pregnancy induced sacroiliac back pain

hi ,
i am seeing a patient who complains of having pain over sacroiliac joints bilaterally that came on during the 4th month of her pregnancy. now its 4 months after her delivery and the pain is more than ever.

on examination there is no tenderness on the SI joint. SI jnt compression causes pain. pain is over the dimples over the SI jnt.

pain is more during sitting to standing transfers. she cannot tolerate supine position. pain is worst when she lies supine for a while and then gets up.

she is not responding to electrotherapeutic modalities like ultrasound therapy or shortwave. she has taken 5 session of these and the pain has remained the same.

please advice me on how to go about the problem. waiting for ur replies......... thank u

Lets forget these electro modalities. They wont do much for your patient. Are there diurnal variations? What about prone position, whats her response to it? What does her lumbar segmental assessment say? Have you checked for any pelvic girdle dysfunctions? What's the SLR? Does the radiographs speak of any sacralization. How does she normally feed her baby? More info is needed to help you.

thnx for replyin.. well she does feel comfortable in prone.. SLR is negative.. PSIS and ASIS appear symmetrical WRT each other. sacroiliac compression produces pain.. she can feed the baby normally.. i hav advised her not to do cross leg sitting or abduct her legs.. n she finds some relief by doing this. there is no diurnal variation.. i have advised her for an X-ray, she is yet to get it done..i have also advised her mild self mobilisation techniques for sacroiliac joint which she says has helped her a bit.. hope u can guide me with this information.. thank u..

If she feels better in prone, take up from there. check for movement preference in sagittal & frontal plane. ask her to lie prone whenever she lies down. she can then be initiated to doing press up in the range of 10-15 degrees. If positive response is seen ask her to go further in progression of forces by achieving full range of repeated extension in lying. when ever she feeds her baby, she must not slump. she can either feed in sidelying position or raise her baby up using pillows etc & then feed. you must not forget to strengthen her core muscles as she has just delivered a baby. If she does not have a pelvic girdle dysfunction, self mobilising si joint techniques will not be of much help. do a complete assessment of SI, instead of just compression tests. I hope this will help you.