• Sacroiliac Joint Pain

    (Joint Pain, Sacroiliac)

    Definition

    The sacroiliac joint (SI joint) is where the bones of the spine connect to the pelvis. There is one joint on the right side and one on the left. These joints are held together with very strong bands of fiber called ligaments.
    The SI joint has very little movement. Its main job is to decrease impact to the spine during activities like walking. Problems in this area can cause pain in the lower back which may also pass into the groin or down the legs.
    Sacroiliac Joint
    sacroiliac joint
    Copyright © Nucleus Medical Media, Inc.

    Causes

    Damage to bones or ligaments of the joint can cause inflammation. The inflammation can cause pain and irritate nearby nerves which leads to more pain. Inflammation of the joint may be caused by:
      Problems in the bones of the joint such as: Injuries to the ligaments from:
      • Regular high impact activities such as jogging
      • Trauma such as an auto accident or fall
      • Falling or taking awkward steps off a curb or step
    • Changes during pregnancy—may allow for more movement of the joint which can cause irritation

    Risk Factors

    SI joint pain may be more likely to happen with:
    • Weak muscles
    • Bending or twisting the back
    • Improper lifting
    • Inflammatory conditions, such as ankylosing spondylitis or psoriatic arthritis
    • High impact sports or activities
    • Trauma

    Symptoms

    SI joint pain will differ based on the exact cause of the pain. The pain may be dull or sharp and may be any of the following:
    • Mild-to-severe low back pain
    • Pain in the buttocks
    • Pain that seems deep in the pelvis
    • Pain in the hip or groin or back of the thigh
    • Pain that radiates down the leg on the affected side
    • Stiffness of the lower spine
    • Certain activities may increase the pain, such as
    Pain may increase with certain activities such as walking, twisting, rising to stand, or bending

    Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will be done.
    The doctor will most likely make a diagnosis based on your symptoms. If there are other more serious symptoms or severe pain your doctor want to take images of the area. This can be done with x-rays or CT scan. Most will not need these tests.
    If needed, the doctor may use a nerve block to make sure the pain is coming from the SI joint. Medicine that blocks pain is injected near the SI joint. If pain stops, then the joint is confirmed as the cause.

    Treatment

    Treatment depends on the cause of the pain. Any underlying condition would receive treatment specific for that disease. For all causes, short-term rest is often the first step to allow time for the joint to heal.
    Talk with your doctor about the best treatment plan for you. Options may include one or more of the following:

    Medication

    Medication can help manage inflammation and reduce pain while the joint heals. Medication options include
    • Over-the-counter pain relievers, such as acetaminophen or other nonsteroidal anti-inflammatory drugs (NSAIDs)
    • Prescription pain relievers
    • Muscle relaxants—to decrease tension in the area which can make pain and injury worse
    • Steroid injections into the sacroiliac joint—to decrease inflammation

    Physical Therapy

    The joint may be moving too much or too little. An imbalance of muscles around the joint can also cause more problems. Physical therapy may help to speed healing and find a cause. Therapy sessions may include:
    • Exercises to stretch or strengthen the muscles of the lower back
    • Exercises to improve the motion of the sacroiliac joint
    • Ice or heat therapy

    Prevention

    Decreasing stress on the back with lower the chance of SI joint pain. Healthy steps include:
    • Exercising regularly to keep muscles strong
    • Maintaining good posture
    • Using proper techniques for bending, lifting, or playing sports

    RESOURCES

    Arthritis Foundation http://www.arthritis.org

    Ortho Info—Academy of Orthopaedic Surgeons http://www.orthoinfo.org

    CANADIAN RESOURCES

    Arthritis Society http://www.arthritis.ca

    Canadian Orthopaedic Association http://www.coa-aco.org

    References

    Chronic low back pain. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116935/Chronic-low-back-pain. Updated August 18, 2016. Accessed September 23, 2016.

    Cohen SP. Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment. Anesth Analg. 2005 Nov;101(5):1440-1453.

    d'Hemecourt PA, Gerbino PG II, et al. Pediatric and adolescent sports injuries: back injuries in the young athlete. Clinics In Sports Medicine. 2000 Oct;19(4):663-679.

    Dreyfuss P, Dreyer S, et al. Positive sacroiliac screening tests in asymptomatic adults. Spine. 1994;19(10):1138-1143.

    Inflammatory arthritis of the hip. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00396. Updated July 2014. Accessed June 2, 2016.

    Sacroiliac joint dysfunction. Orthogate website. Available at: http://www.orthogate.org/patient-education/lumbar-spine/sacroiliac-joint-dysfunction.html. Updated September 4, 2015. Accessed June 2, 2016.

    Sciatica. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115166/Sciatica. Updated February 8, 2016. Accessed June 2, 2016.

    Scopp JM, Moorman CT III. The assessment of athletic hip injury. Clinics In Sports Medicine. 2001 Oct;20(4):647-659.

    Speldewinde GC. Outcomes of percutaneous zygapophysial and sacroiliac joint neurotomy in a community setting. Pain Med. 2011;12(2):209-218.

    Spinal injections. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00560. Updated December 2013. Accessed June 2, 2016.

    van Benten E, Pool J, Mens J, Pool-Goudzwaad A. Recommendations for physical therapists on the treatment of lumbopelvic pain during pregnancy: a systematic review. J Orthop Sports Phys Ther. 2014;44(7):464-473,A1-15. Available at: http://www.jospt.org/doi/pdf/10.2519/jospt.2014.5098. Accessed June 2, 2016.

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