Sacroiliac Joint Pain
Injury and/or inflammation of the sacroiliac joint is recognized as one of the leading causes of chronic lower back pain
It is estimated that around 15% of all patients who come in for evaluation and pain treatment for chronic lower back pain are suffering from sacroiliac joint pain. This translates to as many as 10 million adults in the United States.
The sacroiliac joint is situated at the connecting point of the pelvis and the lower spine (it is the joint between the sacrum and ilium bones of the pelvis). The sacroiliac joint is a strong and stable lower extremity joint capable of shock absorption and supporting the weight of the upper body, thereby reducing pressure on the spine.
Sacroiliac joint pain, sacroiliitis (or sacroiliac joint dysfunction), usually affects adults in their later years and can impact one’s productivity and overall quality of life. The levels of pain and discomfort often experienced from SI joint pain sufferers is thought to be similar to pain levels from conditions such as osteoarthritis and spinal stenosis.
What causes sacroiliac joint pain?
Sacroiliac joint pain is caused by inflammation in one or both sacroiliac joints, leading to a condition known as sacroiliitis or sacroiliac joint dysfunction.
The sacroiliac joint enables pivotal body motions, such as bending forward or backwards, and offers shock absorption for the upper body to reduce pressure on the spinal column. These specific joints are supported by strong muscles and ligaments. During the aging process, these structures often begin to wear down which causes stiffness and inflammation. The sacroiliac joint also has free nerve endings that can cause extreme sensations of pain when a joint (or the neighboring structures) begins to deteriorate. Joint degradation often produces significant pain and inflammation in the affected area(s).
The primary causes of SI joint pain relate to aging, although acute injuries can also create inflammation and degeneration of the joints. Here are some of the common causes of sacroiliac joint pain:
- Post-surgical changes in the area (common with hip and spine surgeries like lumbar fusion)
- Disorders such as psoriatic arthritis, ankylosing spondylitis, gout, and rheumatoid arthritis
- Pregnancy or childbirth-related changes in the ligaments and muscles in the region
- Laxity or tightness in the ligaments and muscles (due to an acute injury)
- Exercises that create a pounding effect on the joints (such as running)
- Autoimmune diseases (such as axial spondyloarthritis)
- Improper footwear (worn for work, sports, activities)
- Wear-and-tear arthritis or osteoarthritis
- Trauma, injury, damage in the joints
- Arthritis in the hips or knees
In rare cases, a bacterial infection in the sacroiliac joints can also cause inflammation and pain.
Sacroiliac joint pain can range from mild to severe depending on the extent of the injury and level of inflammation that injury has caused. Acute pain experienced from the sacroiliac joint region can often be resolved within several weeks with treatment. Chronic pain conditions are more challenging and can take months to adequately address and/or resolve.
What are the signs and symptoms of sacroiliac joint pain?
The pain caused by sacroiliac joint can be experienced in a variety of ways based on the damage to the joint(s), although inflammation, acute pain and stiffness are typical symptoms for this type of joint injury.
Other signs and symptoms of a SI joint injury include:
- Pain during the transition of movements (from standing to walking or sitting to standing)
- Reduced ability to bear weight – typically on the same side of the body as the affected joint
- Reduced range of motion in the hips, pelvis, groin, and lower back
- Hot, sharp, stabbing, sciatica-like pain in the buttocks and thighs
- Spreading and radiating pain to the groin, hips, and buttocks
- Dull, aching lower back pain
- Aggravated symptoms while sitting, standing, sleeping, walking, etc.
- Difficulty in movements related to bending and/or climbing
- Increased pain during exercising or playing sports
- Feeling of instability in the lower back and pelvis
- Increased pain in one of the sacroiliac joints
- Tingling sensations in the lower limbs
- Burning sensations in the hips
- Numbness in the region
What are the risk factors associated with SI joint pain?
There are certain factors (or triggers) that can increase the chance of someone experiencing SI joint pain. They include:
- History of contact sports / intense physical activity
- Lower back or spine surgery
- Pregnancy and childbirth
- Improper form during lifting and/or manual labor
- Weak muscles
- Age and Gender
What are the complications associated with SI joint pain?
If SI joint pain is not correctly diagnosed and treated, it can lead to further health complications such as bone fractures, damage to muscles and ligaments in affected area(s), reinjuries and chronic pain conditions.
Patients who experience high levels of pain from a chronic SI joint pain condition can also experience anxiety, depression, and insomnia.
When should I see a doctor for sacroiliac joint pain?
It can be difficult to know when to consult the doctor for sacroiliac joint pain as the signs and symptoms often mimic other conditions, such as sciatica and arthritis. If you are experiencing any of the signs and symptoms of sacroiliac joint pain (listed below), it is recommended to visit a doctor at Advanced Pain Care for a complete evaluation, diagnosis, and customized SI joint pain treatment plan.
- Inability/Reduced ability to bear the weight
- Increased pain during movement
- Gait-related issues
- Persistent pain for several weeks
- Inability to bend or climb
How is sacroiliac joint pain diagnosed?
