Sakroiliyak Eklem Biyomekaniği Sağlık ve Hastalıkta: Bir Anlatısal Derleme
Year 2025,
Volume: 10 Issue: 2, 289 - 295, 14.06.2025
Zelal Apaydın
,
Tülay Ülkü Sevim
,
İrem Çaylak Yetüt
,
Rüstem Mustafaoğlu
Abstract
Sakroiliyak (Sİ) eklem, bel ağrısı olan hastaların %10 ile %25'inde birincil ağrı kaynağı olarak belirtilen bir eklemdir. Sİ eklem öncelikli olarak stabiliteye yönelik tasarlanmış olup vücudun üst kısmı ve omurganın ağırlığını dağıtarak alt ekstremitelere iletmek, gövdenin pelvis üzerindeki dönüşünü sınırlamak ve hamile kadınlarda doğumun kolaylaştırılmasını sağlamak gibi temel işlevleri bulunur. Genel anlamda eklemdeki hareketin 3 vücut düzleminde meydana geldiği, ancak ilerleyen yaşla birlikte hareketin yavaş yavaş azaldığı kabul görmüştür. Benzersiz anatomik ve fizyolojik özellikleri, eklemi mekanik strese karşı duyarlı hale getirir ve aynı zamanda Sİ eklem ağrısının tanısında zorluklar yaratır. Sİ eklemin biyomekaniğindeki değişiklik veya yaralanmalar sonucunda kas ve ligament gibi çevre dokularda meydana gelen değişiklikler ağrı ile belirginleşir. Sakroiliyak eklem disfonksiyonu yaşayan çok sayıda hasta olmasına rağmen, semptomlar hastalar arasında tutarsız bir şekilde ortaya çıktığından tanı ve tedavi için optimal yöntemler konusunda anlaşmazlıklar vardır. Bu derleme, Sİ ekleminin anotomi ve kinematiğini değerlendirirken fonksiyonel eklem biyomekaniğinin önemini vurgulamayı ve Sİ eklem disfonksiyonu ve inflamatuar hastalıklarında görülen patomekaniği incelemeyi amaçlamaktadır.
References
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- Hamidi-Ravari B, Tafazoli S, Chen H, Perret D. Diagnosis and current treatments for sacroiliac joint dysfunction: a review. Curr Phys Med Rehabil Rep. 2014; 2(1): 48–54. DOI: 10.1007/s40141-013-0037-7
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- Cohen SP. Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment. Anesth Analg. 2005;101(5):1440–1453. DOI: 10.1213/01.ANE.0000180831.60169.EA
- Zelle BA, Gruen GS, Brown S, George S. Sacroiliac joint dysfunction: evaluation and management. Clin J Pain. 2005;21(5):446-55. DOI: 10.1097/01.ajp.0000131413.07468.8e.
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- Ashby K, Yilmaz E, Mathkour M, Olewnik L, Hage D, Iwanaga J et al. Ligaments stabilizing the sacrum and sacroiliac joint: a comprehensive review. Neurosurg Rev. 2022;45(1):357-364. DOI:10.1007/s10143-021-01625-y
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- Rawlings CE 3rd, Wilkins RH, Martinez S, Wilkinson RH Jr. Osteoporotic sacral fractures: a clinical study. Neurosurgery. 1988;22(1 Pt 1):72-6. DOI: 10.1227/00006123-198801010-00011.
- Poley RE, Borchers JR. Sacroiliac joint dysfunction: evaluation and treatment. Phys Sportsmed. 2008 Dec;36(1):42-9. DOI: 10.3810/psm.2008.12.10.
- Ou-Yang DC, York PJ, Kleck CJ, Patel VV. Diagnosis and management of sacroiliac joint dysfunction. J Bone Joint Surg Am. 2017;99(23):2027-2036. DOI: 10.2106/JBJS.17.00245.
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- Le Huec JC, Tsoupras A, Leglise A, Heraudet P, Celarier G, Sturresson B. The sacro-iliac joint: a potentially painful enigma. Update on the diagnosis and treatment of pain from micro-trauma. Orthop Traumatol Surg Res. 2019;105(1S):S31-S42. DOI: 10.1016/j.otsr.2018.05.019.
