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Causes of Sacroiliac Joint Pain

Posted by Michal Szczodry, MD on March 31, 2017

Causes of Sacroiliac Joint Pain.jpgYou may have heard of SI joint pain without realizing that the abbreviation SI stands for the sacroiliac, which is the joint connecting the sacrum – or tailbone – and the iliac bone of the pelvis.

Sacroiliac (SI) joint pain is fairly common – though not as common as some practitioners think – and while it can be uncomfortable, the good news is that it responds well to a variety of treatments.

Let’s look at some common questions regarding sacroiliac joint pain and my treatment recommendations.

What Does SI Joint Pain Feel Like?

If you’re experiencing tenderness on either side of your tailbone, especially when walking, the SI joint may be the cause. SI joint pain is usually localized on either side of the bottom of your spine, and the location of the pain will depend on which SI joint has the problem – the left or the right.

Keep in mind, though: Not all back tenderness is caused by the SI joint, and you’ll need to be examined by a specialist to know for sure.

How Common is SI Joint Pain?

This is a question I enjoy discussing because, in my opinion, SI joint pain is being overdiagnosed. It’s almost as if we, as practitioners, discovered it, and now everybody has an SI joint problem. Not true.

For patients experiencing localized pain at the bottom of spine, roughly 10 to 25 percent have an SI problem. The vast majority of pain in the lower back is actually related to your spine, not your SI joint. Even for patients experiencing pain below the lumbar spine, more than 70 percent actually have a spinal problem.   

There are rare cases when SI joint problems are underdiagnosed, but for the most part, the opposite is true. Again, you’ll need a specialist to confirm the real source of your pain.

What Are the Main Causes of Sacroiliac Joint Pain?

It is not yet well established what triggers SI joint pain. It appears to be an inflammatory response to either injury, overuse or potentially a change in biomechanics of the gait that aggravates the joint and causes it to inflame.

We can’t always pinpoint the specific reason for each instance of SI joint pain, but what we do know is that it can be successfully treated.

Are there Any At-home Treatments I Should Try?

The at-home treatments for SI joint pain are similar to the treatment for any lower back pain: a course of anti-inflammatory medications and modification of any activity that aggravates the pain. Your goal is to let the joint rest and reduce the inflammation.

When Should I See a Doctor for My Pain?

If your pain persists for longer than three weeks and doesn’t improve, you should see a specialist to get a diagnosis and a tailored treatment plan.

Of course, if the pain becomes unbearable or severely affects your daily functions, you should seek medical attention immediately.

What Are My Treatment Options?

As I’ve said, SI joint pain is a very treatable condition that responds to multiple modalities. Help is available, and you don’t have to just endure the pain.

Treatment options include:

Physical therapy: We usually start here for SI joint pain as it tends to be very successful and it’s a non-invasive treatment.

Injections: We inject a numbing and/or an anti-inflammatory medication. Numbing medication alone serves as a diagnostic tool, and anti-inflammatory medications can often be curative.

Surgical fusion: If the pain is resistant to non-operative treatments, we can stop the motion in the joint with spine surgery that fuses the sacrum and iliac bone. The joint has minimal motion and doesn’t contribute to daily activities, so immobilizing it makes little difference on a patient’s overall mobility.

We’ve found that the fusion surgery has very good results for patients with persistent pain. In fact, I will sometimes see patients for a second opinion who continue to experience discomfort after SI joint fusion surgery, and this usually means the problem wasn’t with their SI joint to begin with. That’s one reason it’s so important to get a proper diagnosis about your back pain from an experienced specialist.

Any lower back pain can be tricky to diagnose and treat, but once you identify the source of your pain as the sacroiliac (SI) joint, the prognosis is very good. The SI joint responds well to multiple treatments, from physical therapy to surgery.   

Complete Guide to Joint Pain


 

Topics: Spine, Joint Pain

About the author: Michal Szczodry, MD

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Michal Szczodry is an orthopedic specialist in surgical and non-surgical treatment of spine conditions. He graduated from Medical University of Warsaw, Poland; completed a research fellowship at University of Pittsburgh; did his orthopedic residency at University of Illinois at Chicago; and obtained subspecialty training in spine at Johns Hopkins University.