Talking to Your Doctor About Sacroiliac Joint Dysfunction

SI joint dysfunction is a diagnosis that may be overlooked. Here’s how you can help your doctor get to the source of your back pain.

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Sacroiliac joint dysfunction can cause low back pain, but diagnosing it can be challenging for some doctors. SI joint dysfunction and pain may involve one or both joints. Other medical terms sometimes associated with SI joint dysfunction are sacroiliitis or degenerative sacroiliitis. If you suspect your low back pain may be SI joint-related, you may wonder how to start the conversation with your doctor. The information in this article may be the help you need to start the conversation.

doctor listening to his patientIf you suspect your low back pain may be SI joint-related, you may wonder how to start the conversation with your doctor. Photo Source:

Three Things to Do Before Your Appointment

Your role in diagnosing SI joint-related pain starts before your first appointment with your medical doctor or chiropractor. Doing 3 simple things before your meeting can help position you for a productive visit with your doctor.

#1. Run through your medical history. Do you have an existing spinal condition that may be associated with potential SI joint dysfunction? Have you been through a recent trauma (such as a fall)? Are you pregnant? These medical history questions are good to think through beforehand, as they may help your doctor identify a potential link to or cause of SI joint dysfunction.

#2. Know your symptoms inside and out. Make it a point to know what your symptoms are so you can explain them to your doctor (eg, dull pain, achy, feel stiff). It may be helpful to write them down.

The most common symptoms of SI joint dysfunction are:

  • Low back pain
  • Pain through the hips, buttocks, thighs, and/or groin
  • Pain when you press on the SI joints (if you look at your low back and see 2 dimples, the SI joints are located below those dimples)
  • Stiffness or burning sensations in your pelvis

Also, keep track of when your symptoms worsen and subside. With SI joint dysfunction, pain tends to increase when standing or walking for extended periods, climbing stairs, or getting up from a chair. The pain usually goes away when you lie down.

#3. Write down questions for your doctor. You have limited time with your doctor, so think about what you want to accomplish during your appointment and the questions you want answered. Write your questions down and bring them with you to your appointment.

Sample questions to prepare include:

  • Do you think my pain could be from a SI joint problem?
  • If not, why are you ruling out SI joint dysfunction?
  • When should I expect relief from treatment(s) you recommend?
  • Is your treatment plan intended to provide sustained, long-term relief or immediate, short-term relief?

At the Appointment: Broaching Sacroiliac Joint Dysfunction with Your Doctor

You may feel nervous about asking your doctor to examine you for SI joint dysfunction. One way to open the door to this conversation is to reference research linking the SI joint to low back pain.

Low back pain research has shown that the sacroiliac joint, specifically SI joint dysfunction, is a potential cause of low back pain. In fact, one study reports that SI joint problems affect “upwards of 30% of patients with low back pain.”1

Your doctor can typically diagnose SI joint dysfunction from your medical history and a physical exam. During the physical exam, your doctor may perform specific maneuvers, or movements designed to ignite SI joint pain and, thus, help confirm a diagnosis. Don’t be afraid to prompt your doctor to perform these tests by saying: “I heard there are diagnostic movements you can perform that may suggest my back pain is caused by a problem with my sacroiliac joints.”

Provocative physical tests may initiate SI joint pain and help diagnose your low back pain as potentially being caused by SI joint dysfunction.

  1. Distraction
  2. Thigh Thrust
  3. FABER (Flexion Abduction External Rotation)
  4. Compression
  5. Gaenslen's maneuver
  6. Fortin finger test (pressing near the SI joints)

If 3 out of the first 5 tests produce pain, then it’s likely that you have SI joint dysfunction. A diagnostic sacroiliac joint injection can help confirm or rule out the SI joint as the pain generator. This injection contains powerful anti-inflammatory medicine sent directly to your one or both SI joints. If you experience pain relief after the injection, that can be an indicator that the tested SI joint (one or both) is the pain source.

A Dialogue Not a Dictation: Your Relationship with Your Doctor is a 2-Way Street

It’s normal to feel intimated or overwhelmed during a visit with your doctor, especially if you have a hard-to-diagnose condition like sacroiliac (SI) joint dysfunction. But remember: Your doctor’s voice should not be the only one heard during your appointment. It’s a conversation, and your role in imparting information is essential to helping arrive at an accurate diagnosis. If you suspect your low back pain may be SI joint dysfunction, tell your doctor. If your doctor isn’t comfortable diagnosing SI joint pain, ask for a referral to a spine specialist who may help.

Updated on: 04/30/19
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Stewart G. Eidelson, MD
SpineUniverse Founder
Orthopaedic Spine Surgeon
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