Understanding Inflammation in Sacroiliac Joint Dysfunction: What Therapists Need to Know

Inflammation is a key player in many cases of sacroiliac joint (SIJ) dysfunction, especially when sacroiliitis is involved. Sacroiliitis refers to inflammation of the SI joint and is most commonly associated with systemic inflammatory conditions such as ankylosing spondylitis, psoriatic arthritis, and other spondyloarthropathies. These conditions can trigger chronic inflammation that leads to persistent pain, reduced mobility, and even joint fusion in severe cases.

But inflammation in the SI joint isn’t always driven by autoimmune disease. It can also arise from mechanical overload, trauma, or – in rare cases – infection. This makes it essential for manual therapy practitioners to consider a wide range of contributing factors when working with clients presenting with sacroiliac pain.

Understanding Sacroiliac Joint Dysfunction: Inflammation as a Key Factor, with Causes Including Trauma, Overuse, and Infection.

What Drives Inflammatory Sacroiliac Joint Dysfunction Pain?

In systemic inflammatory conditions, the body’s immune system becomes overactive. Inflammatory cytokines play a central role, promoting synovial inflammation, bone erosion, and sclerosis within the joint. Over time, this chronic inflammatory state may lead to joint fusion (ankylosis), which severely limits movement and contributes to long-term disability.

However, localised inflammation can also occur in the absence of systemic disease. For example:

• Trauma – A fall, car accident, or sudden jolt can injure the SIJ ligaments or capsule, triggering inflammation.

• Overuse – Repetitive loading, prolonged standing, or asymmetrical movement patterns (as seen in athletes and some occupations) may provoke an inflammatory response.

• Infection – Although uncommon, bacterial infection can invade the SIJ, leading to acute septic sacroiliitis characterised by fever, severe pain, and systemic illness.

Recognising the Clinical Picture

Clients with inflammatory SI joint pain often report a unique set of symptoms that can help distinguish it from mechanical dysfunction:

• Morning stiffness that eases with movement.

• Pain that disrupts sleep, particularly in the second half of the night.

• Systemic symptoms such as fatigue, skin issues, or eye inflammation in clients with autoimmune conditions.

Understanding these patterns is vital for appropriate referral and treatment planning. While manual therapy may not directly address the root cause of inflammatory sacroiliitis, recognising the signs can help guide clients towards a timely diagnosis and a multidisciplinary approach to care.

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