The sacroiliac joints, also known as SI joints, are the largest axial joints in the human body and are situated almost at the center of the human body connecting the lower part of the spine to the pelvis. As such, they help distribute load transfer from the spine to the legs. When operating normally, we don’t really notice the SI Joints as much, but whenever pain erupts from the lower spine and pelvis areas, they become very noticeable. SI joint pain is often the result of joint stress. This article explains in detail the sacroiliac joints and their causes for sacroiliac joint pain such as sacroiliitis. It also discusses in detail effective treatments for SI joint pain such as SI joint injection.
Before proceeding, we’d like to remind you that should you be experiencing pain, do not self-diagnose. Instead, get the advice of a qualified medical professional.
What are the Sacroiliac Joints?
Think of the sacroiliac joints as the midpoint of your body. These two joints connect the sacrum, or the lowest part of the spine before the tailbone, to the iliac bone, or the pelvis. The SI joints are the crucial bridgeway between the upper part of the body (the lower spine) to the lower part (the pelvis, which connects to the legs). Note that the iliac bone and the sacrum do not connect to the SI joints directly but rather connect with a number of strong ligaments.
The SI joints transfer weight and forces between your upper body and legs. As such, they play a pivotal role in providing efficient load distribution when carrying heavy equipment. In addition, they hold a critical role in transferring energy between the legs and the torso. By itself, the sacroiliac joints are some of the strong parts of the human anatomy. It is their job to support a significant amount of body weight.
The relative strength of the SI joints is essential as they bear the weight and stress the upper body. To give you a better idea, think of a normal activity while standing up or walking. As your legs move, the sacroiliac joints work continuously to ensure that your upper body stays straight while you walk or run. Even while seated, your SI joints need to stay in optimal condition to ensure your upper body remains upright.
The SI joints are unassuming body parts, working quietly but efficiently in maintaining posture. Because of their efficiency, people usually don’t notice the presence of the sacroiliac joints. That is until they start to hurt and send pain signals. When this happens, hips and legs often get affected as well.
Muscles and Ligaments
Supporting the sacroiliac joints is a tight network of muscles and ligaments. These limit the motion of the joints, which helps them manage loads better. A normal SI joint only allows for a limited movement of 2-4 mm in any direction.
The ligaments surrounding the SI joints are:
- Anterior sacroiliac ligament
- Interosseous sacroiliac ligament
- Posterior sacroiliac ligament
- Sacrotuberous ligament
- Sacrospinous ligament
The anterior ligaments are thinner and less defined compared to the others. The posterior and interosseous ligaments are very strong ligaments and often stay in place even if the pelvis fractures. They keep the sacroiliac joint from dislocating or opening. Meanwhile, the sacrotuberous and sacrospinous ligaments limit the sacrum’s movement.
SI Joint Differences in Gender
Given their roles in reproduction, ligaments supporting the SI joints in males and females are slightly different. Women are more likely to suffer from sacroiliac pain than men due to structural and hormonal differences. Female sacroiliac joint ligaments are less rigid and allow more flexibility to accommodate childbirth. As they mature, male sacroiliac ligaments strengthen while female joints become more mobile. Increased mobility in the joints often signals pregnancy. During pregnancy, the sacroiliac joint ligaments loosen thanks to the hormone relaxin. This allows the pelvic joints to widen during childbirth.
What Causes Sacroiliac Joint Pain?
Like any other joint, strain and injuries can happen to the sacroiliac joints. Common causes of SI joint pain include the following:
- Normal wear and tear, as regular repetitive motion gradually wears down the joints. Mechanical strain often builds up as people age, weakening joints.
- Trauma caused by accidents or overexertion can often damage the SI joints. This happens when people slip and fall hard on their hips or on their backsides. Or when people overly strain their bodies performing manual labor or strenuous physical activities.
- Pregnancy-related issues can strain the SI joints. While the female body often releases relaxin to help stretch the pelvis during birth, the changes in the SI joints eventually build up and make them more stretchy than usual. As a woman bears more children, the SI joints loosen more. It also increases the chances of wear-and-tear arthritis.
- Diseases and autoimmune disorders can affect the sacroiliac joints. They include many types of arthritis such as osteoarthritis, juvenile rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. Diseases such as gout and Reiter’s Syndrome can also cause SI joint pain. In addition, infections such as staphylococcus, gonorrhea, and TB can also aggravate the sacroiliac joints.
