One of the most common complaints that people have when they visit their primary care doctor is lower back pain. Lower back pain complaints may range from annoying muscle strains to medical conditions that causes debilitating pain that affects every aspect of a patient’s life.
Lower back pain is the leading cause of disability and Americans spend an estimated $50 billion every year on treatments for it.
One of the medical conditions that can cause debilitating pain is sacroiliac joint dysfunction. It is estimated that 15 to 25% of lower back pain comes from the sacroiliac joints.
The pain of SI joint dysfunction changes people’s lives and not for the better. The pain can be agonizing on a daily basis for sufferers.
This condition can lead to depression because of the inability to cope with the pain and the changes that occur in their daily activities.
If not treated, depression can lead to suicidal thoughts for sufferers that try to cope with such severe pain. Unfortunately, some sufferers have taken their own lives in order to not have to suffer anymore.
What are the Sacroiliac Joints?
The sacroiliac (SI) joints are formed by the connection of the sacrum and the right and left iliac bones. The sacrum is a triangular shaped bone that sits at the end of the spine, below the spine’s lumbar region.
Most of the spine has mobile vertebrae, but the sacrum have five vertebrae that are fused together and are not meant to move.
The iliac bones are the two large bones that make up the pelvis, so the SI joints connect the pelvis to the spine.
The SI joints normally move very little. There are usually less than 4 degrees of rotation and just 2 millimeters of translation in these joints.
Most of the movement in the pelvis occurs at the hips or the lumbar spine. The SI joints support the entire weight of the body when it is erect, which is when people are standing.
Since these joints are load bearing, there can be wear in the cartilage of the SI joints and/or arthritis.
What is Sacroiliac Joint Dysfunction?
While there are many names for sacroiliac joint problems including sacroiliac joint dysfunction, SI joint inflammation, SI joint syndrome, etc., it all refers to a condition that causes pain the SI joints. There are several causes for SI joint dysfunction.
What are the Causes of Sacroiliac Joint Dysfunction?
All joints in the body are covered with a layer of cartilage that covers the bone and the SI joints are no exception.
Cartilage acts like a shock absorber between the two bones of a joint and it allows for some movement of the joints.
With time, the cartilage can be damaged or worn, which can cause the two bones to rub against each other.
When that occurs, degenerative arthritis, or osteoarthritis, is the result, which is the most common cause of SI joint dysfunction.
Another common cause of SI joint dysfunction in women is pregnancy. When a woman is pregnant, the ligaments in the body become relaxed as hormones are released in her body in preparation for giving birth.
When the ligaments of the SI joints relax, they allow for additional motion of the joints that increases stress on them and causes abnormal wear on the SI joints. The added weight of the child and changes in walking patterns add addition stress on the SI joints.
Any changes in walking patterns will add stress to the SI joints. An altered gait can be caused by one leg being longer than another or pain in the hip, knee, ankle or foot can also cause a change in walking patterns.
Any pain in the lower half of the body can cause problems with the lumbar spine or the SI joints. However, if the underlying cause of the pain is treated, the resulting problems in the lumbar spine or the SI joints will usually improve.
Many medical conditions that affect the joints can also cause inflammation in the SI joints. Those conditions are gout, rheumatoid arthritis, psoriasis and ankylosing spondylitis.
These conditions are all types of arthritis that affect joints throughout the body. Ankylosing spondylitis is an inflammatory form of arthritis that always affects the SI joints.
It leads to stiffness and pain in the SI joints and as AS progresses, it causes the SI joints to fuse together and there is no further motion in them. After this happens, there is no longer pain in the SI joints.
What are the Symptoms of Sacroiliac Joint Dysfunction?
The most prevalent symptom of SI joint dysfunction is pain. Many people who have this dysfunction experience pain in the lower back or at the back of the hips.
There could also be pain in the thighs and groin area, but many times, the pain is difficult to locate. The pain can worsen when walking or standing, but it can feel better when lying down.
Inflammation and arthritis in the SI joints can cause stiffness and a burning sensation in the pelvis.
