The sacroiliac or SI joint is where the sacrum and pelvis meet. These joints are the source of many individuals' low back pain and one of the most common reasons for visiting a physician in the United States.
Here are some of the facts from the Centers for Disease Control and Prevention (CDC) regarding severe joint pain. It is:
- Higher among women than men
- Highest among adults aged 45 to 64 year
- More common among adults with arthritis (who also have other chronic conditions such as a disability, diabetes, heart disease, and obesity
With over 15 million people reporting severe joint pain in the U.S. alone and an estimated annual expenditure of over US$ 85 billion in 2005 has led some health policymakers to question the efficacy of current medical treatments.
But before discussing treatments that are available we need to answer these questions– what is SI joint pain? And what does it feel like?
What is SI Joint Pain?
Sacroiliac (SI) joint pain feels like a sharp pain when the joint degenerates due to arthritis, aging, or other factors. Pain is typically felt from the hips and pelvis, radiating down to the thighs or up to the lower back.
The SI joint transfers the weight from the upper body to the lower body (pelvis and legs). As people become older, the ligaments and cartilages that support the SI joints weaken. The support that aids the SI joints is the fluid that prevents the cartilage from rubbing together and causing pain. When people have arthritis, this synovial fluid becomes less viscous and it leaks out more out of the cartilages. As a result, the SI joint’s nerve endings rub with each other, causing more inflammation and chronic pain.
Also known as SI joint dysfunction, SI joint syndrome, SI joint inflammation, or SI joint strain — SI joint pain is typically felt nonstop and be worse with activities that pressure the SI joint.
Examples of activities that make SI joint pain worse are single-leg activities like walking, stair climbing, and getting up and down from the ground.
There are two types of sacroiliac joint pain — (1) acute or (2) chronic. Acute SI joint pain heals within a few days to weeks. SI joint pain that occurs for more than three months is considered chronic.
What Does SI Joint Pain Feel Like?
For nonstop pain, the sensation is a dull, aching nonstop pain. This can radiate to the buttocks, groin, thighs, or upper back. Other activities that can trigger sharp SI joint pain is when a person stands up, especially in the morning. Usually, pain is on one side of the lower back.
Image source: Shutterstock
What Are The Causes of SI Joint Pain?
SI joint pain causes can be traumatic or atraumatic.
Traumatic causes of SI joint pain are
- Pelvic ring fractures
- Indirect injury from motor vehicle accidents
- Strain or torsion from heavy lifting
- Soft tissue injury from fall on the buttock
Atraumatic causes of SI joint pain are
- Previous lumbar fusion
- Leg length discrepancy
Some people get SI joint dysfunction when they have a history of injury like falling onto their buttocks. In this, the ligaments holding the joint together become damaged — making the joint move abnormally.
SI joint pain may also be due to inflammation or sacroiliitis. This type of pain is often felt on the buttocks or lower back. The pain is worse after going up, going down, running or walking, or standing for a long time.
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For some people, arthritis is the cause of SI joint pain. Different forms of arthritis may contribute to this type of joint pain. For example, degenerative arthritis is from the wear-and-tear of the joints.
Another form of arthritis that can cause SI joint pain is ankylosing spondylitis or AS. This rare type of arthritis causes stiffness and pain in the spine. People with AS have reported that the pain is worse after sitting for a long time or lying down (like in the morning after a night’s sleep).
Also, one other factor that can cause SI joint pain is pregnancy when hormones are released, causing the joints to loosen up and move abnormally.
How Can You Tell The Difference Between Sacroiliac Joint Pain and Sciatica?
People with SI joint dysfunction have sciatica-like symptoms. Below is a table that highlights the differences between sciatica and SI joint pain symptoms.
What Are The Diagnostic Tools That Can Detect SI Joint Dysfunction?
Magnetic resonance imaging (MRI) can detect sacroiliitis. As one of the most reliable diagnostic tools, it can detect inflammation and structural changes on the sacroiliac joints. Some of the ways SI joint pain are detected are listed below.
- Cranial shear test – A pain provocation test used to diagnose sacroiliac dysfunction. The doctor will put pressure on the tailbone to check for pain.
- Gillet test – Also known as the one—leg stork test, the patient will stand with one foot raised and feet 12—inches apart. The doctor will then stand behind the patient, push on the tailbones with their thumbs, and check the movement.
- Flamingo balance test – This test will assess the ability of a person to balance. The test involves the patient standing on the painful leg and then hopping.
- Gaenslen’s test – This is also a pain provocation test where the doctor bends and presses one knee toward the chest. At the same time, the other leg is outstretched and pointed to the side.
