Sacroiliac Joint Animation

The sacroiliac (SI) joints are located where the ilium of the pelvis meets the sacrum—at the left and right sides of the sacrum. Strong ligaments and muscles hold the SI joints in place and allow only a few millimeters of movement when the body bears weight or flexes forward. Smooth cartilage covers the bony parts of the SI joints, which allows the SI joints to move friction-free while absorbing shock between the iliac (ilium) and sacral (sacrum) bones.

What Can Cause SI Joint Pain?

The sacroiliac joints are susceptible to problems that affect other joints in the body, such as arthritis, age-related degeneration, and trauma. Back pain is one of the most common symptoms suggesting sacroiliac joint dysfunction.

Osteoarthritis and certain age-related degenerative disorders may gradually erode protective joint cartilage, which can cause joint pain. Another structural change involves the joint ligaments—loss of elasticity and strength. Many problems and disorders may affect the function of the SI joints.

Other possible causes of SI joint dysfunction, pain, and other symptoms:

  • Pregnancy (ligament laxity, or loosening, in readiness for childbirth)
  • Congenital problem (discovered at birth)
  • Leg length discrepancy (one leg is longer than the other)
  • Abnormal thickening of bone
  • Ankylosing spondylitis
  • Rheumatoid arthritis
  • Reiter’s syndrome (reactive arthritis; inflammatory response to bacterial infection)
  • Pelvic, sacral, iliac, or lower back spinal fracture
  • Benign or malignant spinal tumor

Elderly man using a cane, having trouble standing up.Pain is a primary symptom of an SI joint problem. Some patients have difficulty sitting, standing, walking, bending, and lifting. Photo Source:

How Do You Know If You Have SI Joint Dysfunction?

Pain is a primary symptom of an SI joint problem. Some patients have difficulty sitting, standing, walking, bending, and lifting. The pain and symptoms may mimic other types of lumbar spine (lower back) disorders.

Possible areas where pain may be felt:

  • Lower back
  • Hips
  • Buttocks
  • Groin
  • Thighs and legs

Some patients experience pain that spreads—radicular pain (also known as radiculopathy). Other symptoms may include numbness, tingling, and/or weakness. Pain and other symptoms may disrupt sleep, too.

SI Joint Disorder Diagnosis

Your doctor carefully considers your entire medical history, which may include your family history. Next, he or she performs a thorough physical and neurological examination that includes your spine and hips.

Furthermore, your doctor will perform specific movements to test the function of your sacroiliac joints. Sometimes, a movement may replicate your pain and/or symptoms. Although temporarily uncomfortable, the results of each movement test help your doctor determine if one or both SI joints are the pain generator(s).

Questions the doctor may ask you include:

  • When did pain start?
  • Is the pain (and symptoms) different from previous lower back pain?
  • Describe your pain.  Is it stabbing, aching, electric-like, gnawing?
  • Please rate your pain on a scale from 1 to 10, with 10 being the worse pain imaginable.
  • What aggravates your pain?
  • What improves your pain? Lying down?

Possible tests your doctor may order include:

  • CT scan or MRI
  • Bone scan
  • Diagnostic injection: A diagnostic injection is the gold standard to test for a SI joint problem. The injection is performed using fluoroscopic guidance—a special type of x-ray performed in real time. It allows the doctor to guide the needle precisely into the SI joint(s). Medication to numb the joint is injected. If the medication stops or reduces your pain, it is likely the SI joint tested is a pain generator.

SI Joint Pain Treatments

If the cause of your pain is SI joint-related, non-surgical treatment is recommended.

Non-surgical treatment may involve:

  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Medication to relax muscle spasms
  • Ice and/or heat
  • Sacroiliac joint brace
  • Physical therapy (to reduce pain and strengthen SI musculature)
  • Corticosteroid joint injections

Seldom is surgery necessary for SI joint problems. Traditional sacroiliac joint surgery may involve screw fixation and fusion, however—certain minimally invasive surgical procedures are available.

Next Steps If You Have SI Joint Pain

If you think you may have sacroiliac joint pain, talk with your doctor. If necessary, he may refer you to a doctor who specializes in the treatment of SI joint pain and disorders.

Updated on: 07/30/19
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Christy’s Journey with Sacroiliac Joint Pain

Christy lived with sacroiliac (SI) joint dysfunction and shares her important story, including symptoms, causes and that some doctors don't consider SI joint dysfunction as part of the diagnostic picture.
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