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Sacroiliac Joint Syndrome
In the first part of the 20th century, sacroiliac (SI) joint syndrome was the most common diagnosis for lumbago (low back pain). Any pain in the low back, buttock, or adjacent leg was usually referred to as SI joint syndrome. Before 1932, SI joint syndrome was a particularly popular diagnosis. There was actually a period referred to as the “Era of the SI Joint.”
In the late 1980s, many physicians “rediscovered” the SI joints as a possible source of back pain.
Yet even today, SI joint pain is often overlooked. Many physicians do not consider it as an important aspect of severe joint syndromes. Many are still reluctant to believe a joint that has so little movement can cause back pain.
Learn about SI joint syndrome including
- Where the SI joints are located and how they are affected
- What causes the condition
- What symptoms are present
- How a diagnosis is made
- What treatment options are available
- Human sacroiliac joint, artwork
Questions and Answers
What are the Symptoms of Sacroiliac Joint Syndrome?
The common symptoms of Sacroiliac Joint Syndrome include lower back pain, buttock pain, hip pain, and pain that radiates down the leg (sciatica-like symptoms). Some individuals may also experience stiffness, aching, or a feeling of instability in the lower back and hips.
What Causes Sacroiliac Joint Syndrome?
Sacroiliac Joint Syndrome can be caused by various factors, including:
- Trauma: Injury or trauma to the sacroiliac joint, such as a fall or car accident, can lead to joint dysfunction and pain.
- Pregnancy: Hormonal changes and increased joint laxity during pregnancy can contribute to sacroiliac joint dysfunction and pain.
- Repetitive Motion: Repetitive activities or movements that place stress on the sacroiliac joint, such as certain sports or occupations, can lead to joint irritation and inflammation.
- Arthritis: Conditions such as osteoarthritis or ankylosing spondylitis can affect the sacroiliac joint and result in pain and dysfunction.
How do you Diagnose and Treat Sacroiliac Joint Syndrome?
- Diagnosis: The diagnosis of Sacroiliac Joint Syndrome often involves a combination of medical history evaluation, physical examination, and diagnostic tests. These tests may include imaging studies (such as X-rays, MRI, or CT scans) to assess the joint’s structure and rule out other potential causes of pain.
- Treatment: Treatment options for Sacroiliac Joint Syndrome may include:
- Non-Surgical Approaches: These can include rest, activity modification, physical therapy, chiropractic care, pain medication, and the use of supportive devices (such as belts or braces) to stabilize the joint.
- Injections: Corticosteroid injections can be administered directly into the sacroiliac joint to reduce inflammation and alleviate pain.
- Minimally Invasive Procedures: In some cases, minimally invasive procedures, such as radiofrequency ablation or sacroiliac joint fusion, may be recommended to provide long-term pain relief.
- Surgical Intervention: Surgery is usually considered as a last resort and may be recommended for individuals who do not respond to conservative treatments or have severe joint damage.
Summary
In essence, the accessory sacroiliac joint and iliosacral complex are pivotal in understanding the origins of sacroiliac joint pain. Their susceptibility to degenerative changes and strain makes them primary contributors to the discomfort felt in this critical joint. Understanding these structures helps in diagnosing and treating SI joint pain more effectively.
Anatomy of the Back
To understand your symptoms and treatment options, it helps to begin with a basic understanding of the anatomy of your lower back. This means that one should become familiar with the various parts that make up the lumbar spine and recognize how each part works with another.
Learn more about the anatomy of the lumbar spine
There are two sacroiliacs (SI) joints in your pelvis that connect the sacrum (tailbone), and the ilium (large pelvic bone). The SI joints connect your spine to the pelvis, and thus, to the entire lower half of the skeleton. Like any other joint, there is articular cartilage on both sides of the SI joint surfaces. But unlike most other joints, two different kinds of cartilage cover the SI joints. The articular surfaces have both hyaline (glassy, slick) and fibrocartilage (spongy) surfaces that rub against each other. The joints also have many large ridges (bumps) and depressions (dips in the surface that fit together like a puzzle).