- Pelvic compression test – The doctor presses down on the upper hip while the person lies on his or her side. As a pain provocation test, this stresses the posterior SI joint ligament to replicate the patient’s pain.
- Pelvic distraction test – Another pain provocation test is where the patient is made to lie face up and the doctor presses down on both sides of the pelvis.
When all of these pain provocation tests do not reproduce symptoms of pain, low back pain due to SI joint dysfunction can be ruled out.
What Exercises Are Bad for SI Joints?
Exercises such as lunges or impact (running or jumping) ones are bad for the SI joints. These types of exercises jostle the SI joint, which then makes the pain worse. Physical therapists recommend exercises that are easier on the low back and pelvis such as walking.
Image source: Shutterstock
Can a Chiropractor Help SI Joint Pain?
Resetting the SI joint requires a method best tolerated by the patient. The chiropractor may do different methods to treat the patient’s sacrum pain. SI joint pain symptoms include pain near the joint, popping or clicking at the joint during movement, and tenderness to palpation.
What Kind of Doctor Can You See for SI Joint Pain?
Patients with SI joint pain may be seen and treated by the following professionals.
- Pain management specialists
- Physical therapists
- Pelvic health specialists
Also known as rehabilitation physicians, physiatrists treat injuries or illnesses that affect movement.
Pain management specialists
These physicians have special training in the evaluation, diagnosis, and treatment of many types of pain (acute, chronic, or cancer pain). These experts focus on a nonsurgical approach to managing pain.
A physical therapist assesses and develops a treatment plan to prevent disability, improve mobility, and management of pain.
Pelvic health specialist
This specialist may help with pelvic organ problems like incontinence, pelvic pain, urinary tract infections, and SI joint dysfunction.
Can sacroiliac joint pain be cured?
Sacroiliitis can’t be cured. Over-the-counter pain relievers and muscle relaxants are prescribed to reduce inflammation. In more severe cases, there are prescription medications that can be used.
What is the Treatment for Sacroiliac Pain?
SI joint pain treatment is varied. There is no permanent cure for SI joint pain. However, there are many nonsurgical and surgical treatments that can effectively manage one sacroiliac joint pain symptom or more.
Non-invasive natural treatments such as oral medications are one of the first lines of defense against joint pain. Examples of non-invasive treatments include physical therapy, chiropractic manipulation, oral medications, and SI joint brace.
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A physical therapist may use manual techniques to reduce tissue pain associated with SI joint condition. They can use techniques such as massage and mobilization of muscles to reduce inflammation in target areas.
A study shows that the most effective nonsurgical treatment for SI joint pain treatment is manipulation therapy or manual therapy, most common in physiotherapy offices.
One of the techniques of a physical therapist is strengthening the gluteus muscles, which support the SI joint. As the first line of treatment, physical therapy also uses a stretching or stabilization program for footwear adjustment to correct leg length difference. This type of footwear is useful for pregnant women who have SI joint problems.
Some muscle relaxation techniques are used to reduce excessive strain on the SI joint. These muscles that may require stretching are listed below.
- TFL or tensor fascia lata muscle of the thigh
- Low back paraspinal muscles
In addition, exercise and athletic tapes are also effective in the treatment of disability, pelvic asymmetry, and pain in SI joint dysfunction.
There are two general approaches for SI joint dysfunction in chiropractic manipulation.
- Traditional chiropractic adjustment
- Spinal mobilization
The traditional chiropractic adjustment or spinal manipulation involves high-velocity, low-amplitude (HVLA) thrust. This type of approach is said to produce a reduction in a pre-existing pain problem, according to a study. When the HVLA is applied, a popping or cracking sound is created by air being released from the joint.
The HVLA thrust involves the following actions below.
- The patient is made to lie on his or her side where the knee on top is bent and then raised toward the patient’s chest.
- To produce a stretch in the low back, the shoulder on the bed is in forward position.
- One hand of the chiropractor is on the SI joint and the upper shoulder is pushed back as the knee is pushed facing the floor.
- If the patient is comfortable, high-velocity, low amplitude (HVLA) thrust is done by the chiropractor.
Another less forceful spinal manipulation involves the low-velocity, low-amplitude thrust. The difference between these two thrusts is just the speed. The LVLA movement allows the joint to remain in its passive range of motion.
Image Source: Photo by Karolina Grabowska from Pexels
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen sodium may be effective in relieving pain. NSAIDs block prostaglandins, responsible for promoting inflammation for healing. However, inflammation brings pain and supports the blood clotting function of platelets.