- Lumbar spine surgery can also cause SI joint pain when the iliolumbar ligament is damaged.
- Leg length discrepancy, gait abnormalities, and long scoliosis fusions to the sacrum can also lead to painful episodes of the sacroiliac joints.
Sacroiliac Joint Pain Symptoms
People with SI joint problems can experience limited movement and pain. They can appear as one or more of the following symptoms:
- Lower back pain
- Numb, tingling, or weakened sensation in the lower extremities
- Pain in the pelvis, buttocks, hip, or groin
- Legs buckling or giving way
- Inability to sleep due to pain
- Inability to stay seated for long periods.
- Need to shift sitting position
- Pain when performing regular physical activities such as standing up from a sitting position or lifting the knees.
SI joint pain is often described as dull, low pain emanating around the dimple, or the posterior superior iliac spine area. It happens more frequently on just one side but occasionally can happen on both sides. When sacroiliac joint pain is severe, it can travel from the hip to the leg but stops above the knee. Pain may also occur during sexual intercourse.
Get An Accurate Diagnosis
Note that SI joint pain symptoms may be similar to other conditions that affect the spine, hip, and pelvis. Often, a hip or lumbar pathology can exist alongside an SI joint pathology. A thorough sacroiliac joint examination is necessary to determine the cause and location of the pain. To ascertain whether the origin of the pain resides in the sacroiliac joint, a qualified pain specialist or another medical professional will need to check clinical results, medical history, and imaging studies of the patient.
A diagnostic SI joint injection can be used to help confirm the cause of pain. A pain specialist injects a numbing agent using X-ray fluoroscopy. The pain level is then evaluated within 30 minutes of the injection and monitored for a week. If the pain decreases by more than 75% after the procedure, it confirms the SI joint condition diagnosis.
A healthcare provider that specializes in pain diagnosis and treatment can help diagnose and pinpoint the cause of pain. An accurate diagnosis is needed in order to create a targeted treatment program that can relieve pain. If you think you are suffering from sacroiliac joint pain and want to get a proper diagnosis, contact MidSouth Pain Treatment Center and schedule an appointment.
The medical term for the condition in which one or both sacroiliac joints are inflamed is Sacroiliitis. It can cause pain in the lower back or buttocks, which can sometimes extend down one or both legs. Sacroiliitis is a condition that can be difficult to diagnose, as the symptoms often mimic those of other lower back pain conditions such as ruptured disk, collapsed vertebrae, spinal stenosis, and osteoarthritis.
The symptoms of sacroiliitis are aggravated when the sufferer performs extended periods of walking or standing, or when transitioning from sitting to standing. Sacroiliitis pain can be felt when the patient favors one leg over the other, or while running, climbing stairs, or taking large strides. When suffering this condition for a long period, other symptoms may appear, including fever or diarrhea. It can also cause the sufferer to find sitting or sleeping on one side difficult. In addition, they can experience difficulty staying in a single position when riding a vehicle.
Sacroiliac Joint Pain Treatments
Treating sacroiliac joint problems will require an accurate diagnosis. Once diagnosed as an SI joint issue, treatments often will focus on managing pain and restoring joint function. In mild cases, SI joint pain can be treated using non-surgical methods.
In the initial stages where going to a medical professional or a healthcare provider seems premature, sufferers can opt to apply initial remedies and see if their condition improves.
Resting and abiding any strenuous physical activity for 1 or 2 days can help rest the joint as well as determine the extent of the condition. Any additional day of rest may prove counterintuitive as it can aggravate stiffness and increase the pain.
Apply Ice or Heat
Applying ice or cold compress to the lower back and pelvis area can provide temporary relief and reduce inflammation and discomfort. Similarly, applying heat around the joint area can relieve pain by reducing muscle tension and spasms.
Taking over-the-counter pain relievers such as acetaminophen, or non-steroidal anti-inflammatory drugs such as ibuprofen can help relieve pain in mild or moderate cases. For more severe or acute pain, prescription medication may be issued by the attending physician or pain specialist.
