Sacroiliac or Sl Joint pain is a sharp and stabbing pain that radiates from the pelvis area or hips and spreads over your thighs or lower back. About 15 to 30 percent of people who suffer from chronic lower back pain suffer from Sl joint pain. Sometimes this pain is tingly or numb and may make you feel that your legs are about to buckle.
“The SI Joint is the junction between the iliac crest and the sacrum, beneath our spine and above our tailbone. We have two, one for each side of the pelvis” says Alice Holland, Director of Regional Development and Doctor of Physical Therapy at Stride Strong Physical Therapy LLC
“It is regarded as a mostly stable joint, that has very small, minuscule degrees of movement, except in childbirth. It is the connecting joint between the pelvis and the lower extremity and the rest of the spine.”
SI Joint Dysfunction Symptoms
SI joint problems are more common with women, typically surfacing after puberty and worsen in severity and frequency as women near childbirth ages, says Holland. She says in men, SI joint problems are less prevalent, and come from movement dysfunctions (such as in sport or lifestyle activities) or accidents. In people with spinal deformities, like scoliosis, SI joint dysfunction “is almost always present because of posture asymmetry – and symptoms may be felt earlier in age depending on the scoliotic severity,” she says.
Though every person experiences Sl joint pain differently, the most common symptoms surface in the lower back pain, pelvis, groin or buttocks areas.
“Symptoms are low-grade but irritable unilateral (one-sided) pain and ache in the posterior hip or upper buttocks, referring up to the low back; worsened after prolonged sitting and slouching; a general feeling of weakness or malaise in the lower extremity–thighs and calf. The pain usually lessens during physical activity,” Holland says.
Daniel Paull, M.D., an Orthopedic Surgeon and Founder and CEO of Easy Orthopedics
, adds, “The most common SI joint dysfunction symptom is purely pain. Some might have a limp associated with the pain, but by far and away, most people with SI dysfunction experience mostly pain. You can have both SI joint pain and low back pain at the same time which can complicate matters.”
Diagnosing SI Joint Problems
If you are the patient, your medical history will be collected along with information on your pain status and symptoms. The medical history usually includes information on sleep, diet, exercise habits, injuries, etc.
Michael Hildebrand, PT, DPT, COMT, a physical therapist with M3 Physio
says he starts in this fashion, followed by an examination featuring special tests to gauge movement and function. He can then decide on the correct course of action.
“Once this is completed, your therapist will explain their findings and discuss how best to get you out of pain and back to your activities—either a referral to another health care provider and/or treatment,” he says.
Once passed to a health care provider, that doctor uses clinical examinations to determine the source of your pain. “There are no imaging studies that show SI joint dysfunction; the diagnosis is clinical,” Paull says.
Sacroiliac Joint Injection
Also known as sacroiliac joint block, it consists of injecting a numbing solution into your sacroiliac joint. The injection is usually bupivacaine or lidocaine. If the injection succeeds in relieving pain, the sacroiliac joint is confirmed as the source of the pain. Live x-ray or fluoroscopic guidance or ultrasound is used to ensure that the needle reaches the joints.
“Sometimes steroid injections are done if the pain is not getting better. Rarely surgery is done if everything else has failed, this usually entails fusing the SI joints to the pelvis,” says Paull.
In some cases, diagnostic imaging tests such as x-ray, CT, or MRIs are used to rule out other possible conditions such as facet joint arthritis or herniated disc.
SI Joint Pain Causes
When one or both of your SI joints are inflamed, it is known as sacroiliac joint dysfunction or sacroiliitis. It is a general term that includes a lot of conditions such as:
- Osteoarthritis. When the SI joint has been dealing with years of stress, it could lead to wearing down of the cartilage and might lead to osteoarthritis. Osteoarthritis, which is usually associated with aging can not only affect the SI joint, but it can badly affect your spine, and other joints throughout your body.
- Gout. Gout is an inflammatory arthritis caused by uric acid buildup. It presents with joint pain, which is often severe. While it characteristically affects the big toe, it can present in any joint.
- Ankylosing spondylitis (AS). This is another type of inflammatory arthritis that affects the joints of the spine and vertebrae. It not only causes pain but also can lead to new bone growth that fuses joints in your spine. In rare cases, it can affect eyes and other organs.
- Injury. Your SI joints might be injured by trauma like injuries resulting from a car accident or falls.
- Pregnancy. When a woman is pregnant, a hormone known as Relaxin is released that makes your SI joint more elastic. It allows the pelvis to be wide enough to birth a child. This also makes your joints less stable. If a woman is gaining weight during the pregnancy and the weight of the baby is also there, it leads to SI joint pain. Women who go through this pain are more prone to getting arthritis and the risk increases with every pregnancy.
- Walking Habits. If you walk abnormally due to issues like one leg being shorter than the other or you are pregnant then you might suffer from sacroiliac joint dysfunction.
SI Joint Treatment
Working with a physical therapist is one of the first treatment options your health care provider will recommend.
“The most conservative and common treatment is physical therapy. Manual mobilization of joints, soft tissue work around the SI ligaments, muscles that attach to the sacrum like the piriformis, and gluteal and core exercises to instill more stability for the joint,” says Holland.
“Lifestyle changes are recommended: anywhere from avoiding asymmetrical sitting, crossing legs, prolonged leaning or rotational positions. Success in conservative PT treatment is high and sessions need not be long or arduous, though the pain may come back if core and gluteal strength is lost, or if the patient compromises themselves from an activity.”
The first option you have with regard to treating SI joint pain is to do low impact exercises such as yoga and massage.
You can also use cold packs to get pain relief and when the pain reduces, switch to a heat wrap. Post that, you need to soak in a warm bath.
Some people also use a sacroiliac belt to offer support to the SI joint to reduce pain.
If easy options like the above don’t get the desired results, your doctor may advise you to try non-surgical options like medications. Some of the options offered are:
- Muscle relaxants
- Oral steroids (short-term solution)
- Anti-inflammatory medications
- Corticosteroid injections that are added into the joints
- Tumor necrosis factor inhibitors (only if you have AS)
- Radiofrequency Ablation (In this option, energy is used to deactivate the nerves that cause the pain)
“Conservative management is typically recommended as a first-line treatment for non-traumatic SI joint pain by most medical guidelines. If this does not begin to relieve your symptoms after 4-8 weeks, other options include medicine, injections, and surgery which are best discussed with your medical provider,” says Hildebrand.
If all of the above treatments don’t work, you might be referred for a sacroiliac joint fusion surgery in which small plates and screws will hold the bones in the SI joint together to ensure that the bones fuse. This is the last resort as far as treatment options are considered.
The symptoms of SI joint can be easily misdiagnosed. The causes vary from one person to another. If you suspect you have SI joint pain or sacroiliac joint dysfunction, see a healthcare professional to discuss diagnostic options and possible treatment. Don’t delay as the problem might worsen with time.
Updated: June 11, 2020