The SI joints are also unique, but they are not designed for lots of movement. As people age, it is common for the SI joint to become stiff and actually “lock.” The SI joint only moves about two to four millimeters during weight-bearing and forward flexion. This small amount of motion that occurs in the joint is known as a “gliding” type of motion. Due to the small amount of movement and the complexity, it is difficult to determine any motion of the SI joint during a physical exam.
Several components influence the movements of the sacroiliac joints:
- Age: Younger individuals often require more mobility in their sacroiliac joints. Conversely, older adults typically need more stability. As people age, the joint surfaces develop ridges and depressions, which promote better interlocking and increased stability.
- Sex: Women, particularly during pregnancy and childbirth, need increased mobility in their sacroiliac joints. This adaptive change allows for pelvic expansion to accommodate the growing uterus.
- Mechanical Loads: Athletes and active individuals demand more mobility for optimal performance. On the other hand, those who are overweight or frequently carry heavy weights need more stability, which is provided by the joint’s strong ligaments.
The SI joints are viscoelastic joints, meaning that the major movement comes from giving or stretching. This motion is quite different than the hinge motion of the knee or the ball and socket motion of the hip. Furthermore, during pregnancy, the joints become more mobile to compensate for the growing uterus and pelvic expansion.
Understanding these factors helps in appreciating the complex nature of the sacroiliac joints and their critical role in maintaining both stability and mobility in the human body.
Factors Affecting SI Joint Movements
Several components, including age, sex, and the mechanical loads placed on the sacroiliac joint, affect its movements.
Age and Mobility
- Young Individuals: Younger individuals may need more mobility in their sacroiliac joints.
- Older Individuals: Older persons often require more stability, which is supported by the joint’s strong ligaments and age-associated ridges and depressions that promote better interlocking.
Sex and Mobility
- Women: Women, particularly around the time of pregnancy and childbirth, may experience an increased need for mobility in the sacroiliac joints.
Mechanical Loads
- Athletes vs. Overweight Individuals: Athletes might need more mobility, whereas overweight individuals or those who frequently carry heavy weights typically require more stability.
Adaptive Changes During Pregnancy
Adaptive changes in the sacroiliac joint occur during pregnancy. The joints become more mobile to compensate for the growing uterus and pelvic expansion, facilitating childbirth.
Primary Function of SI joints
The main function of the SI joints is to provide shock absorption for the spine through stretching in various directions. Additionally, the SI joints may provide a “self-locking” mechanism that helps you to walk. When you transfer weight from one leg to the other, the joints lock on one side
Understanding Sacroiliac Joint Pain: The Role of Accessory Structures
Anatomical variations in the sacroiliac (SI) joint are quite common, affecting anywhere from 3% to 50% of the population. These variations can contribute significantly to SI joint pain. Two notable structures, the accessory sacroiliac joint and the iliosacral complex, play key roles in this discomfort.
Accessory Sacroiliac Joint
The accessory sacroiliac joint is an additional joint surface that can form in some individuals. This variant is particularly prone to degenerative changes due to its constant involvement in weight-bearing activities. Over time, the wear and tear on this accessory joint surface can lead to painful symptoms, making it one of the most common sources of sacroiliac joint-related pain.
Iliosacral Complex
The iliosacral complex is another anatomical variation that can impact the SI joint. This structure involves a more elaborate arrangement of the ligaments and cartilage, sometimes including additional or unusual bone formations. The added complexity of these tissues can make the area more susceptible to strain. When these ligaments are stretched or stressed, they can cause significant discomfort.
Pain Mechanisms
The SI joint’s unique anatomy requires it to bear a substantial portion of the body’s weight. Because of this, any structural irregularities, like those found in the accessory sacroiliac joint and iliosacral complex, can easily lead to damage. Cartilage may be worn, bones might show signs of degenerative changes, and ligaments can become overstressed.