As a precaution, a person should take NSAIDs after eating as these drugs may irritate the stomach. Other reactions that NSAIDs may have are related to blood thinners, lithium, methotrexate, or cyclosporine. In some cases, physicians prescribe opioid medications for better pain relief.
Other groups of drugs that can help stop inflammation in the SI joint are TNF inhibitors. These types of drugs treat diseases like rheumatoid arthritis, psoriatic arthritis, sacroiliac joint arthritis, juvenile arthritis, and ankylosing spondylitis.
SI joint brace or sacroiliac belt
A sacroiliac belt wraps around the hips to hold the SI joints tightly together, reducing pain. This belt is a supportive brace that prevents excessive movement of the SI joint. When the SI joint is stabilized, the synovial fluid is gently forced out of the joint space and the ligaments begin to heal.
Therapists may advise wearing the joint belt according to individual needs, but healthcare providers advise a common protocol:
- Wear the belt for ten days for 24 hours.
- After ten days, spend six to eight weeks wearing the belt during weight-bearing activities such as walking or stair climbing.
Other terms for the SI joint brace include the trochanteric belt, sacroiliac belt, and trochanter belt.
Enough sleep and rest are crucial as it can help the body recover more quickly. Therapists advise putting a pillow between the knees and ankles to align the hips in a neutral posture.
For people who’ve been standing for hours, sitting or lying down may relieve SI joint pain.
In a study, sleep disturbance is said to contribute to chronic joint pain. The causes are related to biological and psychological factors. In the study, participants who have eight or more hours of sleep maintained a positive physical and psychosocial function through different kinds of pain. Similarly, patients who reported seven or fewer hours of sleep have reduced positive affect.
Heat or ice
Alternating heat and ice may help relieve pain in the SI joint. Ice applied directly on the low back can reduce inflammation and reduce pain. While heat around the joint may relieve pain by reducing muscle spasms and tension.
Start slow with a 20-minute walk twice a week. And if there is no pain in walking, add on more time or speed. Wear comfortable and supportive shoes, too.
When non-surgical treatments fail, there are surgical treatments that can lead to better patient outcomes. In particular, some surgeries involving a metal hardware are used to fuse bones to relieve SI joint pain. In some procedures, an implant is inserted to mask the pain perceived by the brain.
SI joint fusion
SI joint fusion is a surgery that grafts together the ilium and sacrum to eliminate movement.
The modern SI joint fusion is minimally invasive. A study on this type of SI joint fusion surgery resulted in reduced pain felt by the participants. Better yet, 94 percent of these participants are satisfied by the procedure. And as a plus, there were no procedure complications.
Spinal cord stimulator (SCS)
A spinal cord stimulator may help reduce SI joint pain caused by sacroiliitis. An implant is placed in the sacroiliac joint and uses electrical impulses to mask pain.
Radiofrequency ablation (RFA)
RFA of the sacroiliac joint uses radio waves to destroy nerves responsible for carrying signals from the injured SI joint to the brain. As a result, the brain does not register pain. RFA is done using fluoroscopic (x-ray) guidance and is ill-advised on people who are pregnant, have an infection, or have bleeding problems.
Treatment involves injections of an irritant solution, commonly a sugar solution, into part of a joint to trigger connective tissue growth, causing less pain. Inform the healthcare provider for acute infections such as cellulitis or septic arthritis, acute gouty arthritis, and acute fracture.
Intraarticular injections such as steroids reduce inflammation tendons and ligaments in osteoarthritic joints. Healthcare providers monitor skin reactions, blood glucose levels, and flare responses (infections, tendon ruptures, and osteonecrosis).
Pulsed radiofrequency or PRF
An alternative to continuous radiofrequency ablation (RFA) in the treatment of some chronic pain problems – PRF is delivered two times per second on short bursts followed by a pause.
Compared to CRF, PRF has less tissue destruction – making it safer than CRF. Other benefits include less neuritis-like reactions and motor deficits in PRF. More so, PRF is less costly than CRF.
Low back pain erodes the quality of life. The statistics involving chronic back pain are higher than some of the top causes of morbidity such as cancer or chronic obstructive pulmonary disease.
As the leading unrecognized cause of low back pain, SI joint dysfunction has been overlooked by many physicians as they don’t include it in a typical diagnostic workup. However, finding out the cause of the pain is just as important as managing it.
What You Can Do Next
If you are suffering from back pain, give us a call at (866) 707-1942 to schedule a time for you to see one of our providers so you can get back on your feet. We are the “pain doctor near me.”