The sacroiliac joints are the two joints formed between the sacrum of the spine (hence Sacro) and the two iliac or hip bones (hence iliac!).
They provide the connection between your spine and your lower body. These joint are now known to cause back pain in some individuals, but is the number of people affected by SI joint pain, considerably underestimated?
The function of the SI joints is to provide gliding movements between the two bones, which transmit motion between our upper and lower bodies. As well as allowing these movements, the joints must provide stability for the core of the body.
The sacroiliac joint is the part of the body that connects the base of the spine (sacrum) and the part of the pelvis called the ilium. There are two connections and each connection forms a strong robust joint due to the formation of grooves and ridges at the end of the bones.
Both ends of the bone are covered with cartilage, which acts as a shock absorber. The strength of the joint is really due to two factors the grooves and ridges and mentioned earlier and extremely strong ligaments surrounding the joint (both anterior and posterior)
There is two main causes of sacroiliac joint pain, sacroiliitis and sacroiliac joint dysfunction. Sacroiliitis is an inflammation of the joint and as such may cause pain in the lower back, buttocks, and thighs.
Sacroiliac joint dysfunction can also cause pain in the low back and legs but is commonly believed to be caused by problems with the joint movement i.e. either too much movement or too little.
Sacroiliitis tends to be caused by degenerative tissue diseases such as psoriasis. Strained ligaments are unlikely to be a cause of sacroiliac joint pain as the ligaments surrounding the joint are extremely strong; they are actually stronger than the bold so in most cases the pelvis will break before the ligaments too.
The following are symptoms that may be an indication of sacroiliac joint problems
- Pain very low down in the back
- Pain is often located on one side
- Pain may refer to the buttock or leg
- Stiffness in the mornings or after long periods of rest
- Pain is common following driving, bending over and trying to put socks on!
- Assessment techniques and treatment for SIJ dysfunction remain controversial due to the complexity of the area, movement patterns and variety of techniques and therapists who deal with the condition.
- A dull ache in the lower back and hips may be a sign of a mechanical sacroiliac joint problem. The joint has a very limited range of movement and the ache may be a product of the person exceeding the range.
- The pain will usually be a mild or moderate an around the posterior that may become worse when standing from a seated position.
- The pain usually appears on the left-hand side of the body.
- You notice yourself changing your posture and body position to avoid discomfort.
- Lower back pain and stiffness that often increases throughout the prolonged sitting all prolonged walking.
There are many ways to test for sacroiliac dysfunction but unfortunately, most of the individual tests have proven to be unreliable by themselves.
Your doctor will usually recommend a combination of tests and then take great care and significant time to analyze and correlate the results. Careful interpretation of tests is critical to both false positives and false negative test results in our common with individual tests.
Commonly, Treatment involves:
- Rest from aggravating activities
- Anti-inflammatories (may require a prescription)
- Massage to the surrounding areas
- Electrotherapy to ease pain
- Mobilisation of a qualified professional
- A rehabilitation programme to correct causative factors.
- Corticosteroid injections are used in severe, persistent cases
- The sacroiliac joint should be considered in all cases of lower back pain.
Sacroiliac Joint Dysfunction
The Sacroiliac joint (SI) connects the base of the spine to the pelvis. It has two connection points and a hefty network of ligaments because it is a weight-bearing joint. The connection points have a kind of interlocking mechanism that limits movement at the joint.
The SI joint can become irritated and is easily inflamed, resulting in pain in the lower back and buttocks. If left untreated, this joint can become arthritic.
What Causes It?
The most common reason for the SI joint to work improperly and become inflamed is that the position of the pelvis in relation to the curvature of the base of the spine gets out of balance.
If the pelvis is tipped or tilting and the connection points of the joints are not seated correctly, there will be uneven wear and tear and, over time, the joint will break down and lead to arthritis.
It is important to understand that the position of the pelvis and the position of the spine do not change overnight. It takes time, often many years of your muscles being out of balance with each other for this to happen.
These muscle imbalances cause postural imbalances. Eventually, if the muscles, bones, and SI joint are not working together as they should, this will result in a condition known as Sacroiliac Joint Dysfunction.
Sacroiliac joint dysfunction can be caused by different conditions. As with other joints in the body, the sacroiliac joint can also be affected by arthritis. Osteoarthritis, an arthritic condition can occur when the cartilage of the joint becomes thinner. The bone will then rub with each other and could lead to arthritis, which is the number one cause of SI dysfunction.
Another condition that may cause SI dysfunction is a direct impact on the joint like it falls. Due to postural changes and abnormality in hormones brought about by pregnancy, SI dysfunction is common in pregnant women.
Abnormal kinematics in the joint can lead to pain, and this is true in people with leg length discrepancy, or when one leg is longer than the other. Systemic disorders may also affect the SI joint like gout, RA (rheumatoid arthritis), ankylosing spondylitis and psoriasis.
Pain in SI dysfunction is felt in the lower back region but can extend up to the buttocks. The intensity of pain increases when the back is extended like in walking, lying down or standing. Pain can be perceived in the hips and groin area. During the physical examination, pain can be reproduced by giving stress to the joint.