These changes create a pathway for pain. The dense network of nerves surrounding the SI joint is exceptionally sensitive. Any irritation or damage in this area can send powerful pain signals to the brain, making SI joint pain a debilitating condition for those affected.
Roles in Movement and Posture
The sacroiliac joints play a crucial role in several essential functions:
- Walking: They allow for smooth weight transfer from one leg to the other by locking on one side, facilitating stable and coordinated walking.
- Spinal and Thigh Movements: These joints enable a variety of spinal and thigh movements, essential for daily activities.
- Posture Changes: The SI joints assist in changing posture or position, such as shifting from lying to standing and from standing to sitting.
By supporting these functions, the sacroiliac joints ensure that movements are efficient and less taxing on the spine.
How Do the Sacroiliac Joints Move, and What Are Nutation and Counternutation?
The sacroiliac (SI) joints, which link the spine to the pelvis, are crucial for overall mobility. These joints primarily allow for forward and backward movements, but they also move along different planes, including upward and downward.
Types of Movements
Nutation
- This is the forward and downward motion of the sacroiliac joint.
- During nutation, the tailbone (coccyx) moves backward relative to the hip bone.
- This movement enhances the stability of the sacroiliac joint.
Counternutation
- This refers to the backward and upward movement.
- During counternutation, the tailbone moves forward relative to the hip bone.
Despite these movements appearing slight, they’re vital for balance and flexibility. The typical range of motion within the SI joint is limited to 2 mm to 4 mm and 2° to 5° because of the joint’s bony structure and surrounding ligaments. The full range of sacroiliac motion usually occurs at the extremes of hip movements, like when rotating the hip outward to its furthest point.
Understanding these movements helps in diagnosing and treating various issues related to the SI joints. Proper functioning of these movements is essential for activities like walking, sitting, and bending.
The Role of the Joint Capsule and Synovial Fluid in the Sacroiliac Joint
The sacroiliac (SI) joint features a complex structure that’s crucial for its function.
The Joint Capsule
The outer part of the SI joint is enveloped by a joint capsule made of robust, fibrous tissue. This capsule:
- Serves as a protective layer.
- Provides structural stability to the joint.
- Is primarily located on the front side of the joint, with the back portion lacking this fibrous coverage.
The inner part of the capsule contains a delicate synovial membrane.
The Synovial Fluid
The synovial membrane within this capsule plays a key role by secreting synovial fluid. This fluid:
- Lubricates the joint, reducing friction between the bones.
- Facilitates smooth movement.
- Nourishes the cartilage and other joint structures.
Joint Classification
Due to the presence of the joint capsule and synovial membrane, the SI joint is classified as a synovial, diarthrodial joint—meaning it’s moveable. However, because of the specific arrangement of these components, some experts refer to it as an atypical synovial joint or a modified synarthrodial joint.
Causes of Sacroiliac Joint Syndrome
Many problems can lead to degenerative arthritis of the SI joints. It is often hard to determine the reason for wear and tear to the joints. One of the most common causes of problems at the SI joint is an injury. The injury can come from a direct fall on the buttocks, a motor vehicle accident, or even a blow to the side of your pelvis.
Consequently, these injuries cause force that can strain the ligaments around the joint. Ligaments are the tough bands of connective tissue that hold joints together. The tearing of these ligaments can cause additional motion in the joint. Excessive motion can eventually result in wear and tear of the joint and pain from degenerative arthritis.
Also, injuries can damage the articular cartilage lining the joint. Certainly, it will lead to degenerative arthritis in the joint over time. An abnormality of the sacrum bone can cause pain. The sacrum bone is a very specific set of vertebrae. When your body undergoes development in the womb, several vertebrae fuse together to form the sacrum.
Abnormalities
In some people, the bones that make up the sacrum never fuse together. In this situation, two or more of the vertebrae remain separated rather than fused together. This creates an odd situation where a doctor malformed the SI joint and a false joint occurs (also known as “transitional syndrome”). Subsequently, one can see this abnormality on X-rays. And, people having this syndrome seem to have more problems with their SI joints. They also feel back pain that appears to come from that area.
