Sacroiliac Joint Pain

What is Sacroiliac Joint Pain?

Sacroiliac (SI) joint pain occurs in the lower back and buttock area due to the dysfunction of the sacroiliac joint (Cohen, Chen, & Neufeld, 2013). This sacroiliac joint connects the spine and pelvis. Usually, this pain originates because of damage or injury to the sacroiliac joint. People have 2 sacroiliac joints in the lower back, one on each side of the spine. These joints have strong ligaments that connect the sacrum (base of the spine) to the ilium (top of the pelvis). While standing or walking, these joints work together to support the weight of the upper body, absorbing impact and relieving pressure on the spine.

According to research, almost 15% to 30% of chronic lower back pain cases have a connection with sacroiliac joint pain (Hamidi-Ravari, Tafazoli, Chen, & Perret, 2014). Sacroiliac discomfort might look like a herniated disc or a hip issue. Lower back pain affects around 80% of individuals in the United States at some point in their life. Lower back discomfort becomes responsible for the most frequent cause of work-related impairment and a significant source of missed workdays. Other terms for this joint pain include sacroiliac joint syndrome, sacroiliac joint dysfunction, sacroiliac joint inflammation, and sacroiliac joint strain.

What Are The Common Symptoms of Sacroiliac Joint Pain?

The severity of sacroiliac joint pain varies based on the degree and cause of the injury. Acute SI joint pain appears out of nowhere and generally goes away within a few days to weeks. Chronic SI joint pain lasts more than three months, and gets worse with particular activities.

Typical signs and symptoms of SI pain often begin in the lower back and buttocks and can extend to the lower hip, groin, or upper thigh. Patients may also feel numbness or tingling in their legs, as well as a sense of weakness. The discomfort generally occurs on one side, although this can happen on both sides. Common symptoms of sacroiliac joint dysfunction may include (Falowski et al., 2020):

  • Severe pain in the lower back
  • Pain radiates to the hips, buttocks, or groin
  • Pain in the buttock area (sciatica)
  • Pelvic instability
  • Stiffness in the lower back, hips, pelvis, etc.

Sitting, standing, sleeping, walking, or climbing stairs may aggravate symptoms. Some people have trouble traveling in a car for extended periods of time, or standing, sitting, or walking for lengthy periods of time. Transitional movements (moving from a sitting to a standing position), standing on one leg, and climbing stairs might aggravate pain.

What Are The Common Causes of Sacroiliac Joint Pain?

Several factors increase the risk of developing sacroiliac dysfunction and pain among patients. SI joint dysfunction can result in inflammation of one or both SI joints, known as sacroiliitis. This condition arises from a variety of causes such as:

  • Osteoarthritis
  • Gout
  • Gait issues
  • Pregnancy or recent childbirth
  • Injuries resulting from falls or car accidents
  • Prior lower back surgery, such as laminectomy or lumbar fusion
  • Autoimmune diseases, such as axial spondylarthritis, and biomechanical conditions
  • Heavy activities that put pressure over the joint such as contact sports, regular heavy lifting, labor-intensive jobs, etc.

How Do Spinal Specialists Diagnose Sacroiliac Joint Pain?

Accurate diagnosis of sacroiliac joint pain depends upon a combination of diagnostic tests performed by a physician. Initial diagnosis of SI pain includes a complete medical history check and physical examination of the patient. During the examination, physicians will consider any history of injury, location and duration of the pain, and problems while standing or sleeping. Specific tests for diagnosis may include (Laslett, 2008):

  • Imaging tests: This includes X-rays, MRI, or CT scans to check the condition of the spine.
  • Orthopedic provocation tests: This includes several tests such as sacral thrust test, distraction test, FABER test, and palpation test to confirm the sources of the pain.
  • SI joint injection: This includes injecting numbing drug-like lidocaine into the SI joint. If the pain goes away within a short time, this indicates a positive diagnosis for the SI joint pain.

How Do Neurosurgeons Treat Sacroiliac Joint Pain?

Treatment for SI joint pain focuses to alleviate pain and restore the normal motion in the joint. Initial treatment procedures for SI joint pain may include (Barros, McGrath, & Gelfenbeyn, 2019):

  • Complete rest for a couple of days.
  • Ice or heat therapy: Applying ice in the lower back and pelvis helps to reduce inflammation and alleviate pain and discomfort. In contrast, heat therapy helps to relieve the pain by reducing muscle spasms.
  • Medications: This includes over-the-counter pain relievers like acetaminophen) and NSAIDs like ibuprofen for mild-to-moderate pain relief. Muscle relaxants and narcotic pain killers also help to improve the condition.
  • Physical therapy: This includes low-impact exercise like yoga, and massage to strengthen and stabilize the SI joints to relieve pain.
  • Steroid injections: This also helps to reduce inflammation and alleviate pain.

Also, physicians suggest using pelvic braces around the waist to support the area. Finally, if the above approaches fail, neurosurgeons recommend surgery as a last option. During this surgery, neurosurgeons place a titanium implant and bone graft material to stabilize the joint and promote bone growth. This requires several weeks for a complete recovery and patients need to avoid heavyweight for a long time. For more information, contact us.

References

Barros, G., McGrath, L., & Gelfenbeyn, M. (2019). Sacroiliac Joint Dysfunction in Patients With Low Back Pain. Federal Practitioner : For the Health Care Professionals of the VA, DoD, and PHS, 36(8), 370–375. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/31456628%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC6707638

Cohen, S. P., Chen, Y., & Neufeld, N. J. (2013). Sacroiliac joint pain: A comprehensive review of epidemiology, diagnosis and treatment. Expert Review of Neurotherapeutics, 13(1), 99–116. https://doi.org/10.1586/ern.12.148

Falowski, S., Sayed, D., Pope, J., Patterson, D., Fishman, M., Gupta, M., & Mehta, P. (2020). A review and algorithm in the diagnosis and treatment of sacroiliac joint pain. Journal of Pain Research, 13, 3337–3348. https://doi.org/10.2147/JPR.S279390

Hamidi-Ravari, B., Tafazoli, S., Chen, H., & Perret, D. (2014). Diagnosis and Current Treatments for Sacroiliac Joint Dysfunction: A Review. Current Physical Medicine and Rehabilitation Reports, 2(1), 48–54. https://doi.org/10.1007/s40141-013-0037-7

Laslett, M. (2008). Evidence-based diagnosis and treatment of the painful sacroiliac joint. Journal of Manual and Manipulative Therapy, 16(3), 142–152. https://doi.org/10.1179/jmt.2008.16.3.142