ISG Syndrome

ISG syndrome: description

The sacroiliac joint (sacrum-iliac joint) connects the lower spine (Os sacrum) with the pelvis (Os ilium). It is only slightly mobile, is backed by a strong ligament and can not be actively moved. Physicians call such a joint as amphiarthrosis.

If the joint surfaces tilt, the ISG syndrome develops. Frequently, joint strain causes ISG syndrome, and it is more common during pregnancy, causing ISG pain.

Degenerative changes in the sacroiliac joint are common with increasing age, but usually do not cause pain.

ISG syndrome: symptoms

Patients with ISG syndrome mainly have pain in the sacroiliac joint. The ISG pain usually occurs as an attack and when bending or turning the trunk on. Even when walking, after a long physical effort or prolonged sitting in a certain position, sufferers suffer from the typical symptoms.

In the process, the articular surfaces of the joint tilt, resulting in a so-called ISG blockage. The ISG blockage causes ISG pain on the affected side as well as pain that can radiate from the lower back to the buttocks, the back thigh along the knee. These radiating ISG pains are similar to discomfort that can occur with herniated discs. The doctor will take this into account when making his diagnosis.

Some patients report pain in the lower abdomen and groin caused by tension in the lumbar iliac muscle (iliopsoas muscle).

ISG syndrome: causes and risk factors

ISG syndrome: bad stress and the activation of pain receptors

Tens or compressive loads on the ligamentous apparatus of the sacroiliac joint are often responsible for ISG syndrome. These arise, for example, by poor posture, heavy lifting or overweight. Inflammatory reactions triggered by this cause pain and transmit this information to the brain via the spinal cord via pain receptors (nociceptors). The pain receptors of the sacroiliac joint are particularly active in ISG syndrome.

In the ISG syndrome, the therapist will correct both the causes, such as abnormal stress, and reduce the activity of the nociceptors.

ISG syndrome: diseases as a trigger

In the case of ankylosing spondylitis, a chronic inflammatory disease of the spine and the pelvis, processes of remodeling occur on the spine and inflammatory processes occur. This can trigger an ISG syndrome and cause discomfort.

ISG syndrome in pregnancy

Due to the hormonal change in pregnancy, the ligaments relax and can trigger an ISG syndrome. Because the ligamentous apparatus loses stability and the sacroiliac joint less well withstands pressure, the back muscles take on a stabilizing function. This tenses the muscles and hurts.

ISG syndrome: examinations and diagnosis

Anyone who has pain in the sacroiliac joint should consult a doctor. First, many patients can be treated by the family doctor, later they are usually referred to an orthopedic surgeon. For pain in the sacroiliac joint, your doctor will first ask you the following questions, among other things, to inform yourself about your medical history (anamnesis):

• When did the pain first appear?
• Where exactly is the pain?
• Does the pain radiate, for example into the leg?
• How does the pain feel? Like a burning or stinging for example?
• Which pre-existing conditions do you suffer from?
• Are hereditary diseases known in your family?
• Did you fall?
• Do you have fever?

ISG Syndrome: Physical Examination

Subsequently, your doctor will examine you physically. In doing so, he performs, among other things, the following examinations:

• Knock Pain Test: Your doctor will grope and tap the spinous processes of the spine in turn. Pain can indicate a vertebral fracture. In ISG syndrome, the spine usually does not hurt. Pain is more likely to occur laterally to the spine on the lower back.
• Leading phenomenon: They stand with their backs to the doctor, who puts his thumbs on the two sacroiliac joints. Then bend forward. In the event of ISG irritation, the thumb on the affected side is pulled into flexion earlier.
• Mennell sign: They lie on their stomach and the doctor fixes the sacroiliac joint with one hand. With the other hand he raises your leg. If you feel pain in the joint, the Mennell sign is positive and indicates an ISG syndrome.
• Quad (Patrick test): They are on their backs. Now bring the right hoe to the left knee and drop the bent right leg to the right side. If you look at your legs from above, they form the number four. Subsequently, the test is carried out on the opposite side. In pain or limited mobility, this indicates involvement of the hip or sacroiliac joint.

ISG syndrome: further diagnostics

Usually, no blood tests are necessary. For chronic low back pain, before the age of 45, the doctor may take you blood to have it checked for signs of ankylosing spondylitis in the laboratory.

In addition to an X-ray examination, computed tomography (CT) can detect possible vertebral fractures or dislocations.

ISG Syndrome: These diseases must be ruled out

Of a possible ISG syndrome, the physician must differentiate other diseases that can also cause ISG pain. These include:

• bone fractures
• Tumors (for example cancer of the spine)
• infections
• Nerve damage (for example with a herniated disc)
• ankylosing spondylitis
• Mental back pain
• Hip diseases (for example hip joint arthrosis)

ISG syndrome: treatment

ISG Syndrome: Exercises relieve ISG symptoms

Physical activity is an important aspect in the successful treatment of ISG syndrome. Therefore, move sufficiently even if you have complaints. An accompanying physiotherapy treatment with special sacroiliac joint exercises to relieve the joint can help you.

ISG syndrome: infiltration therapy

In infiltration therapy, the doctor injects narcotic drugs (local anesthetics) directly to the site of the pain. Either the local anesthetics are injected into the ligaments of the sacroiliac joint or directly into the joint space. Often, it is sufficient to shut down the pain receptors in the ligaments in this way, otherwise injects the drug under X-ray control directly into the joint.

In addition to local anesthetics, anti-inflammatory and analgesic glucocorticoids, such as cortisone, can be injected.

ISG blockade: therapy by mobilization or manipulation

Specially trained physicians or physiotherapists can resolve joint blockages through manual therapy. Two different methods are used:

• Mobilization: Careful stretching improves the mobility of the affected joint.
• Manipulation: By briefly applying force (impulses) to the affected joint, especially a newly occurring ISG syndrome can be treated. The manipulation may be performed in Germany only by doctors.

ISG syndrome: Additional treatment options

Also, heat treatment can help relieve ISG discomfort. Use it for heating patches from the pharmacy, hot water bottles or infrared lamps.

Pain-relieving medications such as ibuprofen or diclofenac are among the so-called non-steroidal anti-inflammatory drugs (NSAIDs) and are often not very effective in ISG syndrome.

ISG syndrome: disease course and prognosis

The prognosis of a sacroiliac joint syndrome is individually very different. In most cases a new ISG syndrome can be treated well. Also spontaneous improvements are common. A prolonged ISG syndrome is often difficult to treat and the symptoms persist. Especially in younger patients, the treatment of the ISG Syndrome difficult.