Noninvasive treatment for SI joint dysfunction includes physical therapy. Invasive procedures include joint injections of local anesthetic and steroid. Lumbar stabilization techniques and stretching of the back are typical exercises that are beneficial for SI joint dysfunction patients
Radiofrequency Neurotomy (Ablation) of The Sacroiliac Joint
Pain in the sacroiliac joint causes low back pain in 10 to 25% of those with chronic low back pain. Unfortunately, there are 2 SI joints which can both cause pain at any one point in time due to degenerative arthritis.
The SI joints have cartilage just like any other joint and can be afflicted with painful arthritis. Ahh, the beauty of getting older!
Typical treatments for pain coming from the SI joint include over-the-counter medications such as Tylenol and anti-inflammatory’s, physical therapy, chiropractic treatment, along with potentially a TENS unit.
As individuals age, arthritis ensues and weight bearing mobile joints may experience significant pain. There are sacroiliac joints on both sides of the body.
They are joints with cartilage and some movement does occur in the joints. It is not nearly as much movement as a ball and socket joint like the hip, but enough to cause daily pain for individuals. Radiofrequency ablation may help for an extended duration in the SI joints and be an excellent nonoperative treatment.
The Unfortunate Things about sacroiliac Joint pain are That
- it is a very common problem to have
- It can be tough to diagnose the SI joint as a pain generator
- It is a tough problem to treat either non-operatively or operatively
Similar to the facet joints in the lumbar spine, it can be difficult for a pain doctor to accurately place a needle into the joint.
A significant angle may be necessary to achieve placement, and it should always be performed under x-ray guidance. Having a sacroiliac joint injection performed without it entails a high miss rate, upwards of 50%.
The objective of a radiofrequency ablation also called a radiofrequency neurotomy, is to heat up and “deaden” the small nerve endings supplying the sacroiliac joint causing a patient’s pain.
These are not nerves that supply vital motor or sensory functions, but tiny little nerve endings that bring sensation to the joint itself. If those can be negated, pain can be decreased.
Prior to it being performed, the pain doctor will perform a diagnostic injection containing numbing medicine around these nerve endings to make sure the patient will obtain pain relief and the joint is the source of the pain.
If it works, then the radiofrequency procedure is indicated and the patient’s insurance company usually approves the procedure.
The procedure has been shown on average to alleviate pain from six to 18 months, which is more than double the average of a standard cortisone injection.
A radiofrequency ablation is an outpatient procedure. Patients who are on blood thinning medications like Coumadin will need to stop this for at least 5 days or so prior – the physician can give specific time frames.
The procedure usually lasts 30 to 45 minutes and the patient will be sore for days afterward. In fact, the patient may get worse for a few weeks as the initial trauma from the procedure wears off and the benefits “kick in”.
At a certain point after the procedure, the nerve endings will grow back and regenerate. This may bring back the pain from before, it may not. If this happens, the procedure may be repeated.
Potential complications of a radiofrequency neurotomy include pain around the injection site, numbness of the skin over the injection site, initially worsened pain due to muscle spasms, infections (rare), or in a few cases worsened pain from the procedure (unusual).
The Sacroiliac Joint Exercises
Sacroiliac joint pain is a common ailment that affects many lower back pain sufferers. While some individuals have stable joints, others just seem to deal with constant subluxations of the joint, thus leading to the common ups and downs of no pain cycled with sometimes excruciating pain.
Adjustments to the joints can be effective, but over the long run, strengthening and balancing the muscles that support this area is the ideal choice for long-term relief.
How To Neutralize Your Back To Prepare For The Exercises?
Important: Don’t skip this. If you do the below exercise without doing this first, you will risk further injury to your sacroiliac joint by only making any misalignments worse than before. So make sure you do this!
To do this preparation exercise, you start from a standing position. The first thing to do is placing the shoulder blades and the buttocks and against a wall so that you can check the position of the lower back.
Make sure there is an arch between the lower back and the wall (which is where it is a normal position). In order to neutralize the spine, it is important to stay in the same position that pushes the center of your back toward the wall.
The SI Joint Exercise
The exercises for sacroiliac joint pain involve the gluteal muscles. These large, powerful muscles, when contracted bilaterally, have the ability to stabilize the joints, and in cases in which the joints are misaligned, can bring balance. The deep abdominal muscles are also essential for creating sacroiliac joint stability.
Supine Hip Extension: This movement is performing while laying on your back. With your feet approximately 12 inches from your hips, squeeze your butt muscles and slowly lift your hips to the sky.
At the top, squeeze for 2-3 seconds, then lower back to the floor again. This movement can be repeated for up to 20 reps.
Standing Sumo Stance Squat: This useful variation of the squat is done with a wide stance. Your feet should be turned out at 45-degree angles, and your knees always follow your toes.
While holding a light curve in your lower back, (called a lordosis), slowly squat down while maintaining an equal weight between your legs. Upon returning back to the top, emphasize squeezing your butt muscles together.
These two movements are a few of the top sacroiliac joint exercises that can be performed. Focus on getting stronger at them, and in no time you will be stronger, more stable, and have less pain!
No universal accepted standard exists for the diagnosis of low back pain stemming from the sacroiliac joints.
The joint itself is fairly irregular in appearance and difficult to properly evaluate in imaging studies, so trying to “hang one’s hat” on the sacroiliac joint as a source of pain from x-rays, CT scans, or MRI’s is not accurate.
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