- Joukar A, Shah A, Kiapour A, Vosoughi AS, Duhon B, Agarwal AK, et al. Sex specific sacroiliac joint biomechanics during standing upright: a finite element study. Spine (Phila Pa 1976). 2018;43(18):E1053-E1060. DOI: 10.1097/BRS.0000000000002623.
- Schmidt GL, Bhandutia AK, Altman DT. Management of sacroiliac joint pain. J Am Acad Orthop Surg. 2018;26(17):610-616. DOI: 10.5435/JAAOS-D-15-00063.
- Barros G, McGrath L, Gelfenbeyn M. Sacroiliac joint dysfunction in patients with low back pain. Fed Pract. 2019;36(8):370-375.
- Duyur B, Genç H, Erdem HR. Sakroiliak eklem anatomi ve biyomekani. Fiziksel Tıp. 2002;5(1): 51-55.
- Slipman CW, Jackson HB, Lipetz JS, Chan KT, Lenrow D, Vresilovic EJ. Sacroiliac joint pain referral zones. Arch Phys Med Rehabil. 2000;81(3):334-8. DOI: 10.1016/s0003-9993(00)90080-7.
- O'Sullivan PB, Beales DJ. Diagnosis and classification of pelvic girdle pain disorders, Part 2: illustration of the utility of a classification system via case studies. Man Ther. 2007;12(2):e1-12. DOI: 10.1016/j.math.2007.03.003.
- Javadov A, Ketenci A, Aksoy C. The efficiency of manual therapy and sacroiliac and lumbar exercises in patients with sacroiliac joint dysfunction syndrome. Pain Physician. 2021;24(3):223-233. DOI:10.36076/ppj.2021/24/223
- Kamali F, Zamanlou M, Ghanbari A, Alipour A, Bervis S. Comparison of manipulation and stabilization exercises in patients with sacroiliac joint dysfunction patients: A randomized clinical trial. J Bodyw Mov Ther. 2019;23(1):177-182. DOI: 10.1016/j.jbmt.2018.01.014.
- Peebles R, Jonas CE. Sacroiliac joint dysfunction in the athlete: diagnosis and management. Curr Sports Med Rep. 2017;16(5): 336-342. DOI: 10.1249/JSR.0000000000000410
- Rashbaum RF, Ohnmeiss DD, Lindley EM, Kitchel SH, Patel VV. Sacroiliac joint pain and its treatment. Clin Spine Surg. 2016;29(2):42-8. DOI: 10.1097/BSD.0000000000000359.
- Telli H, Telli S, Topal M. The Validity and Reliability of Provocation Tests in the Diagnosis of Sacroiliac Joint Dysfunction. Pain Physician. 2018;21(4):E367-E376. PMID: 30045603. DOI:10.36076/ppj.2018.4.E367
- Cohen SP, Chen Y, Neufeld NJ. Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment. Expert Rev Neurother. 2013;13(1):99-116. DOI: 10.1586/ern.12.148.
- Morimoto K, Harrington A, Nelson C, Loveless B. Osteopathic approach to sacroiliac joint pain in pregnant patients. J Osteopath Med. 2022;18;122(5):235-242. DOI: 10.1515/jom-2021-0231.
- Dreyfuss P, Dreyer SJ, Cole A, Mayo K. Sacroiliac joint pain. J Am Acad Orthop Surg. 2004;12(4):255-65. DOI: 10.5435/00124635-200407000-00006.
- Capobianco R, Cher D; SIFI Study Group. Safety and effectiveness of minimally invasive sacroiliac joint fusion in women with persistent post-partum posterior pelvic girdle pain: 12-month outcomes from a prospective, multi-center trial. Springerplus. 2015;4:570. DOI: 10.1186/s40064-015-1359-y.
- Fiani B, Sekhon M, Doan T, Bowers B, Covarrubias C, Barthelmass M, et al. Sacroiliac joint and pelvic dysfunction due to symphysiolysis in postpartum women. Cureus. 2021;13(10):e18619. DOI: 10.7759/cureus.18619.
