SACROILIAC JOINT DYSFUNCTION

WHAT IS SACROILIAC JOINT DYSFUNCTION

The Sacroiliac joint, more commonly referred to as the SI joint, is the point where the sacrum and pelvis meet. This joint plays a major role in transferring weight between your upper body and lower body. For this reason, it is susceptible to damage and irritation. Moreover, as our society becomes more and more sedentary, this joint becomes less and less taken care of. Essentially, either too much action, or too little action, can lead to dysfunction. Some physicians estimate that 15%-30% of cases of lower back pain are actually caused by SI joint dysfunction.

WHAT CAUSES IT?

We touched on how too little, or too much, movement may lead to SI joint dysfunction, but what else can cause it? Well, there is a whole host of possible causes, including but not limited to:

  • Imbalanced walking/strides. Whether caused by differing leg lengths, compensatory injuries, or other anatomical issues, walking off balance for an extended period of time can put undue stress on the SI joint.
  • Childbirth, puts tremendous stress on the body, specifically the pelvis. For this reason, women who have recently given birth may be predisposed to having pain at their SI joint.
  • Traumatic injury, such as motor vehicle accidents or hard falls can damage the SI joint and the surrounding tissues.
  • Age-related degeneration. Commonly referred to as arthritis, the inevitable wear and tear of bones and cartilage can manifest itself at the SI joint.

WHAT DOES IT FEEL LIKE?

We already touched on the fact that SI joint dysfunction makes up to a third of all lower back cases. But what other symptoms might be associated with the ailment? Part of the reason the numbers range from 15%-30% is because there are other ailments that have similar symptoms. This makes it difficult to distinguish the root cause of the pain. For example, sciatica shares many of the same symptoms, such as: sharp, stabbing, radiating pain from the spine into the buttocks. Structurally, patients may feel instability and stiffness associated with the dysfunction of the joint. Increased activity would exacerbate this pain.

HOW DO YOU DIAGNOSE IT?

As mentioned previously, SI Joint dysfunction has symptomology that is similar to other ailments. This makes accurate diagnosis more difficult. As in most cases, the first step includes obtaining a thorough medical history and performance of a physical exam. There are certain indicators that may distinguish SI joint dysfunction from other ailments. Multiple positive physical findings are the best way to confirm the existence of SI joint dysfunction. 

Furthermore, there are diagnostic injections that may provide the most definitive proof of SI joint dysfunction. Essentially, if injecting numbing medicine into the SI joint provides relief, it can be safely assumed, that this is the specific cause of pain and discomfort.

Though imaging studies cannot necessarily confirm SI joint dysfunction, they may provide a clearer picture of the issue at hand. For example, if an MRI of the lumbar spine reveals a disc herniating that may cause sciatica, then your doctor may deduce that your symptoms are more likely coming from that.

HOW DO YOU TREAT SI JOINT DYSFUNCTION

When treating patients, our goal is to exhaust any and all conservative options first. Arguably the most conservative treatment option, resting for a couple, cures symptoms without any more intervention. However, resting for too long can actually be counterproductive. If there are underlying pathologies, that need fixing, delaying treatment could make matters worse.

Therefore, the treatment regimen may include a couple days of rest immediately followed by medication, physical therapy, and use of ice and heat if rest doesn’t provide relief. Still very conservative, but more active.

If after the aforementioned treatment plan does not provide relief, a therapeutic SI joint injection may be recommended. The injection, similar to the diagnostic injection mentioned above, would administer both a numbing agent and a steroid. The numbing agent would provide short term relief (up to a few hours), while the steroid would begin working within 2-3 days. This injection’s effect could last indefinitely but could only be effective for a short amount of time. Depending on the length of symptom relief, patients may choose the get repeat injections (up to a few a year). Though if the relief only lasts a week or so, patient’s may be candidates for surgical intervention.

SI joint fusions (the surgery required) would eliminate any movement between the scrum and the pelvic bone. This, in turn, would ideally alleviate the symptoms experienced. However, surgery is typically only recommended if patients have had several weeks of conservative treatment enacted.