Anatomical Variations and Pain Implications
Anatomical variations of the sacroiliac joint exist in 3% to 50% of the general population. These variants may include changes to the cartilage or ligament tissues or be associated with structural changes in the adjacent bone. Common variations include:
- Accessory sacroiliac joint
- Iliosacral complex
- Bipartite iliac bony plate
- Crescent-like bony plate
The accessory sacroiliac joint is generally prone to degenerative changes and is the most common symptomatic variant.
Due to its constant role in weight-bearing and unique anatomy, the sacroiliac joint(s) can become a source of pain. Symptoms can develop within the joint if the cartilage or bone gets damaged and/or when the ligaments that support the joint are strained. The vast network of nerves around the joint is highly sensitive and can transmit painful signals originating in this region.
Due to childbirth, women are at risk for developing SI joint problems later in life. During the pregnancy, the female releases certain hormones. These hormones allow the connective tissues in the body to relax. The relaxation is necessary so that the female pelvis can stretch enough to allow birth during the delivery. This stretching results in some changes to the SI joints that make them hypermobile (extra or overly mobile).
For years, these changes can eventually lead to wear-and-tear arthritis. During pregnancy, the SI joints can cause discomfort both from the effects of the hormones that loosen them and from the stress of carrying a growing baby in the pelvis. The more pregnancies a woman has, the higher her chances of SI joint problems.
Sacroiliac Joint Syndrome Symptoms
The symptoms of SI joint syndrome are often difficult to distinguish from other types of low back pain. In most cases, there is a confusing pattern of back and pelvic pain that mimics each other. Finally, this makes SI joint syndrome diagnosis very difficult. The most common symptoms include:
- Low back pain
- Buttock pain
- Thigh pain
- Difficulty sitting in one place for too long due to pain
Diagnosis of Sacroiliac Joint Syndrome
Usually, the diagnosis begins with a complete history and a physical exam. Your clinical exam may include the following orthopedic tests. These orthopedic tests will determine the involvement of the SI joints. If you feel pain during these tests, it generally indicates that the SI joints can be a problem.
- Distraction Test – The doctor stresses the SI joints. They attempt to pull them apart a bit.
- Compression Test – The two sides of a joint are forced together. Pain may indicate that there is an involvement of the SI joint.
- Gaenslen’s Test – The examiner will place you on a table with both legs brought up to the chest. After that, you need to shift to the side of the table so that one buttock is over the edge. The unsupported leg drops over the edge and the supporting leg is flexed. In this position, SI joint problems will cause due to stress to the joint.
- Patrick’s Test – The heel of one leg is crossed on top of the opposite knee, and the medical practitioner press down the top knee down to test for hip mobility and pain. Also, a provider can recommend determining the abnormalities of the joint.
- If X-rays are taken and they suggest something, a doctor may suggest a CT scan to get a better look.
- Sometimes, a CT scan can show more detail about the joint surfaces and the surrounding bone.
- Additionally, the bone scan is useful to determine the inflammation of the joint. An inflamed SI joint usually shows up as a hot spot on a bone scan of the pelvis.
Treatment Options for Sacroiliac Joint Syndrome
The choice of treatment is dependent on whether the SI joint is stiff or loose. A stiff or “locked” joint responds best to mobilization. Mobilization is a form of stretching joints that helps in improving joint movement. The therapist uses hands-on techniques to treat the problem along with mobilization. These techniques include specific exercises that will help in improving SI joint mobility.
For conditions like arthritis or SI ligament injuries, when the joint becomes too loose, one should choose stabilization treatments to hold the joint in the correct alignment. Stabilization exercises involve posture and muscle training.
