SACROILIAC JOINT PAIN/DYSFUNCTION (SI JOINT PAIN)
WHAT IS SACROILIAC JOINT DYSFUNCTION?
The sacroiliac joints (SI joints) connect the base of the spine (sacrum) to the hip bone (ilium) on both sides of the body. Their primary function is to provide stabilization, support and shock absorption during movements like walking and bending over. Additionally, they transfer all the weight from the upper body to the lower body during movement. The SI joints have very little movement of their own; they’re supported by a web of strong ligaments and muscles. The joints make small movements to enable normal flexibility and range of motion.
SI joint pain and dysfunction occurs when one or both of the joints and surrounding ligaments suffer from damage, injury or inflammation. Pain can be the result of many types of dysfunction, including:
- Hypermobility. Hypermobility occurs when the joint has too much movement, leading to pain and instability in the low back, hip and groin.
- Hypomobility. Hypomobility occurs when the joint has too little movement, leading to tightness, muscle tension and loss of mobility in the low back and pelvis.
- Sacroiliitis. Sacroiliitis is a term used to describe inflammation of the SI joint. Inflammation in the joint causes pain, stiffness, swelling and loss of mobility.
Sacroiliac joint pain goes by many names, including: SI joint dysfunction, SI joint inflammation, SI joint strain, SI joint disease and SI joint syndrome. It can be an acute condition that resolves within a few weeks or months or a chronic condition that causes pain and symptoms for several months or years.
CAUSES AND RISK FACTORS
There are many conditions and activities that can cause damage and inflammation to the SI joints and surrounding ligaments. Common causes of SI joint pain and dysfunction include:
- A traumatic incident. A fall, car accident or contact sports collision can damage the SI joints and surrounding ligaments.
- Repetitive use movements. Physically demanding jobs, heavy weight lifting or high-impact activities like running or dancing cause repeated stress on the SI joints and ligaments. Over time, the stress can lead to inflammation, loosening or tightening of the ligaments, and degenerative changes in the joint.
- Degenerative arthritis. Over time, normal wear and tear, and repeated stresses from weight bearing, can cause the joint cartilage to erode. Cartilage erosion leads to pain, stiffness, swelling and inflammation in the joints. Once the cartilage is completely worn away, the bones of the joint painfully rub together.
- Inflammatory arthritis. Ankylosing spondylitis is a type of inflammatory arthritis that affects the spine. It causes inflammation, pain, stiffness and swelling in the SI joints.
- Pregnancy. Pregnancy hormones cause the ligaments in the low back to relax, leading to increased movement and instability in the SI joints. Additionally, weight gain, pelvic changes and an abnormal gait place more stress and pressure on the joints, causing wear and tear.
- Prior back or hip surgery. Surgeries like spinal fusions and hip joint replacement procedures can redistribute stress and pressure to the SI joints.
- Gait dysfunction. Conditions that cause an abnormal gait can lead to displaced stress and pressure on the SI joint on one side of the body. Leg length discrepancy, foot/ankle/knee/hip pain or injury, scoliosis, wearing a walking boot after surgery and wearing unsupportive footwear can all lead to uneven weight distribution and degenerative changes.
- Muscle weakness. Weak pelvis, low back and core muscles can place repeated stress and pressure on the SI joints during long periods of sitting or standing.
Sacroiliac joint pain and symptoms can range from mild discomfort to severe and debilitating. Significant pain can lead to difficulty performing normal daily activities. Typically, pain and symptoms only occur on one side of the body. You may experience the following:
- One-sided low back pain that may feel dull and aching or sharp and stabbing
- Pain that radiates to the upper back, hip, buttock, groin, or thigh
- Stiffness in the low back, hip, pelvis and groin
- Reduced range of motion and movement in the low back, hip, pelvis and groin
- Instability in the low back and pelvis
- Numbness, tingling or weakness that accompanies pain
- Muscle spasms in the low back
SI joint pain usually worsens with increased pressure on the joint, which means you may feel more pain with prolonged standing or sitting, climbing stairs, walking or sleeping on the affected side. You may also experience pain while transitioning from sitting to standing, or standing while placing more weight on the affected side.
