Spine doctor explains mystery how the sacroiliac joint causes low back pain

Sacroiliac joint pain (sacroiliac joint dysfunction)

Best ways to get rid of SI joint pain (sacroiliac pain)

The sacroiliac joints (SI joints) are located at the back side of the pelvis below the belt  lineEach person hast two sacroiliac joints, one on each side just below the waistline on the back side of the pelvis, not too far from the hip joint.  The sacroiliac joint lies next to the bottom of the spine – below the lumbar spine and above the tailbone (coccyx). The SI joints, as the sacroiliac joints are sometimes called, are formed at the place where the sacrum connects with the two ilium (hip) bones.

The sacroiliac joints are “kidney bean” or “L-shaped” and allow for only a small amount of movement, perhaps 2-16 degrees of normal movement.  This small amount of movement allows a slight but complex pattern of twisting and rocking of the pelvis to occur when the legs are moved in a normal manner while walking. As a result the pelvis is able to gently rock or sway as we walk – women more than men – without much wasted lateral movement of the head.

The sacroiliac joints have important characteristics for weight bearing in the upright posture:

  • Very strong in spite of their small size, due to reinforcement from many large strong ligaments that surround the SI joints
  • Does not allow much movement, keeping it stable
  • Transmits forces from the upper body down to the pelvis, hip joints and legs
  • Shock absorbing structure
  • Provides for smooth pelvic movement while walking or running

The sacroiliac joints move together as a single unit.  From the back it is common to see a pair of dimples on the buttock near the base of the spine.  These are sometimes called the “dimples of Venus” and they are a landmark for the top portion of the sacroiliac joints.

Only a minor part of the stability of the SI joints comes from the placement of the two joint surfaces against each other bony structure; the great majority of SI joint strength is due to a deep and complex group of intrinsic and extrinsic sacroiliac ligaments.  The small movements of both sacroiliac joints are limited by the thick ligaments on the back of the pelvis that hold the SI joints together.  Any painful or abnormal movement of the sacroiliac joints is typically due to weakness of the ligaments or excessive forces applied to the SI joints – or both.

Sacroiliac joint dysfunction

There are many different terms for painful sacroiliac joint problems, such as SI joint dysfunction, SI joint syndrome, SI Sacroiliac joints are only slightgly moveable and can cause low back pain when taken beyond their normal range of movementjoint dysarticulation, SI joint strain, and SI joint inflammation. Each term describes a different aspect of a problem in the SI joints that causes pain as a result of a variety of causes.

Pain in the region of the sacroiliac joints is thought to be caused by inflammation of the ligaments and joint surfaces of the SI joints, or sacroiliitis.  Growing evidence over the last 20 years suggests that lower back, that may be accompanied by thigh pain in the front or buttock pain with or without leg pain is commonly due to the inflammation of one or both of the sacroiliac joint(s), or sacroiliitis.

Common problems of the sacroiliac joint that cause mild and diffuse ache or massive pain with limited movement and leg pain can be due to what is called sacroiliac joint dysfunction, also known as SI joint dysfunction.  Sacroiliac joint dysfunction is a general term for variable pain in the area of the sacroiliac joint(s), caused by abnormal motion in the sacroiliac joint.  This abnormal movement can be in the form of too much movement or too little movement.  In either case, joint inflammation of the SI joint, or sacroiliitis, results because of this excessive or reduced movement.

  • Too much movement causes instability, or the tendency to move more than normal or necessary. The pain that results is typically felt in the lower back and/or hip; it may extend into groin or upper thigh area.
  • Too little movement causes fixation or a fixed or locked feeling in the joint with inability to move easily.  This abnormal reduction of movement is irritating to the joint and eventually causes low back pain.  The pain that results is typically felt on one side of the low back or buttocks, with possible radiation down the back of the leg, similar to sciatica.  However, in SI joint fixation the leg pain usually remains above the knee, and rarely extends to the ankle or foot.


Effective help for sacroiliac joint pain

It can be difficult to accurately diagnose a sacroiliac joint dysfunction because the symptoms are so similar to and overlap those from several common lower back pain problems, such as lumbar facet syndrome, disc herniation, and sciatic nerve radiculopathy.