- Sipko T, Grygier D, Barczyk K, Eliasz G. The occurrence of strain symptoms in the lumbosacral region and pelvis during pregnancy and after childbirth. J Manipulative Physiol Ther. 2010;33(5):370-7. DOI: 10.1016/j.jmpt.2010.05.006.
- Lee A, Gupta M, Boyinepally K, Stokey PJ, Ebraheim NA. Sacroiliitis: A review on anatomy, diagnosis, and treatment. Adv Orthop. 2022;2022:3283296. DOI: 10.1155/2022/3283296.
- Baronio M, Sadia H, Paolacci S, Prestamburgo D, Miotti D, Guardamagna VA, et al. Etiopathogenesis of sacroiliitis: implications for assessment and management. Korean J Pain. 2020;33(4):294-304. DOI: 10.3344/kjp.2020.33.4.294.
- Mester AR, Makó EK, Karlinger K, Györke T, Tarján Z, Márton E, et al. Enteropathic arthritis in the sacroiliac joint. Imaging and differential diagnosis. Eur J Radiol. 2000;35(3):199-208. DOI: 10.1016/s0720-048x(00)00243-6.
- Buchanan BK, Varacallo M. Sacroiliitis. 2023 Aug 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.
- Braun J, Sieper J, Bollow M. Imaging of sacroiliitis. Clin Rheumatol. 2000;19(1):51-7. DOI: 10.1007/s100670050011.
- Topal H. Aksiyal spondiloartrit hastalarında kinezyofobinin düşme riski üzerine etkisi ve hastalık parametreleri ile ilişkisi [Doctoral dissertation].[Bursa]: Uludag University; 2022.
- Barozzi L, Olivieri I, De Matteis M, Padula A, Pavlica P. Seronegative spondylarthropathies: imaging of spondylitis, enthesitis and dactylitis. Eur J Radiol. 1998;27 Suppl 1:S12-7. DOI: 10.1016/s0720-048x(98)00037-0.
- Khan MA. Clinical features of ankylosing spondylitis. In: Hochberg M, et al., editors. Rheumatology. Section 9: Spondyloarthropathies. Spain: Elsevier; 2003. p. 1161-1181.
- Viroli G, Cerasoli T, Barile F, Modeo M, Manzetti M, Traversari M, et al. Diagnosis and treatment of acute inflammatory sacroiliitis in pregnant or post-partum women: a systematic review of the current literature. Musculoskelet Surg. 2024;108(2):133-138. DOI: 10.1007/s12306-023-00786-x.
- Lu X, Hu J, Dai M, Wang J, Yan J, Zhang J, et al. Clinical characteristics, treatment and outcomes of acute postpartum inflammatory sacroiliitis: a retrospective study. Arch Gynecol Obstet. 2022;306(6):2187-2195. DOI: 10.1007/s00404-022-06534-z.
- Al-Mnayyis A, Obeidat S, Badr A, Jouryyeh B, Azzam S, Al Bibi H, et al. Radiological insights into sacroiliitis: A Narrative Review. Clin Pract. 2024;14(1):106-121. DOI: 10.3390/clinpract14010009
The Biomechanics of the Sacroiliac Joint in Health and Disease: A Narrative Review
Year 2025,
Volume: 10 Issue: 2, 289 - 295, 14.06.2025
Zelal Apaydın
,
Tülay Ülkü Sevim
,
İrem Çaylak Yetüt
,
Rüstem Mustafaoğlu
Abstract
The sacroiliac (SI) joint is cited as the primary source of pain in 10% to 25% of patients with low back pain. The SI joint is primarily designed for stability, distributing the weight of the upper body and spine to the lower extremities, limiting the rotation of the trunk over the pelvis, and facilitating childbirth in pregnant women. It is generally accepted that joint movement occurs in three body planes, but as age advances, movement gradually decreases. Unique anatomical and physiological features make the joint sensitive to mechanical stress and also create challenges in diagnosing SI joint pain. Changes or injuries in the biomechanics of the SI joint result in alterations in surrounding tissues such as muscles and ligaments, which become accentuated with pain. Despite the presence of a significant number of patients experiencing SI joint dysfunction, there are disagreements regarding optimal methods for diagnosis and treatment since symptoms inconsistently manifest among patients. This review aims to emphasize the importance of functional joint biomechanics while assessing the anatomy and kinematics of the SI joint and to examine the pathomechanics observed in SI joint dysfunction and inflammatory diseases.