TREATMENT AND PREVENTION
Making an accurate diagnosis of SI joint dysfunction can be difficult because the symptoms mimic other common back conditions. To begin, your doctor will take down your medical history and perform a physical exam. During the exam, you may do several specific exercises that can help your doctor pinpoint the exact location of your pain. Your doctor may order imaging tests like an X-ray or CT scan to look for other spine conditions that cause similar pain. Finally, your doctor may administer an anesthetic injection directly into your SI joint. If you experience relief, that’s an indication the SI joint is the source of pain.
Acute SI joint pain can typically be resolved within a few weeks with conservative, at-home care and treatment. Your treatment plan will include a combination of the following:
- Ice and heat therapy. Use cold compresses for up to 20 minutes several times a day to reduce pain, swelling and inflammation. You can alternate with hot compresses, which soothe pain, tension, and tight muscles and ligaments in the low back.
- Medications. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, aspirin and naproxen can relieve pain and reduce inflammation. If you have risk factors that prevent you from using NSAIDs, pain relievers like acetaminophen can help reduce pain. If you have severe pain, your doctor may prescribe a stronger painkiller or muscle relaxants.
- Physical therapy and stretching. A physical therapist can work with you to strengthen your back, core and leg muscles, correct gait abnormalities, and improve flexibility and range of motion in the low back. Your therapist can also show you several stretching exercises to relieve tension and pressure in the low back.
- Manual manipulations. Chiropractic manipulation and massage are effective treatments if you have sacroiliac pain and symptoms from too-tight ligaments.
- Bracing. Your doctor may recommend a pelvic brace if you have sacroiliac pain and symptoms from too-loose ligaments. The brace wraps around your waist to stabilize and support the pelvis and low back.
- Injections. Corticosteroid injections directly into the painful joint can reduce pain and inflammation in the area. Injections only provide temporary relief, but they can buy you time to start physical therapy, get stronger and resume your normal activities.
If your pain isn’t relieved by conservative methods or lasts longer than a few months, it may be time to consider surgical treatment.
Surgery is a treatment option if severe sacroiliac joint pain is affecting your daily quality of life and ability to perform your normal activities. When your pain can’t be relieved by conservative treatments, you may be a candidate for the following:
- Radiofrequency nerve ablation. Nerve ablation is a minimally invasive procedure that destroys the nerve fibers sending pain signals to your brain. It’s a safe and effective procedure to treat chronic pain.
- SI joint fusion surgery. A joint fusion is a minimally invasive procedure that fuses the hip bone (ilium) to the sacral bone to eliminate movement of the SI joint and reduce pain.
CONTACT INTEGRITY SPINE AND ORTHOPEDICS TO LEARN MORE ABOUT THE CONDITIONS WE TREAT
At Integrity Spine and Orthopedics, we specialize in identifying, diagnosing and treating a wide range of acute and chronic back, spine and joint conditions. Our board-certified orthopedic surgeons specialize in performing minimally invasive spine surgeries to reduce pain and improve mobility for patients diagnosed with spinal arthritis, degenerative disc disease, bulging or herniated discs, a pinched nerve, spinal stenosis and more.
Some of the primary benefits of minimally invasive surgery include:
- Smaller incisions
- Fewer complications and bloss loss during surgery
- Less damage to surrounding muscle and soft tissues
- Lower risk of infection
- Less post-op pain and less reliance on strong pain medications during recovery
- Faster recovery and rehabilitation
- Better cosmetic results with minimal scarring
If you’re experiencing back or joint pain, weakness, or a loss of mobility, reach out to us today to schedule a consultation with our team. We provide compassionate and comprehensive care to help you find relief from pain and get back to doing the activities you love.
Call us at 904-456-0017 or contact us online to request an appointment.