A diagnosis is usually arrived at through physical examination (eliminating other causes) and/or an injection (utilized to block the pain).

Sacroiliac pain and pregnancy

A common cause of SI joint dysfunction and pain is the stress applied to the low back and pelvis during pregnancy.  The hormones relaxin and oxytocin are released all throughout the pregnancy into the woman’s body to allow for widening of the pelvis to give more room to the growing baby and prepare for ligament relaxation that occurs during childbirth.  Relaxation of the many ligaments around the SI joints can result in excessive motion in the SI joints, allowing for abnormal pelvic mechanics, increased SI joint stress, abnormal wear and pain.  The changes in the SI joint ligaments are the reason for the altered waddle gait so common in pregnancy.

Sacroiliac joint arthritis

Just like any other weight-bearing joints of the body, the SI joints have a layer of cartilage that covers the bone surface of the joint. This cartilage serves to provide improved movement and a shock absorber between bones of the joint .  If this joint cartilage becomes damaged or is worn down by excessive use, the bones begin to rub against each other, allowing degenerative arthritis (osteoarthritis) to develop.  Arthritis of the SI joint is said to be the most common reason for pain and joint dysfunction.

Lifting Do’s and Don’ts to avoid sacroiliac joint pain

Symptoms and signs of SI joint dysfunction

Common signs and symptoms/signs of an SI joint problem:

  • Deep dull pain lower back pain on one side, occasionally on both sides.
  • Pain is often a mild to moderate ache around the dimple near the sacrum.
  • Pain aggravated while doing those activities that stress the SI joints (getting up from a chair, bending the knees while climbing stairs).
  • When SI joint dysfunction is severe it can cause referred or reflex pain into the hip, groin or lower leg on the same side as the involved SI joint.  Even when severe the pain rarely radiate below the knee.
  • SI joint pain often increases with prolonged sitting or prolonged walking.

Treatments for sacroiliac joint dysfunction (SI joint pain) are usually effective and are conservative in nature, designed to ultimately restore normal motion in the joint and provide low back pain relief.

Typical treatments for sacroiliac joint pain:

  • Ice and rest – with heat only later in the recovery cycle
    Initially use ice or cold packs, applied in 20 minute intervals to reduce inflammation in the SI  area, along with rest to reduce irritation.  The need for ice and rest is based on the presence of intense and sharp pain that is aggravated by prolonged sitting or standing.   This can continue for several days to several weeks, depending on ability to reduce pain and increase activity.  After the pain subsides, meaning the inflammation is reduced, the use of moist heat to the same area can begin to assist the healing process.  At this time it is advised that a slow and gradual return to normal activities that do not provoke a return of pain.
  • SI brace or support
    When the SI joint movement is excessive (“hypermobile” or too loose), an orthopedic support can be used to snugly hold the SI joints together.  The SI brace looks like a rather wide 3-4” belt that is worn below the hips and waist, to stabilize the area and allow rest for the excessively mobile SI joints.   Pain reduction and comfort are often immediate when the SI brace is worn.   As the symptoms improve the belt is worn less often and more loosely than during the acute stage, perhaps only during extreme or prolonged activity.
  • Medications
    A small amount of pain medication (acetaminophen), or anti-inflammatory medication (ibuprofen) to reduce the swelling that is contributing to the pain can be used.  Once acute pain is reduced this probably should be discontinued to allow the individual to know exactly how much inflammation is present and what types of actions and postures are aggravating the SI joint problem.  Too much medication allows the individual to often aggravate the condition because of the absent pain warning signal.
  • Acupuncture
    Because a high percentage of SI joint arthritis is the wear and tear type (osteoarthritis) treatment with acupuncture or acupressure can be extremely effective.
  • Chiropractic manipulation
    Manual manipulation provided by a chiropractor or osteopath is indicated to restore normal SI joint movement when the joint is fixated or “stuck” outside its normal position.
  • Exercise
    Controlled, gradual stretching and exercise of muscles is often indicated to tone the ligaments and muscles around the affected sacroiliac joint, as well as to increase range of motion.  This activity will increase the flow of blood into the area, and increase the flow of lymphatic fluid out of the area, both promoting a healing response.

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