References
- Slipman CW, Patel RK, Shin C, Braverman D, Lenrow D. Pain management: studies probe complexities of sacroiliac joint syndrome. Biomechanics. 2000; 67(4):67-78.
- Trentadue TP, Anderson TL, Wenger DE, McKenzie GA. Prevalence of accessory sacroiliac joint anatomy and associated clinical features. Skeletal Radiol. 2023;52(7):1359-1368. DOI:10.1007/s00256-023-04281-z
- Hamidi-Ravari B, Tafazoli S, Chen H, Perret D. Diagnosis and current treatments for sacroiliac joint dysfunction: a review. Curr Phys Med Rehabil Rep. 2014; 2(1): 48–54. DOI: 10.1007/s40141-013-0037-7
- Thawrani DP, Agabegi SS, Asghar F. Diagnosing sacroiliac joint pain. J Am Acad Orthop Surg. 2019;27(3): 85-93. DOI: 10.5435/JAAOS-D-17-00132
- Cohen SP. Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment. Anesth Analg. 2005;101(5):1440–1453. DOI: 10.1213/01.ANE.0000180831.60169.EA
- Zelle BA, Gruen GS, Brown S, George S. Sacroiliac joint dysfunction: evaluation and management. Clin J Pain. 2005;21(5):446-55. DOI: 10.1097/01.ajp.0000131413.07468.8e.
- Bowen V, Cassidy JD. Macroscopic and microscopic anatomy of the sacroiliac joint from embryonic life until the eighth decade. Spine (Phila Pa 1976). 1981;6(6):620-8. DOI: 10.1097/00007632-198111000-00015.
- Kiapour A, Joukar A, Elgafy H, Erbulut DU, Agarwal AK, Goel VK. Biomechanics of the sacroiliac joint: anatomy, function, biomechanics, sexual dimorphism, and causes of pain. Int J Spine Surg. 2020;14(Suppl 1):3-13. DOI: 10.14444/6077
- Ashby K, Yilmaz E, Mathkour M, Olewnik L, Hage D, Iwanaga J et al. Ligaments stabilizing the sacrum and sacroiliac joint: a comprehensive review. Neurosurg Rev. 2022;45(1):357-364. DOI:10.1007/s10143-021-01625-y
- Foley BS, Buschbacher RM. Sacroiliac joint pain: anatomy, biomechanics, diagnosis, and treatment. Am J Phys Med Rehabil. 2006;85(12):997-1006. DOI: 10.1097/01.phm.0000247633.68694.c1.
- Van Wingerden JP, Vleeming A, Snijders CJ, Stoeckart R. A functional-anatomical approach to the spine-pelvis mechanism: interaction between the biceps femoris muscle and the sacrotuberous ligament. Eur Spine J. 1993;2(3):140-144. DOI:10.1007/BF00301411.
- Gartenberg A, Nessim A, Cho W. Sacroiliac joint dysfunction: pathophysiology, diagnosis, and treatment. Eur Spine J. 2021 Oct;30(10):2936-2943. DOI: 10.1007/s00586-021-06927-9.
- Rawlings CE 3rd, Wilkins RH, Martinez S, Wilkinson RH Jr. Osteoporotic sacral fractures: a clinical study. Neurosurgery. 1988;22(1 Pt 1):72-6. DOI: 10.1227/00006123-198801010-00011.
- Poley RE, Borchers JR. Sacroiliac joint dysfunction: evaluation and treatment. Phys Sportsmed. 2008 Dec;36(1):42-9. DOI: 10.3810/psm.2008.12.10.
- Ou-Yang DC, York PJ, Kleck CJ, Patel VV. Diagnosis and management of sacroiliac joint dysfunction. J Bone Joint Surg Am. 2017;99(23):2027-2036. DOI: 10.2106/JBJS.17.00245.
