What is Sacroiliac (SI) Joint Pain & how is it treated?

In my pain management practice at Center for Spine Care, I see patients with Sacroiliac Joint issues almost on a daily basis.

While the symptoms of low back and hip pain can mimic several other diagnoses, we’ve developed a protocol at CSC to delineate the diagnosis and readily treat it. Here’s a quick summary of SI pain.

What is it? The Sacroiliac joints are located on both sides of the lowest portion of the spine. They make up the rear part of the pelvic girdle and sit between the sacrum and the ilia (hip bones), hence the abbreviation SI. The function of the SI joints is to allow twisting movements when we move our legs. Without the pubic symphysis (in the front) and the sacroiliac joints which allow very small movements, the pelvis would be at a higher risk of fracture.

The idea of the SI joint causing low back pain is very well understood now; however, due to the complex anatomy and movement patterns in the pelvis, evaluation and treatment of sacroiliac dysfunction remains controversial. The term dysfunction refers to either hypo or hyper mobility. This can lead to problems with the surrounding ligaments and muscles.

Symptoms: The pain can be either right or left of the very low back and can range from a dull ache to a sharp pain. The pain can then radiate into buttocks or even the groin. Pain turning over in bed or getting in/out of the car are pretty classic symptoms. Pain to one side of your back with driving or rising from a seated position are also possible. There may also be tenderness in the joint or surrounding ligaments.

Causes: One could break this down into 4 categories.

  • First, the cause could be from traumatic injuries to the SI joint such as landing on the buttocks or a jolt from a car wreck.
  • Second, biomechanical injuries are common and often associated with a recent change in sporting activities or change in workplace ergonomics. Biomechanical problems include leg length discrepancy, overpronation, and muscle imbalances.
  • A third cause would be hormonal changes such as seen during pregnancy. In preparation for giving birth, the ligaments of the pelvis increase in laxity. Combine this with increased weight and mechanical changes may produce pain.
  • And finally, inflammatory spondyloarthropathies such as Ankylosing Spondylitis are a common cause of SI joint pain.

What can you do?

  • Rest from any activity that reproduces the pain
  • Ice the area in pain. Though heat can relax muscles, you would NOT want to apply heat to an inflammatory disorder
  • Anti-inflammatory medications such as ibuprofen or naproxen
  • Try wearing a sacroiliac belt

 

What can your doctor do?

  • Use diagnostic tools to discover the problem. Remember, several diagnoses can cause low back pain. Sciatica, a more common diagnosis, can present with very similar symptoms. A thorough history, physical exam, and possibly imaging can delineate the diagnosis.
  • Rule out medical diseases such as Ankylosing Spondylitis
  • Treat the cause, not just the symptoms
  • Order diagnosis specific therapy to include pelvic strengthening, manipulation, massage, electrotherapy
  • If the above treatments fail, a corticosteroid injection into the SI joint may be used. (This provides diagnostic information as well.)
Nathan Walters, M.D., is director of pain management and specializes in conservative treatments.
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To learn more about Center for Spine Care, visit our website!

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