Sacroiliac Joint Pain
Your sacroiliac (SI) joint is where the sacrum and iliac bone come together. The sacrum is the triangular piece of bone below the lumbar spine. The iliac bone connects to your hip. The surfaces where the iliac bone and the sacrum come together are covered with a thin plate of cartilage. The space between the two bones is filled with clear, viscous synovial fluid and is enclosed within a fibrous joint capsule.
The sacroiliac joint itself is a large, weight-bearing joint. All the weight of your body and upper extremities comes down the spine as we walk, sit, run, and generally move through our day. This one joint connects the hips and the spine and is responsible for bearing all of the weight of the patient’s upper body and limbs. In order to maintain stability, this joint only permits a restricted range of motion.
With this much pressure and the joint’s limited mobility, it may begin to fuse with age. Additionally, some people develop arthritis in the sacroiliac joint either due to wear and tear or as an autoimmune response.
As the pain in the SI joint worsens, it can begin to affect other joints in the body. You can learn more about this condition in the following video.
A common condition that leads to sacroiliac joint pain is bursitis, a pain on the side of the legs or in the hip joint itself. Whenever a person has pain in one part of the body, they may begin to adjust their movement to alleviate that pain.
This slight adjustment is usually the cause of bursitis, and irritation and inflammation in the connective tissue of the joints. This pain can be very severe and radiate from the front or back of the hips and legs. In these cases, you’ll treat both the bursitis and sacroiliac joint pain at the same time.
Other common causes or risk factors for sacroiliac joint pain include: trauma (e.g., falls, accidents, or acute injury), repetitive stress or strain, pregnancy, scoliosis, discrepancy in leg length, and gait and biomedical abnormalities
SI pain usually feels like lower back and buttock type pain. Usually the pain doesn’t radiate below the knee, but in rare occasions it can. Sitting may be increasingly uncomfortable, but movement can lead to pain as well, with your pain worsening over time.
Sacroiliac joint pain can be difficult to diagnose as it may be attributed to a new injury or strain in the lower back. Often patients identify the pain as originating in the lower back when in fact the origin point is the sacroiliac joint.
Your doctor will take a thorough medical history and perform a physical examination that includes movement to test your SI joint. In many cases, diagnosing sacroiliac joint pain comes down to ruling out other causes. Your doctor may also perform imaging tests, like an MRI or X-ray, to confirm a diagnosis.
Sacroiliac joint pain treatments usually begin with more conservative measures. Here are non-invasive treatment options that you and your doctor may explore.
- Rest: Most often prescribed for a short period of time in the acute phases of injury
- Medication: Over-the-counter non-steroidal-anti-inflammatory drugs can minimize inflammation and help relieve acute pain
- Physical therapy: In the case of mechanical issues, physical therapy can help restore range of motion and build strength in your surrounding muscles
- Exercise: Supportive stretching like yoga and other non-weight-bearing, full body exercise (e.g., swimming and boking) can help to heal an injury and keep joints healthy
- Chiropractic care: Proper alignment of the spine can alleviate pressure on a stressed SI joint
- SI joint belts: These supportive belts wrap around the pelvis to provide additional support
Sacroiliac joint injections
If the above non-invasive treatment options are unsuccessful, your doctor may consider joint injections. Of the existing interventional treatments available, steroid injections within the sacroiliac joint have provided patients with pain reducing benefits above and beyond placebo in randomized control trials. Further, these findings were sustained when the patients were evaluated at a one-month follow-up.
These injections are a minimally-invasive procedure that can be done on an outpatient basis. You can also receive them along with physical therapy to manage acute pain while you resolve any underlying causes of your pain.
Your doctor performs a sacroiliac joint injection in the area just outside the membrane of your sacroiliac joint fibrous capsule. Using only a local anesthetic and a fluoroscopic device (or X-ray) as a guide, a physician inserts a very small needle into the desired area between the vertebrae. Contrast dye tests for proper placement of the needle prior to injecting the steroids, as well as appropriate distribution of the solution within the area. Once proper placement has been assured, the physician administers the steroids. Note that steroids are administered only in the areas with the most inflammation. This reduces the amount of exposure the patient has to the steroids.
You can learn more about this procedure in the following video.
However, because two-thirds of the nerves in the SI joint originate in the back of the joint and doctors can only inject nerves in the back section, any pain originating in the front of the joint may remain.
For patients with intractable pain, SI joint surgery to fuse the joint is a last resort.
