If you feel pain in your lower back when standing from a sitting position, the pain could be from one of your Sacroiliac (SI) Joints. The two sacroiliac joints, one on each side of the spine, link the pelvis (iliac bone) to the sacrum (lowest part of the spine above the tailbone) and are held together by ligaments. The sacroiliac joints move slightly, acting as shock absorbers that transfer weight and force between your upper body and legs as you walk and move.
As we age, the movement of the SI joints wears down the cartilage, which can result in arthritis and pain.
What Is Sacroiliac Joint Pain?
The sacroiliac joint is the cause of 15 to 30 percent of patients suffering from chronic lower back pain. Sacroiliitis, though, can be difficult to diagnose, because it can be mistaken for other causes of low back pain, such as sciatica and pain caused by a lumbar disc herniation.
The sacroiliac joint is filled with fluid and nerve endings. If the pelvis and sacrum are out of alignment, they can pinch a nerve resulting in inflammation and pain. Doctors call an inflammation of one or both SI joints sacroiliitis.
Patients with sacroiliitis may experience pain that is dull, or a sharp stabbing pain that begins at the SI joint and radiates from the hips and pelvis. In some cases, the patient may have a numbness or tingly sensation, and the legs may feel like they are not strong enough to support standing.
In addition, the pain may:
- Radiate up to the lower back or down to the thighs.
- Be on one or both sides of the lower back.
- Be worse with prolonged standing.
- Be worse when climbing stairs.
- Be worse in the morning, but improve during the day.
What Causes Sacroiliac Joint Pain?
Pain starts when the SI joint becomes inflamed, which is a condition called Sacroiliac Joint Dysfunction or Sacroiliitis. Causes of sacroiliac joint dysfunction include:
- Traumatic injury. A sudden impact, such as a motor vehicle accident, a fall, or sports injury can damage the sacroiliac joints.
- Regular wear. An activity that gives the joint a regular pounding, like jogging.
- Physical factors. If one leg is longer than the other, it can force uneven strides when walking and cause SI joint pain. Damage could also occur to the ligaments because of abnormal movement of the joint.
- Arthritis. Inflammatory arthritis and the wear-and-tear of osteoarthritis can occur in the sacroiliac joints.
- Pregnancy. Added weight and an altered gait during pregnancy, in addition to the sacroiliac joints loosening and stretching to accommodate childbirth, can stress the joints and result in pain. After childbirth and the resumption of a normal walking gate, sacroiliac joint pain may go away.
- Infection. In rare cases, the sacroiliac joint can become infected.
- Aging. The pain may be the result of aging and the wearing away of the sacroiliac joint cartilage.
What are the Symptoms of SI Joint Pain?
Pain from sacroiliac joint disorders can be felt anywhere in the lower back, buttocks, or in the legs. Chronic sacroiliac joint pain can make it difficult to perform common daily tasks, and affect every aspect of a patient’s life.
Common symptoms include:
- Lower back (lumbar) pain (below L5).
- Sensation of lower extremity: pain, numbness, tingling, weakness.
- Pelvis/buttock pain.
- Hip/groin pain.
- Disturbed sleep patterns due to pain.
- Disturbed sitting patterns (unable to sit for long periods, sitting on one side).
- Pain limited to just one of the sacroiliac joints.
- Increased pain when standing from a sitting position.
- Stiffness or a burning sensation in the pelvis.
- Pain radiating down into the thighs and upper legs.
- Feeling like your legs may buckle and not support your body.
Also, sacroiliitis pain can be aggravated by:
- Prolonged standing.
- Bearing more weight on one leg than the other.
- Stair climbing.
- Taking large strides.
How is SI Joint Pain Diagnosed?
Accurately diagnosing sacroiliac joint pain can be difficult because the symptoms mimic other common conditions. The sacroiliac joints are located deep in the body, making examinations and motion testing difficult. Also, the symptoms of sacroiliac joint pain are very similar to conditions like sciatica, bulging discs, and arthritis of the hip. So, it is important a doctor knows about previous injuries that may have directly affected the pelvis, or caused the patient to walk abnormally.
In a physical exam, the doctor tries to pinpoint the source of the pain by pressing on the hips and buttocks. The doctor will also move the legs into different positions to gently stress the sacroiliac joints.
If the movement recreates the patient’s pain, and no other cause is apparent, the sacroiliac joint may be the cause of the pain.
An X-ray of the pelvis can reveal signs of damage to the sacroiliac joint. If inflammatory arthritis affecting the spine and large joints is suspected, the doctor will order an MRI (a test using radio waves and a strong magnetic field) to produce very detailed cross-sectional images of bones and soft tissues.
