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
Anatomy of the back
To understand your symptoms and treatment options, it helps to begin with a basic understanding of the anatomy of your low back. This means that one should become familiar with the various parts that make up the lumbar spine and recognize how such parts work together.
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 joints, 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.
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. The main function of the SI joints is to provide shock absorption for the spine through stretching in various directions. Also, 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.
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.
In some people, the bones that make up the sacrum never fuse together. In this situation, two or more of the vertebra remains 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.
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 the 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. A 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 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
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
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 pelvic to aid in the fusion.
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.
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.