You can schedule therapy sessions 2-3 times each week. These sessions are available for up to six weeks. The goals of physical therapy are to help you
- Learn ways to control symptoms and manage your condition
- Learn correct posture and body movements to reduce SI joint strain
- Obtain optimal movement and alignment of the SI joint Physical Therapy
Physical Therapy
Patients commonly receive physical therapy treatment for SI joint problems. A well-rounded Rehabilitation program assists in calming pain and inflammation, improving your mobility and strength, and helping you do your daily activities with greater ease and ability.
Learn more about spinal rehabilitation
Sacroiliac Belt
Medical experts will issue a sacroiliac belt to help stabilize a loose and painful SI joint. The belt wraps around the hips to squeeze and hold the SI joints together. This supports and stabilizes the pelvis and the SI joints.
Learn more about back and neck braces
SI Joint Injection
Your doctor may also recommend that you undergo a fluoroscopic injection into the joint. During this test, the doctor injects a local anesthetic into the joint. The doctor uses the fluoroscope to make sure the needle is actually in the joint before injecting the medication. The SI joints are located fairly deep in the upper buttocks. A thick muscle covers these SI joints.
It is difficult to put a needle into the joint without some guidance. The doctor uses a special TV camera that uses X-rays to see the exact placement of the needle on the screen and to make sure that it is in its accurate position. This device is known as a fluoroscope.
Once the needle is in the right place, the doctor injects an anesthetic to numb the joint. If the pain goes away, your doctor can be relatively sure that the problem is coming from the SI joint and not somewhere else in the spine. The doctor may also add a dose of cortisone to the injection.
This will help in easing the pain. Cortisone is a powerful anti-inflammatory medication that calms arthritis inside the joint and reduces pain. However, the effect is temporary and will sometimes only last for two to three months.
Surgical Treatment for Sacroiliac Joint Syndrome
When all the conservative methods of treatment fail, surgery on the SI Joints is the best option. Surgery on the SI joint usually consists of a fusion of the joint (also called an “arthrodesis”). The doctor fuses two sides of a joint together to reduce the pain.
An incision is made over the SI joint in the lower back. After that, the surgeon opens the joints and sees each joint surface. He removes the articular cartilage lining the joints from both surfaces. This leaves a fresh surface of bone rather than the normal cartilage.
The bone surfaces are then held together until they heal or fuse. Without the articular cartilage of the joint, the body treats the two raw bone surfaces just like a fracture and tries to heal them like any broken bone.
To hold the bones together, the surgeon will usually insert several metal screws across the joint. He will also place a bone graft around the joint to help fuse it. Usually, he will remove bone from the pelvis to aid in the fusion.
Choose the Best Spine Doctors and Surgeons
The Southwest Scoliosis and Spine Institute with offices in Dallas, Plano, and Frisco, Texas specializes in the treatment of scoliosis and other spinal conditions, including neck pain. They offer a range of non-surgical and surgical treatments for back pain, including physical therapy, medication, injections, and surgical interventions.
The Institute’s team of spine specialists, orthopedic spine surgeons, and pain management specialists, work together to develop individualized treatment plans for each patient. They use the latest technology and techniques to provide effective, minimally invasive treatments that minimize pain and recovery time.
The doctors, Richard Hostin, MD, Devesh Ramnath, MD, Ishaq Syed, MD, Shyam Kishan, MD, and Kathryn Wiesman, MD, treat the various causes of neck pain, such as Sacroiliac Joint Syndrome, degenerative disc disease, herniated discs, spinal stenosis, and scoliosis. The doctors emphasize the importance of early diagnosis and treatment for neck pain to prevent further damage and improve quality of life. Overall, people should consider visiting the Southwest Scoliosis and Spine Institute for neck pain because of their specialized expertise, advanced treatments, and focus on individualized care.
If you or your loved one suffers from spinal pain, you should call Southwest Scoliosis and Spine Institute at 214-556-0555 and make an appointment.
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If you or a loved one suffers from spinal pain, you owe it to yourself to call Southwest Scoliosis and Spine Institute at 214-556-0555 to make an appointment.