Inflammation or discomfort in the sacroiliac joints, which connect the sacrum (the triangular bone at the bottom of the spine) with the pelvic bones, is known as sacroiliac joint pain, often abbreviated as SI joint pain. In this article, we discuss the causes, symptoms, diagnosis, treatment, and prevention of sacroiliac joint pain, which may result from several factors and result in localized pain, stiffness, and difficulty moving.
Sacroiliac joint pain can be caused by several underlying factors that affect the integrity and stability of the joints. These include:
An injury to the pelvis, such as a fall, motor vehicle accident, or sports injury, can damage or strain the ligaments, muscles, or cartilage surrounding the sacroiliac joints, causing pain and inflammation.
Wear and tear on the sacroiliac joints over time can lead to degenerative changes such as osteoarthritis, cartilage loss, and bony spurs, which can result in pain and stiffness.
During pregnancy, hormone changes and increased laxity of ligaments can affect the stability and alignment of the sacroiliac joints, causing sacroiliac joint dysfunction and pain.
Ankylosing spondylitis, psoriatic arthritis, and rheumatoid arthritis can cause inflammation and erosion of the sacroiliac joints, causing pain, stiffness, and limited mobility.
Variation in leg length or asymmetry in pelvic alignment can lead to uneven pressure and weight distribution on the sacroiliac joints, which can result in sacroiliac joint dysfunction.
Sacroiliac joint pain symptoms vary depending on the underlying cause and individual factors. Common signs and symptoms include:
Back pain: A dull, aching pain in the lower back, buttocks, or hips, aggravated by prolonged sitting, standing, walking, or certain movements such as climbing stairs.
Described as deep, sharp, or burning pain, radiating from the sacroiliac joints into the groin, thighs, or legs.
An inability to bend, twist, or transition from sitting to standing due to stiffness or tightness in the lower back or pelvis.
A feeling of instability or "giving way" in the pelvis or lower back when carrying weight or performing activities that require coordination or balance.
Reduced range of motion: Limited flexibility or range of motion in the hips, pelvis, or lower back, which may affect daily activities.
Medical history, physical examination, and diagnostic tests are typically used to diagnose sacroiliac joint pain. Diagnostic procedures can include:
A healthcare provider will ask about the onset, duration, and characteristics of the pain, as well as any precipitating factors, previous injuries, or underlying medical conditions that may contribute to sacroiliac joint dysfunction.
Examination of the spine, pelvis, and lower extremities can help identify signs of sacroiliac joint dysfunction, such as tenderness, swelling, asymmetry, or restricted mobility.
The sacroiliac joints and surrounding structures may elicit pain or tenderness by gentle palpation or pressure, helping to locate the source of discomfort.
The FABER (Flexion, Abduction, and External Rotation) test or Patrick's test may be performed to reproduce symptoms and assess the integrity and stability of the sacroiliac joints.
The injection of a local anesthetic or corticosteroid medication into the sacroiliac joint under fluoroscopic guidance can provide temporary pain relief and confirm the diagnosis.
Sacroiliac joint pain can be treated by alleviating symptoms, improving function, and addressing underlying causes.
Pain and inflammation associated with sacroiliac joint dysfunction can be reduced with over-the-counter pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs). Additional relief may be provided by prescription medications such as muscle relaxants or corticosteroids.
In a structured physical therapy program, stretching exercises, strengthening exercises, and manual therapy techniques can help improve joint mobility, muscle balance, and core stability, reducing pain and improving function.
Under fluoroscopic guidance, local anesthetics and corticosteroids can be injected into the sacroiliac joint to reduce inflammation and pain, enabling individuals to engage in physical therapy and rehabilitation more effectively.
As part of radiofrequency ablation, also called rhizotomy or neurotomy, heat energy is used to disrupt the sensory nerves that transmit pain signals from the sacroiliac joint to the brain, providing long-lasting pain relief for those suffering from chronic sacroiliac joint pain.
In rare cases of severe or refractory sacroiliac joint pain that does not respond to conservative treatments, surgical procedures may be used to stabilize the joint, alleviate pain, and improve function, such as sacroiliac joint fusion or stabilization.
It is important to maintain a healthy lifestyle, practice good posture and body mechanics, and avoid activities that may aggravate joint dysfunction to prevent sacroiliac joint pain. Prevention strategies may include:
Improve joint mobility, muscle strength, and overall musculoskeletal health by engaging in regular physical activity, including strengthening exercises, stretching routines, and low-impact aerobic activities.
Practice good posture habits while sitting, standing, and lifting to minimize stress on the spine, pelvis, and sacroiliac joints.
Lift heavy objects properly by bending at the knees and hips, keeping the spine straight, and avoiding twisting or jerking movements that may strain the lower back.
In order to prevent overuse injuries, limit repetitive or high-impact activities that may exacerbate sacroiliac joint dysfunction, such as running on hard surfaces, jumping, or lifting heavy weights. Include rest and recovery periods into the exercise routine.