Sacroiliac joint pain can often be completely resolved, but that depends on the accuracy of the diagnosis and effectiveness of the treatment plan. To reach an accurate diagnosis, the orthopedic specialists and pain management physicians at Advanced Pain Care conduct a complete and thorough evaluation which will involve:
- Medical examination and evaluation of past medical history — This can include information about posture while sleeping or working, recent injuries, and other symptoms. The physician will also examine and manipulate the joint(s) at different points to check for signs of stiffness, tenderness, range of motion, etc.
- Imaging studies — X-rays, MRIs, and CT scans might be prescribed to check for any problems in the region to support a diagnosis.
- Orthopedic provocation tests — There are specific tests to further identify specific pain sources, such as a sacral thrust test, distraction test, FABER test, Gillet test, and palpation test.
- Diagnostic injections — An injection with a corticosteroid and a local anesthetic using fluoroscopic guidance to address the cause of the pain. If the pain level does not change after the injection, sacroiliac joint pain is ruled out; if it decreases by over 75%, the cause is confirmed as SI joint pain.
How is sacroiliac joint pain treated?
The primary goal of pain management specialists at Advanced Pain Care is to manage patient’s symptoms and pain while allowing the joint time to heal on its own. Non-surgical treatment options to reduce SI joint pain include:
- Over-the-counter pain relievers (such as ibuprofen, muscle relaxants, or steroid injections)
- Rest, Ice, Compression, and Elevation (RICE) treatment
- Manual manipulation for hypomobility
- Pelvic braces
- Physical therapy to increase the range of motion and strength of the joints
- Tumor necrosis factor inhibitors (TNF inhibitors)
- Radiofrequency ablation and nerve blocks
- Electrical stimulation
Minimally invasive procedures and medications are usually enough to effectively treat and/or resolve this condition. If these treatments are not effective in managing the pain and inflammation, then surgical options might be discussed. The pain management physicians at Advanced Pain offer state-of-the-art, multi-modal treatments to identify, treat and resolve pain stemming from sacroiliac joints with multiple specialties in one location (Pain Management, Orthopedics, Rheumatology and Neurosurgery). Advanced Pain Care offers same or next day appointments.
Is surgery required for sacroiliac joint pain?
Surgery is generally the last option in a SI joint pain treatment plan. Sacroiliac joint fusion is a commonly performed surgical procedure for sacroiliac joint pain that involves a surgeon using surgical-grade, titanium implants, and bone graft material to fuse and stabilize the joints while increasing the growth of bones.
This specific procedure is done under general anesthesia and typically takes about an hour. The recovery process usually takes from 3 to 6 months after the procedure, and will often include the following treatments post-surgery:
- Pain medications
- Use of crutches (as needed)
- Physical therapy
- Use of a pelvic brace (as needed)
What are the precautions taken to prevent sacroiliac joint pain?
Most lower back injuries are preventable and you can prevent injury or inflammation to the SI joint in the following ways:
If you are in pain there is no need to wait.
The specialists at Advanced Pain Care are experienced in diagnosing and effectively treating SI joint pain through a multi-modal approach that includes Orthopedics, Rheumatology and Neurosurgery.
We offer patients the latest treatments options in state-of-the-art clinics and surgery centers. Contact Advanced Pain Care at 512-244-4272 or visit www.austinpaindoctor.com for more information or to schedule a same or next day appointment.
Q: What does sacroiliac joint pain feel like?
A: Sacroiliac joint pain (or SI joint pain) is typically experienced as a one-sided, dull, and aching pain in the lower back and buttocks. It can also cause radiating pain in the lower hip, thigh, and groin area. Pain is often accompanied by a sensation of numbness and weakness in the lower limbs.
Q: Is walking good for sacroiliac joint pain?
A: Low-impact exercises (such as walking and light aerobic activity) is advised for patients experiencing sacroiliac joint pain, although heavy exercises or activities that cause significant impact on the joints (such as running) should be avoided.
Q: What causes sacroiliac joint inflammation?
A: Inflammation in the sacroiliac joint can be caused by a multitude of reasons which include:
- Irritation in the hips or knees caused by arthritis
- Laxity or tightness in the ligaments and/or muscles (due to an acute injury)
- Pregnancy or childbirth-related changes in the ligaments and muscles in the area(s)
- Post-surgical changes in the affected area (common with hip and spine surgeries)
- Autoimmune diseases (such as axial spondyloarthritis)
- Trauma and injury leading to damage in the joints
- Wear and tear arthritis or osteoarthritis
- Disorders (such as psoriatic arthritis, ankylosing spondylitis, gout, and rheumatoid arthritis)
Q: How long does it take for sacroiliac joint pain to go away?
A: Sacroiliac joint pain can range from mild to severe and depends on the specific nature and extent of the injury. While acute SI joint pain is often reduced or resolved within several weeks, chronic SI joint pain is more challenging, will last longer, and may require sacroiliac joint pain treatment. The physicians at Advanced Pain Care are leaders in pain management and are available to evaluate, diagnose and treat your specific pain condition. Call 512-244-4272 or visit www.austinpaindoctor.com to schedule a same or next day appointment. If you are in pain, there is no need to wait.