Pain can be triggered when coughing or sneezing and it is often aggravated when standing or walking for a long period of time, as well as bending, twisting or by having poor posture.
It can be difficult for people with this condition to carry out their normal activities, such as climbing the stairs, lifting objects or even sleeping.
Conditions that involve chronic pain can make it difficult to sleep well. Not everyone experiences the same frequency of pain as it can be sporadic or constant.
How is Sacroiliac Joint Dysfunction Diagnosed?
It can be difficult to determine a diagnosis of SI joint dysfunction because the condition can mimic other medical problems.
It can also be hard to diagnosis because few doctors are acquainted with the condition. Information about the disorder isn’t normally taught in medical schools and some patients have had to see multiple doctors before being diagnosed with SI joint dysfunction.
One patient visited 34 medical professionals before finding one that knew about the disorder, which was in a neighboring state from where they resided.
When you make an appointment with your primary care doctor, he or she will begin the diagnosis process by getting a complete medical history, which may help to uncover some underlying factors that could be causing lower back pain.
The questions will help them determine if the pain is caused by the SI joints or whether it is in the hips or lumbar spine. It is important to answer the questions as completely and honestly as you can to help them make a diagnosis.
After completing your medical history, the doctor will do a thorough examination by using their hands to examine your back and spine to check for tender spots.
They may have you move your legs and hips in different positions and apply slight pressure to check the movement of the SI joints or compress them to check if they are the source of your lower back pain. The physical examination will also help exclude other possible sources of your pain.
Diagnostic Imaging
It will also be necessary to take a look at the bones in the lumbar region of the back, hips and the pelvis. Your primary care physician may order X-rays of these areas after they have completed their physical examination.
Instead of X-rays, he or she may order a CT scan because it gives a more detailed look at the joints and bones. Both X-rays and CT scans can help identify sacroiliitis and they can also identify fusion of the SI joints.
A MRI may be ordered instead because the test provides a better look at muscles and ligaments in the area that is being examined.
MRIs can also identify small fractures of the bones or it can also show inflammation in the area by checking for excess fluid in the joints.
Another test that may be performed is a bone scan as the scan can help find bone abnormalities or show increased activity of the bones. However, this test isn’t specific and it can identify other problems not related to SI joint dysfunction.
Joint Injections
One of the most accurate methods for identifying pain in the SI joints is to inject the area with an anesthetic and steroid to numb it.
The injection will relieve the pain caused by inflammation, which is common with SI joint dysfunction. The length of pain relief varies, but it is a good way to accurately determine that the SI joint is the cause of your pain.
How to Find a Doctor to Treat SI Joint Dysfunction
After your primary care doctor has completed your examination, the doctor may refer you to a specialist to confirm the diagnosis of SI joint dysfunction and to receive treatment for the disorder.
They may send you to an orthopedist, which is a doctor that works with disorders involving bones, or they may suggest a rheumatologist because SI joint dysfunction is an arthritis related condition. Another specialist that you may be referred to is a physiatrist.
A physiatrist is a doctor of physical medicine and rehabilitation. They are trained to look at the lumbar spine and the sacroiliac joints as sources of pain.
To verify the source of your pain as the sacroiliac joint, they may do injections in the SI joints or conduct other tests to confirm the diagnosis and begin to treat SI joint dysfunction.
You may be referred to several doctors before an accurate diagnosis is made, but it is important not to give up until you can find one that can help treat the disorder and provide relief from the pain in your SI joints.
How is SI Joint Dysfunction Treatment Options
Along with being used to help diagnose SI joint dysfunction, injections can be used as a form of treatment as well.
Many people get relief from the injections, which allows them to resume their normal day-to-day activities.
The length of pain relief from the injections vary as they may last one day or the relief could last much longer. The injections can be repeated monthly, but it is advised that patients only receive three injections per year.
Medications
Anti-inflammatory medications may also be recommended to help provide pain relief. NSAIDS like ibuprofen or naproxen can be effective and used on a long-term basis if there are no other medical issues that would prevent a patient from taking these medications. An oral steroid like prednisone can be used to treat inflammation, but they are for short-term use only.