Because low back pain can have many causes, a numbing injection (anesthetic) can sometimes help with the diagnosis. For this test, the doctor uses an X-ray to guide the injection of a numbing solution into the sacroiliac joint. If an injection stops the pain, it’s likely that the problem is indeed the sacroiliac joint.
How is Sacroiliac Joint Pain Treated?
There are several treatment options available for sacroiliac joint pain. The first and most obvious step is simply to stop doing things that cause the pain, including sports activities that may inflame the joint.
Physical therapy, low-impact exercises (yoga), and massage can help stabilize and strengthen the sacroiliac joints and ease the pain. If these do not help alleviate the pain, there are other options available.
Typical treatments for sacroiliac joint dysfunction include:
- Over-the-counter pain relievers. Drugs such as ibuprofen and acetaminophen may help relieve pain associated with sacroiliitis.
- Ice, heat, and rest. Initial treatment is to apply ice or cold packs to reduce inflammation, along with rest to reduce irritation. Once the inflammation subsides, a gradual return to normal activities may be advisable. The application of heat (such as a heat wrap or hot bath) may help the healing process.
- Muscle relaxants. Sometimes stronger medications help reduce the muscle spasms often associated with sacroiliitis.
- Chiropractic manipulations. Manual manipulation may also help, and is most effective when the sacroiliac joint is “stuck.” A qualified medical professional must decide if this is an appropriate treatment in each case.
- Physical therapy and exercise. Controlled, gradual physical therapy may be helpful to strengthen the muscles around the sacroiliac joint and help increase the range of motion. Gentle, low impact, aerobic exercise helps improve blood flow and stimulate healing. If there is severe pain, water therapy is a good option since the water provides buoyancy for the body and helps reduce stress on the joint.
- Supports or braces. If the sacroiliac joint is hypermobile (loose), a brace about the size of a wide belt can be worn around the waist to help stabilize the area, which can be helpful when the joint is inflamed.
- Sacroiliac joint injections. While sacroiliac joint injections are primarily for determining if the sacroiliac joint is the cause of the pain, they also provide immediate pain relief. The injection typically contains an anesthetic to help reduce or alleviate pain. The immediate pain relief helps the patient begin physical therapy and return to normal activity levels.
- Electrical stimulation. Implanting an electrical stimulator into the sacrum may help reduce the pain.
- Nerve treatment. A minimally invasive procedure to permanently stop the pain signals from the sacroiliac joint to the brain can significantly reduce the pain.
- If the pain is chronic, and physical therapy, medications or minimally invasive interventions have not been effective, surgery may be an option. There are different types of sacroiliac joint fusion surgery. One procedure uses small plates and screws to hold the bones and allow them to grow together and eliminate abnormal motion and reduce pain. Another, less invasive surgical procedure uses implants to stabilize and limit movement of the pelvis and sacrum bones.
Is It Possible to Prevent Sacroiliac Joint Pain?
Unfortunately, SI joint pain is not preventable in many cases, because it is a part of the normal aging process. However, it is possible to reduce the severity of SI joint pain, and in some cases, slow the progression through healthy lifestyle choices and treatment with medication, injections, or physical therapy.
Maintaining a healthy body weight along with good physical conditioning can help reduce the chances of developing sacroiliac joint dysfunction. By reducing the weight load on the joints, there is less chance for cartilage damage and subsequent arthritis.
- Maintain a healthy weight.
- Get regular exercise.
- Take frequent breaks to stretch and walk around, if seated for extended periods of time.
- Sleep on your side with a pillow between your knees to help keep your hips aligned.
The prognosis of sacroiliac joint dysfunction varies depending on the cause. If it is the result of pregnancy, the prognosis is excellent, since the condition usually improves during the postpartum period. For some chronic conditions affecting the sacroiliac joints, such as arthritis, excellent treatments are available that minimize the pain and help prevent the destruction of the joints. Degenerative arthritis (also chronic) affecting the sacroiliac joint cannot be reversed, but treatments are generally effective in improving symptoms and reducing the pain.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating SI joint pain. By using a comprehensive approach and cutting edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.
SI Joint Pain Resources
Sacroiliac Joint Dysfunction (SI Joint Pain) (Spine Health)
Is Your SI Joint Giving You Back Pain? (WebMD)
Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis, and treatment (PubMed)
Is Your SI Joint Causing Your Lower Back Pain? (HealthLine)
Sacroiliitis (Mayo Clinic)
Sacroiliac Joint Injection (Spine-Health)
About Your Sacroiliac (SI) Joint (S-I Bone)
Sacroiliac Joint Dysfunction (SI Joint Pain) (MedicineNet.com)
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