Sacroiliac Joint Dysfunction

Sacroiliac joint pain (SIJP) is felt in the low back and buttocks. The pain is caused by damage or injury to the joint between the spine and hip. Sacroiliac pain can mimic other conditions, such as a herniated disc or hip problem. Accurate diagnosis is important to determine the source of pain. Physical therapy, stretching exercises, pain medication, and joint injections are used first to manage the symptoms. Surgery to fuse the joint and stop painful motion may be recommended.

The SI joints are located between the iliac bones and the sacrum, connecting the spine to the hips. The two joints provide support and stability, and play a major role in absorbing impact when walking and lifting. From the back, the SI joints are located below the waist where two dimples are visible.

Strong ligaments and muscles support the SI joints. There is a very small amount of motion in the joint for normal body flexibility. As we age our bones become arthritic and ligaments stiffen. When the cartilage wears down, the bones may rub together causing pain. The SI joint is a synovial joint filled with fluid. This type of joint has free nerve endings that can cause chronic pain if the joint degenerates or does not move properly.

Sacroiliac joint pain ranges from mild to severe depending on the extent and cause of injury. Acute SI joint pain occurs suddenly and usually heals within several days to weeks. Chronic SI joint pain persists for more than three months; it may be felt all the time or worsen with certain activities.

Other terms for SI joint pain include: SI joint dysfunction, SI joint syndrome, SI joint strain and SI joint inflammation.

The signs and symptoms of SI pain start in the lower back and buttock, and may radiate to the lower hip, groin or upper thigh. While the pain is usually one sided, it can occur on both sides. Patients may also experience numbness or tingling in the leg or a feeling of weakness in the leg.

Symptoms may worsen with sitting, standing, sleeping, walking or climbing stairs. Often the SI joint is painful sitting or sleeping on the affected side. Some people have difficulty riding in a car or standing, sitting or walking too long. Pain can be worse with transitional movements (going from sit to stand), standing on one leg or climbing stairs.

The SI joint can become painful when the ligaments become too loose or too tight. This can occur as the result of a fall, work injury, car accident, pregnancy and childbirth, or hip/spine surgery (laminectomy, lumbar fusion).

Sacroiliac joint pain can occur when movement in the pelvis is not the same on both sides. Uneven movement may occur when one leg is longer or weaker than the other, or with arthritis in the hip or knee problems. Autoimmune diseases, such as ankylosingspondyloarthropathy, and biomechanical conditions, such as wearing a walking boot following foot/ankle surgery or non-supportive footwear, can lead to degenerative sacroiliitis.

A medical exam will help determine whether the SI joint is the source of your pain. Evaluation includes a medical history and physical exam. Dr. Monsivais  will consider all the information you provided, including any history of injury, location of your pain, and problems standing or sleeping.  

There are specific tests to determine whether the SI joint is the source of pain. You may be asked to stand or move in different positions and point to where you feel pain. Dr. Monsivais may manipulate your joints or feel for tenderness over your SI joint.

Imaging studies, such as X-ray, CT, or MRI, may be ordered to help in the diagnosis and to check for other spine and hip related problems.

A diagnostic SI joint injection may be performed to confirm the cause of pain. The SI joint is injected with a local anesthetic and corticosteroid medication. The injection is given using X-ray fluoroscopy to ensure accurate needle placement in the SI joint. Your pain level is evaluated before and 20-30 minutes after injection, and monitored over the next week. Sacroiliac joint involvement is confirmed if your pain level decreases by more than 75%. If your pain level does not change after the injection, it is unlikely that the SI joint is the cause of your low back pain.

Nonsurgical treatments: Physical therapy, chiropractic manipulation, and stretching exercises help many patients. Some patients may require oral anti-inflammatory medications or topical patches, creams, salves or mechanical bracing.  

• Joint injections: Steroids can reduce the swelling and inflammation of the nerves. Joint injections are a minimally invasive procedure that involves an injection of a corticosteroid and an analgesic-numbing agent into the painful joint. While the results tend to be temporary, if the injections are helpful they can be repeated up to three times a year.
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• Nerve ablations: Injections into joints or nerves are sometimes called “blocks.” Successful SI joint injections may indicate that you could benefit from radiofrequency ablation – a procedure that uses an electrical current to destroy the nerve fibers carrying pain signals in the joint.
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Surgical treatment: If nonsurgical treatments and joint injections do not provide pain relief, Dr. Monsivais may recommend minimally invasive SI joint fusion surgery. 

The iFuse Implant System uses triangular-shaped, titanium implants that are inserted across the SI joint to maximize post-surgical stability and weight bearing capacity. This minimally invasive procedure involves making a small incision on the buttock and takes about an hour. 

SI joint treatment using the patented triangular design of the iFuse Implant™ has produced positive clinical results. More than fifty published, peer-reviewed articles demonstrate safety and effectiveness. iFuse is the only SI joint fusion system with clinical studies demonstrating that treatment improved pain, patient function, and quality of life.