Prolotherapy – PRP
Prolotherapy and platelet rich plasma therapy (PRP) involves injecting a solution around the injury or suspected injury. The solution starts the inflammation process in order to help repair the area.
Prolotherapy uses a dextrose solution as an irritant to stimulate the body so scar tissue is laid down. PRP uses the patient’s own growth factor, found in blood plasma, to promote ligament healing.
Physical Therapy and Exercise
Physical therapy may be suggested to help treat this dysfunction as well because the pain in the SI joints may be related to too much motion in the joint or not enough motion.
Stretching and stabilizing exercises that can be done at home are often taught to patients to help reduce pain.
Aside from physical therapy, other exercises like yoga or Pilates can help stabilize the SI joints. A device called a sacroiliac belt can be worn around the hips to help provide stabilization, which can also help to relieve pain.
Along with reducing pain, physical therapy helps to restore correct joint and muscle function in the body.
Massage Therapy
Muscle pain or tightness is common with SI joint pain. Tight muscles could be caused by the change in walking patterns or in your posture due to the pain you are experiencing.
Extended time spent in either a bed or chair due to your decreased mobility, your body compensating for weak muscles and changes of position in the SI joint can also cause muscle tension.
Massage therapy helps to loosen tight muscles, manage muscle pain and identify which muscles are problematic for you.
Some patients are able to cope using massage therapy only when used along with stretching and strengthening exercises that they do at home.
Chiropractic Care
A chiropractor can recognize a stiff joint and provide gentle spinal manipulations to get the joint to move as it should.
For patients who have pain due to SI joints moving too much, the chiropractor can gently align the spine and SI joints to reduce pain.
They can also help to align and reduce stress to painful SI joints by restoring the mobility of other joints surrounding the area.
Surgical Options
If pain relief is not provided by medications, physical therapy or any other non-surgical treatments, or if the condition continues to interfere with daily activities, than the specialist treating you may refer you to a neurosurgeon or orthopedist for surgery.
The surgery for SI joint dysfunction involves fusing together the SI joints. This prevents any motion in the joints and usually provides pain relief.
However, surgery should only be considered when all other non-invasive options have been tried and proven not to work.
Lateral Branch Block
Although the neuroanatomy of the SI joints is not known and varies among patients, doctors have been able to identify some of the nerves associated with the sensation of the SI joints.
A lateral branch block is used to numb the nerves that transmit pain sensations from the SI joints to the spinal cord.
A radiofrequency ablation will be done next if the block successfully helps to relieve the patient’s pain. The ablation, which is also called a radiofrequency neurotomy, is a longer lasting solution for helping relieve pain.
Radiofrequency Neurotomy
This is done by severing the small sensory nerves that had been injected during the lateral branch block. When it is done, the nerves no longer transmit pain signals and the patient may experience months of pain relief.
Since nerves usually grow back, the procedure usually only provides temporary relief. This should only be viewed as an alternative option for pain management as it does not fix the cause of the SI joint dysfunction.
Can SI Joint Dysfunction be Prevented?
As SI joint dysfunction has many causes including injuries to the back, pregnancy and since it is part of the natural aging process for some people, it can be almost impossible to prevent.
However, the severity of the disorder can be reduced by taking medications, injections or physical therapy. The severity can also be limited by losing weight or maintaining a healthy body weight.
It is also important to be in good physical condition to help reduce the chances of SI joint dysfunction and other forms of arthritis.
By keeping weight down, that lessens the load on joints and helps to prevent cartilage damage and arthritis.
Lower back pain is common, but it is important to get problems like SI joint dysfunction diagnosed as soon as possible so it can be properly treated.
Further reading:
Sacroiliac Joint Dysfunction Foundation: http://www.sijdfoundation.org
Sacroiliac Joint Dysfunction (SI Joint Pain)
http://www.medicinenet.com/sacroiliac_joint_pain/article.htm
