Introduction

Sacroiliitis is the term used to describe the painful inflammation of the sacroiliac joint. Sacroiliitis may occur secondary to mechanical stress of the SI joint, trauma, infective causes, autoimmunity or because of an unknown reason (Baronio et al, 2020). This can make the diagnosis of sacroiliitis, and its management, a diagnostic challenge (Slobodin et al, 2018). Sacroiliitis has also been highlighted as the first manifestation of more complex spondyloarthropathies such as ankylosing spondylitis, inflammatory bowel disease and rheumatic disease (Baronio et al 2020). It’s rarity in professional sport has meant there is no definitive RTP pathway or evidence-based approach to managing this pathology.

The purpose of this article is to discuss and explain the route for two separate incidences sacroiliitis in professional footballers at the same club. We highlight

the challenges in diagnosis and predicting Return to Play (RTP) timeframes whilst discussing ongoing management during a competitive football schedule. We also provide a pathway to follow should you come across or suspect this in an athlete under your care.

Player 1 – 18 years old academy player – gradual onset of left sided SIJ related symptoms over the course of 2/52.

Player 2 – 22 year old first team player – Returning from a high grade hamstring tear – at very end of rehab whilst in team training began complaining of SIJ pain that was debilitating to the point of dropping out of training.