The sacroiliac (SAY-crow-ILL-ee-ack) joint is located at the base of the lumbar spine where it joins the iliac, or hipbone. It sits above the sacrum, or tailbone. It looks stacked together, like Lego toys. The SI joint is circled around with ligaments, much like a basketball hoop. A joint usually moves, but the sacroiliac joint doesn’t move much. During pregnancy, it relaxes to allow the pelvis to expand during childbirth. However, when the body reaches menopause, the sacroiliac can become arthritic.
If the joint is traumatized during a sporting or car accident, then pain can manifest in either the lower back
or legs. Leg pain is sometimes confused with sciatica, while back pain could be caused by anything. Generally, however, pain is felt in the buttocks on either side of the sacroiliac joint. Sometimes the pain extends down into the legs and even the feet. Pain often radiates into the groin area. Since the pain is in the area of the spine that it’s in, many consider the pain caused by a herniated disc
or that it has to do with the sciatic nerve.
Diagnosis and Determining the Source of Sacroiliac Joint Dysfunction
It is called sacroiliac dysfunction because no one is quite sure why it becomes painful. The first step in finding the source of the dysfunction and diagnosing it is a complete history and physical exam. Doctors will need to know several things in order to determine the cause of the pain:
•What are the symptoms?
•How does the pain affect daily activities?
•What position or activity makes the pain go away?
•Have past injuries happened in this area?
•Are medical problems in this area or arthritis there hereditary?
•Posture and walking will be examined
•Muscle strength and reflexes will be tested
•Lab tests for arthritis or infection will be performed
•X-rays, MRIs and CAT scans will be done
•Bone scans are useful for locating inflamed areas
•Injection of numbing medicine also locates inflamed areas
What Conditions Produce Sacroiliac Joint Dysfunction
Conditions that change the normal walking pattern affect the ligaments around the sacroiliac joints. If one leg is longer than the other, or if hip, knee and ankle pain is present, then these can affect the SI joints. Altered walking patterns due to pregnancy may also cause pain to the SI joints. Pain in the lower extremities manifest in lower back pain, so repairing the pain in the lower extremities automatically takes the stress of the SI joints.
Since joints and ligaments become arthritic, this is the most common cause of sacroiliac joint dysfunction. When the ligaments are damaged or worn down with time, the bones they protect rub together. Degenerative arthritis results, as it does with ankle, knee and other joints. There are other types of arthritis that affect the SI joints, namely gout, rheumatoid arthritis and ankylosing spondylitis, a type of inflammatory arthritis that always affects the SI joints. With ankylosing spondylitis, the disease progresses until the joints fuse together, thereafter causing no pain.
Available Treatments for Sacroiliac Joint Dysfunction
Doctors usually begin treating the pain with anti-inflammatory medicines like naproxen and ibuprofen. In extreme cases when the pain does not improve, cortisone injections might help end the inflammation. Success has been noted with another injection, hyaluronic acid. This chemical apparently nourishes the auricular cartilage in the synovial joints and lubricating them. There has been some success with this chemical in those with knee pain, so it was used on the SI joints as well.
The patient will undergo physical therapy as a method of pain management. Strengthening the abdominal muscles and back muscles goes far toward the alleviation of pain. Gentle stretches are also beneficial in the alleviation of pain. If a physical therapist is educated in manipulation, this too will help will the pain. If the therapist is not tutored in manipulation, chiropractic is another method of easing the pain.
Aside from manipulation, chiropractic has many methods of pain relief such as cold laser treatment, TENS or Transcutaneous Electrical Nerve Stimulation treatments, a massage technique called Active Release Therapy and/or acupuncture. By manipulating the body, chiropractic takes the pressure off affected nerves and muscle groups.
A treatment called radiofrequency ablation has been used with some success on sacroiliac joint dysfunction. An injection “burns” the small nerves that carry pain notification to the brain. These nerves provide sensation to the area. “Burning” them kills the sensation, or numbs it. This procedure is temporary, but may relief may last up to two years.
Surgery is rare, but when nothing else works, a fusion surgery is performed. The cartilage is removed, and the bones are held together with screws and plates until they grow together. No more pain. Rest and enough restful sleep, about seven to eight hours, are also recommended for the body to heal itself.