Sacroiliac Pain

Sacroiliac pain is pain that comes from damage or disease in the sacroiliac joint. Sacroiliac pain may be in the lower back, upper leg, and/or buttocks. The pain is caused by damage or injury to the joint, ligaments, cartilage or muscles. Sacroiliac pain can mimic or occur along with other conditions, such as a herniated disc or hip problem.

Because of its location, it is often confused with sciatic nerve pain, since the sciatic nerve runs along the same location. Sacroiliac pain ranges from mild to severe, and in some cases, it can be debilitating. Accurate diagnosis is important to determine the source of pain and best treatment. Physical therapy, stretching exercises, pain medication, and joint injections are used first to manage the symptoms. The SI joint can become painful when the ligaments become too loose or too tight. This can occur as the result of a fall, work injury, car accident, pregnancy and childbirth, or hip/spine surgery (laminectomy, lumbar fusion).

A sacroiliac pain doctor can often determine the source of your pain and formulate a comprehensive treatment plan to relieve your sacroiliac pain.

What Is the Sacroiliac (SI) Joint?

One of the first questions that patients usually ask their sacroiliac pain doctor is “what is the sacroiliac joint?” This is because the sacroiliac joint, or SI joint, is not the kind of visible, bending joint you usually think of, like the knee, hip, or shoulder. The sacroiliac joints are in the pelvis and are located between the ilium (hipbone) and the sacrum (the lowest part of the spinal column just above the tailbone).

Under normal circumstances, the SI joint should not move very much — its main purpose is to keep the hipbones and pelvis together. A small bit of movement at the sacroiliac joint is useful and important, but too much or too little can cause sacroiliac joint pain or SI joint pain.

Symptoms and Causes of Injuries of Sacroiliac (SI) Joint Injuries

The signs and symptoms of SI pain start in the lower back and buttock, and may radiate to the lower hip, groin or upper thigh. While the pain is usually one sided, it can occur on both sides. Patients may also experience numbness or tingling in the leg or a feeling of weakness in the leg.

Symptoms may worsen with sitting, standing, sleeping, walking or climbing stairs. Often the SI joint is painful sitting or sleeping on the affected side. Some people have difficulty riding in a car or standing, sitting or walking too long. Pain can be worse with transitional movements (going from sit to stand), standing on one leg or climbing stairs.

Sacroiliac joint pain is one of the causes of low back pain. SI joint pain is not as common as a lumbar herniated disc or sciatica, but sacroiliac joint pain can be just as severe and difficult for patients as these other causes of low back pain.

Sacroiliac pain is usually caused by the sacroiliac joint being too “tight” or too “loose.” Often this is caused by some sort of trauma, such as an automobile accident, a fall from a height, or even a traumatic childbirth. The SI joint may become inflamed on one or both sides and may cause pain that shoots down either or both legs. People with SI joint pain usually notice pain is worse with prolonged sitting, standing, waking in the morning, or climbing stairs.

Nonsurgical Treatments for Sacroiliac Pain

Typical nonsurgical treatments for sacroiliac pain include over-the-counter or prescribed anti-inflammatory drugs. These may include nonsteroidal anti-inflammatory drugs or corticosteroids, such as prednisone. Some people with SI joint pain find relief from chiropractic manipulation, focused stretching exercises, or directed physical therapy interventions. Corticosteroids placed directly in the SI joint can reduce inflammation and help relieve pain for weeks to months.

Sacroiliac pain can be treated by ablating the nerves that transmit painful information from the SI joint to the spinal cord and brain. Your SI joint pain doctor can discuss and explore these nonsurgical treatments for sacroiliac pain with you during your appointment.

Interventional Treatments

Steroids can reduce the swelling and inflammation of the nerves. Joint injections are a minimally invasive procedure that involves an injection of a powerful corticosteroid and an analgesic-numbing agent into the painful joint. While the results tend to be temporary, if the injections are helpful they can be repeated up to four times a year.

Injections into joints or nerves are sometimes called “blocks.” Successful SI joint injections may indicate that you could benefit from radiofrequency ablation – a procedure that uses an electrical current to destroy the nerve fibers carrying pain signals in the joint.

Surgical Treatments for Sacroiliac Pain

A sacroiliac pain doctor may suggest surgery to treat chronic or debilitating SI joint pain. SI joint surgery is usually reserved for severe cases of sacroiliac pain that do not respond to nonsurgical treatments. The standard surgical treatment for sacroiliac pain is SI joint fusion. In SI joint fusion surgery, the surgeon uses internal fixation to hold the ilium and sacrum together while bone graft material is added to the SI joint, causing it to fuse.

If you suspect you have pain in any of these areas, it's important to consult a medical professional for a proper diagnosis and appropriate management.