that wakes the client at night
- client has morning low back stiffness that lasts over half an hour
- the pain is alleviated by exercise
- the pain is not alleviated by rest
- your client has a loss of lumbar ROM, especially lateral flexion
- the pain may also be accompanied by fatigue, fever, anorexia, weight loss and night sweats
The general goals of your program design should be to maintain spinal ROM in all planes and to maintain or even improve posture.
The client and possibly the physician may be reluctant to see exercise as part of the "prescription." Fortunately, you can site a study reported in the Journal of Arthritis and Rheumatism (2001 Oct, 45(5):430-8; van Tubergen A; et al.) showing that exercise is vital in alleviating pain and optimizing function in patients with bilateral sacroliitis.
Remember, one of the signs is that the pain decreases with exercise and does not decrease with rest. Most clients with billateral sacroiliitis, therefore, will not have to be convinced to exercise.
A common recommendation from physicians is aquatic exercise including swimming as a way to strengthen the muscles without excessive stress on the joints.
You also need to preempt the bodily changes commonly associated with arthritic diseases involving the spine. These include decreased lumbar lordosis, increased kyphosis, forward head carriage, and gluteus maximus atrophy. Be sure to check with the physician for reasonable goals for spinal ROM and for contraindications.
In addition to feeling tenderness at the sacrum, your client may also be sensitive at the costosternal joints, spinous processes, iliac crests, greater trochanters, ischial tuberosities and heels. If so, you'll need to avoid exercises in positions (e.g., side-lying, seated, prone) that put undue pressure on these spots.