The Sacroiliac joint (SI joints) is where the spine meets the pelvis. A joint is where two separate bones communicate and connect by soft tissues including tendons, ligaments, and muscles. The SI joint is designed to take compressive heavy loads of force allowing us to walk, run, jump, bend, etc. When this joint becomes inflamed and causes pain, it is referred to as sacroiliitis. There are many different causes of SI joint related pain most commonly including trauma, pregnancy, lumbar pathology, or lumbar fusion surgery. The majority of treatment is aimed at managing your symptoms non-surgically through physical therapy, joint mobilization, dry needling, manual massage, steroid injections, and strengthening of surrounding muscles.
There are many different causes of Sacroiliac (SI) Joint Dysfunction related pain. The source of the pain often originates from nerve irritation, fluid buildup, misalignment of the joint, or micro-tears in the ligaments responsible for providing stability. Most commonly, the SI joint is not the primary source causing pain. Rather, pain in the SI joint is often related to an underlying problem such as facet syndrome, degenerative disc disease, herniated discs, or segmental instability.
Other common causes include trauma, arthritis, pregnancy, and genetic diseases. Trauma, such as a car accident or fall, may cause the joint to move out normal alignment. The SI joint can also degenerate over time leading to bone spur formation, otherwise known as osteoarthritis. Pregnancy is another cause of SI joint related pain due to laxity of surrounding ligaments from production of the hormone progesterone. Other, less common causes include certain genetic diseases such as Ankylosing spondylitis where the SI joint auto fuses together.
Sacroiliac (SI) joint dysfunction or inflammation can mimic pain similar to degenerative hip disease, hip bursitis, lumbar disc herniation, or pinched nerves. Symptoms of SI dysfunction vary widely depending on the individual person and their underlying cause. Common presenting symptoms include low back pain often found on only one side, that is worsened with prolonged sitting/standing or specific mechanical movements. Other symptoms include buttock pain or radiating pain, numbness, or tingling in the hips, groin, or legs. Patients often report difficulty with sleep due to the lack of ability to find a comfortable position.
The diagnosis of sacroiliac (SI) joint dysfunction related pain involves obtaining a detailed history and performing a comprehensive physical exam. The physical exam including palpation, provocative joint testing, and observing range of motion of your spine is the foundation of diagnosing SI joint related pain. X-ray or MRI imaging studies may reveal osteoarthritis in the bony anatomy of the SI joint. However, just because arthritis is found on imaging does not mean that you will experience pain in the SI joint.
Initial treatment options for sacroiliac (SI) joint dysfunction related pain include spine-specialized physical therapy, anti-inflammatory medications, and steroid injections. Physical therapy with a therapist specialized in spine health is imperative to optimize symptomatic relief. A physical therapist will educate you on proper body mechanics, muscle strengthening, and stretching to name a few. They may also perform joint mobilization, manual massage, and dry needling to help mobilize the soft tissues and relax tight muscles. Steroid injections can also be used as a targeted therapy to decrease inflammation and further optimize physical therapy. If steroid injections only temporarily relieve your pain, radiofrequency ablation of the SI joint can also be utilized.
If you have failed non-surgical treatments as listed above and develop intractable pain, there are surgical options to provide permanent stability and pain relief. At VSI, our surgeons continue to perform innovative, evidence-based spine surgery. In June 2013, Dr. Christopher Good was the first surgeon in North America to perform robotic guided sacroiliac fusion. We continue to evolve as technology develops to optimize your overall treatment outcome.
Dr. Thomas Schuler
Founder of Virginia Spine Institute
Chief Executive Officer
Dr. Niteesh Bharara
Orthopedic Specialist - Non-Surgical Sports Medicine
Director of Regenerative Medicine
“Being able to return to life, it’s the best thing in the world!”
Reviewed by: Dr. Christopher Good, MD, FACS.