Non-surgical Treatment Options
In the case where SI joint pain has been determined, there are a couple of non-surgical options that patients can consider that can offer relief from pain. They include manual manipulation or pelvic braces or supports.
When the SI joint problem is caused by limited motion, physical therapy by a licensed chiropractor, osteopathic doctor, or other health professionals may be considered. Manual therapy techniques applied directly to the SI joint and lower back can reduce joint fixation and reduce muscle tension. This can also lead to a restoration of normal motion to the affected area.
Pelvic Braces or Supports
For the opposite scenario where the SI joint is found to be too loose, a pelvic brace can be used to stabilize the area. Like manual manipulation, a pelvic brace can help alleviate pain and reduce inflammation.
Sacroiliac Joint Injections
SI joint injections are a viable treatment option for SI joint pain sufferers. When conservative treatment solutions such as over-the-counter relief medication or physical therapies don’t work effectively, and if a surgical procedure is premature or out of the question, an SI joint injection may provide long-lasting pain relief.
5 Things You Need to Know About SI Joint Injections
1. SI Joint injections can be used for both diagnosis and treatment
The sacroiliac joint injection can be used to confirm sacroiliitis, and it can be used as the treatment option as well. For diagnosis purposes, a numbing agent such as lidocaine will be used, If the patient reports a pain decrease of 75% or more within a week of observation, it provides an initial confirmation of the SI joint diagnosis. A second diagnostic sacroiliac injection is then performed using a different numbing medication, such as bupivacaine, to confirm the diagnosis.
For treatment purposes, the same procedure as a diagnostic SI injection is followed. However, instead of a numbing agent, a combination of an anesthetic and steroidal medication will be used to provide long-lasting pain relief to the patient. For both cases, the entire procedure takes about half an hour or less.
2. Do Not Eat, Drink, or Take Medication Before An SI Joint Injection
Patients undergoing SI joint injections, whether for diagnostic or therapeutic purposes, should not take any solid food or fluids after midnight before the procedure. Medications for diabetes must be taken after the procedure, not before. Blood thinners must be discontinued well before the procedure. Patients should consult with their medical healthcare provider before proceeding with the SI joint injection to ensure all precautions are met.
3. Relief Can Last As Long As Several Months Per Injection
The combination of anesthetic and corticosteroid medication works to provide pain relief to the SI joint area. The pain relief provided by the injection will last for several months. The state of reduced pain allows patients to undertake additional treatment options such as physical therapy, application of braces or supports, or other rehabilitation programs. Most patients experience pain relief after one or two injections. However, conventional medical wisdom recommends that patients receive no more than three injections within six months.
4. SI Joint Injections Are Performed Under X-Ray Guidance
An SI joint injection is almost always performed using X-Ray (fluoroscopy) image guidance. Once the needle enters the SI joint, contrast is injected to ensure proper needle placement and spread of medication. Accurate placement of the diagnostic or treatment medication is needed as this is the only way to confirm if the problem is with the SI joint. If the numbing agent or steroid injection misses its target, the doctor might misdiagnose the condition if it does not bring relief.
5. SI Joint Injection Side Effects Are Rare But Can Occur
SI joint injection side effects are rare, but they do occur. These include reported instances of the following:
- Allergic reaction to the medication used
- Infection (less than 1% under sterile conditions)
- Bleeding (based on patients with previous bleeding disorders)
- Bone infarct
- Increased blood sugar levels
- Transient vaginal spotting
- Transient facial flushing
- Sciatic nerve injury
- Bowel perforation
In addition, additional (and still rare) side effects may be experienced by patients who regularly take steroids on a daily basis. These include a transient decrease in immunity, stomach ulcers, avascular necrosis, cataracts, increased appetite, increased agitation and irritability, and decreased bone density which can lead to fractures.
Get Relief from SI Joint Pain Now
Relief is available for those suffering from sacroiliac joint pain. However, certain diagnostic tests and procedures are essential in confirming whether your sacroiliac joints are your primary source of pain. Schedule an appointment with us to get expert advice on the best pain management solutions available for your condition. Please call us (866) 707-1942 today to schedule an appointment with a pain specialist near you.
Don’t suffer in silence. Schedule an appointment today, and let us ease the pain you’re experiencing. We’ll be glad to help find out what’s wrong and create a pain management treatment plan.