- El Rafei M, Badr S, Lefebvre G, Machuron F, Capon P, Flipo R et al. Sacroiliac joints: anatomical variations on MR images. Eur Radiol. 2018;28(12):5328-5337. DOI:10.1007/s00330-018-5540-x
- Özbalcı AB. Sacroiliac Joint Variations on Magnetic Resonance Imaging in Patients with Low Back Pain. Kafkas Journal of Medical Sciences. 2022;12(2):146-151. DOI: 10.5505/kjms.2022.30906
- Toyohara R, Ohashi T. A literature review of biomechanical studies on physiological and pathological sacroiliac joints: Articular surface structure, joint motion, dysfunction and treatments. Clin Biomech (Bristol, Avon). 2024;114:106233. DOI: 10.1016/j.clinbiomech.2024.106233
- Le Huec JC, Tsoupras A, Leglise A, Heraudet P, Celarier G, Sturresson B. The sacro-iliac joint: a potentially painful enigma. Update on the diagnosis and treatment of pain from micro-trauma. Orthop Traumatol Surg Res. 2019;105(1S):S31-S42. DOI: 10.1016/j.otsr.2018.05.019.
- Joukar A, Shah A, Kiapour A, Vosoughi AS, Duhon B, Agarwal AK, et al. Sex specific sacroiliac joint biomechanics during standing upright: a finite element study. Spine (Phila Pa 1976). 2018;43(18):E1053-E1060. DOI: 10.1097/BRS.0000000000002623.
- Schmidt GL, Bhandutia AK, Altman DT. Management of sacroiliac joint pain. J Am Acad Orthop Surg. 2018;26(17):610-616. DOI: 10.5435/JAAOS-D-15-00063.
- Barros G, McGrath L, Gelfenbeyn M. Sacroiliac joint dysfunction in patients with low back pain. Fed Pract. 2019;36(8):370-375.
- Duyur B, Genç H, Erdem HR. Sakroiliak eklem anatomi ve biyomekani. Fiziksel Tıp. 2002;5(1): 51-55.
- Slipman CW, Jackson HB, Lipetz JS, Chan KT, Lenrow D, Vresilovic EJ. Sacroiliac joint pain referral zones. Arch Phys Med Rehabil. 2000;81(3):334-8. DOI: 10.1016/s0003-9993(00)90080-7.
- O'Sullivan PB, Beales DJ. Diagnosis and classification of pelvic girdle pain disorders, Part 2: illustration of the utility of a classification system via case studies. Man Ther. 2007;12(2):e1-12. DOI: 10.1016/j.math.2007.03.003.
- Javadov A, Ketenci A, Aksoy C. The efficiency of manual therapy and sacroiliac and lumbar exercises in patients with sacroiliac joint dysfunction syndrome. Pain Physician. 2021;24(3):223-233. DOI:10.36076/ppj.2021/24/223
- Kamali F, Zamanlou M, Ghanbari A, Alipour A, Bervis S. Comparison of manipulation and stabilization exercises in patients with sacroiliac joint dysfunction patients: A randomized clinical trial. J Bodyw Mov Ther. 2019;23(1):177-182. DOI: 10.1016/j.jbmt.2018.01.014.
- Peebles R, Jonas CE. Sacroiliac joint dysfunction in the athlete: diagnosis and management. Curr Sports Med Rep. 2017;16(5): 336-342. DOI: 10.1249/JSR.0000000000000410
- Rashbaum RF, Ohnmeiss DD, Lindley EM, Kitchel SH, Patel VV. Sacroiliac joint pain and its treatment. Clin Spine Surg. 2016;29(2):42-8. DOI: 10.1097/BSD.0000000000000359.
- Telli H, Telli S, Topal M. The Validity and Reliability of Provocation Tests in the Diagnosis of Sacroiliac Joint Dysfunction. Pain Physician. 2018;21(4):E367-E376. PMID: 30045603. DOI:10.36076/ppj.2018.4.E367
- Cohen SP, Chen Y, Neufeld NJ. Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment. Expert Rev Neurother. 2013;13(1):99-116. DOI: 10.1586/ern.12.148.
- Morimoto K, Harrington A, Nelson C, Loveless B. Osteopathic approach to sacroiliac joint pain in pregnant patients. J Osteopath Med. 2022;18;122(5):235-242. DOI: 10.1515/jom-2021-0231.
- Dreyfuss P, Dreyer SJ, Cole A, Mayo K. Sacroiliac joint pain. J Am Acad Orthop Surg. 2004;12(4):255-65. DOI: 10.5435/00124635-200407000-00006.
- Capobianco R, Cher D; SIFI Study Group. Safety and effectiveness of minimally invasive sacroiliac joint fusion in women with persistent post-partum posterior pelvic girdle pain: 12-month outcomes from a prospective, multi-center trial. Springerplus. 2015;4:570. DOI: 10.1186/s40064-015-1359-y.
- Fiani B, Sekhon M, Doan T, Bowers B, Covarrubias C, Barthelmass M, et al. Sacroiliac joint and pelvic dysfunction due to symphysiolysis in postpartum women. Cureus. 2021;13(10):e18619. DOI: 10.7759/cureus.18619.
- Sipko T, Grygier D, Barczyk K, Eliasz G. The occurrence of strain symptoms in the lumbosacral region and pelvis during pregnancy and after childbirth. J Manipulative Physiol Ther. 2010;33(5):370-7. DOI: 10.1016/j.jmpt.2010.05.006.
- Lee A, Gupta M, Boyinepally K, Stokey PJ, Ebraheim NA. Sacroiliitis: A review on anatomy, diagnosis, and treatment. Adv Orthop. 2022;2022:3283296. DOI: 10.1155/2022/3283296.
- Baronio M, Sadia H, Paolacci S, Prestamburgo D, Miotti D, Guardamagna VA, et al. Etiopathogenesis of sacroiliitis: implications for assessment and management. Korean J Pain. 2020;33(4):294-304. DOI: 10.3344/kjp.2020.33.4.294.
- Mester AR, Makó EK, Karlinger K, Györke T, Tarján Z, Márton E, et al. Enteropathic arthritis in the sacroiliac joint. Imaging and differential diagnosis. Eur J Radiol. 2000;35(3):199-208. DOI: 10.1016/s0720-048x(00)00243-6.
- Buchanan BK, Varacallo M. Sacroiliitis. 2023 Aug 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.
- Braun J, Sieper J, Bollow M. Imaging of sacroiliitis. Clin Rheumatol. 2000;19(1):51-7. DOI: 10.1007/s100670050011.
- Topal H. Aksiyal spondiloartrit hastalarında kinezyofobinin düşme riski üzerine etkisi ve hastalık parametreleri ile ilişkisi [Doctoral dissertation].[Bursa]: Uludag University; 2022.
- Barozzi L, Olivieri I, De Matteis M, Padula A, Pavlica P. Seronegative spondylarthropathies: imaging of spondylitis, enthesitis and dactylitis. Eur J Radiol. 1998;27 Suppl 1:S12-7. DOI: 10.1016/s0720-048x(98)00037-0.
- Khan MA. Clinical features of ankylosing spondylitis. In: Hochberg M, et al., editors. Rheumatology. Section 9: Spondyloarthropathies. Spain: Elsevier; 2003. p. 1161-1181.
- Viroli G, Cerasoli T, Barile F, Modeo M, Manzetti M, Traversari M, et al. Diagnosis and treatment of acute inflammatory sacroiliitis in pregnant or post-partum women: a systematic review of the current literature. Musculoskelet Surg. 2024;108(2):133-138. DOI: 10.1007/s12306-023-00786-x.
- Lu X, Hu J, Dai M, Wang J, Yan J, Zhang J, et al. Clinical characteristics, treatment and outcomes of acute postpartum inflammatory sacroiliitis: a retrospective study. Arch Gynecol Obstet. 2022;306(6):2187-2195. DOI: 10.1007/s00404-022-06534-z.
- Al-Mnayyis A, Obeidat S, Badr A, Jouryyeh B, Azzam S, Al Bibi H, et al. Radiological insights into sacroiliitis: A Narrative Review. Clin Pract. 2024;14(1):106-121. DOI: 10.3390/clinpract14010009