Sacroiliac Joint Dysfunction – Causes, Symptoms, and Treatment Modalities

What is Sacroiliac Joint?

The sacroiliac joint is a linkage system between the lower part of the spine and pelvis. Our tailbone (sacrum) connects with the right and left sides of pelvic bones to form sacroiliac joint. Our sacroiliac joint is a fairly stiff and rigid connection between the tailbone and pelvic bones, and only a few degrees of movement occurs here.

Sacroiliac Joint Dysfunction x-ray image.

When our sacroiliac joints are not moving correctly either due to excessive stiffness or excessive movement, it is called sacroiliac joint dysfunction. Feeling pain in the lower back and hip region is a usual symptom of SI joint dysfunction.

Causes of Sacroiliac Joint Dysfunction

There are multiple causes of sacroiliac joint dysfunction some of which are following:

1) Degenerative Arthritis

Degenerative arthritis or osteoarthritis of the sacroiliac joint occurs due to cartilage breakdown as a result of age-related wear and tear changes of cartilage. Breakdown of cartilage is predisposed by:

  • Obesity
  • Ageing
  • Trauma or injury
  • Stress on sacrum due to repeated movements
  • Congenital malformation

2) Ankylosing Spondylitis

Pain and inflammation of the sacroiliac joint is the first symptom of this disease. Ankylosing spondylitis originates first in the sacroiliac joint and then further progresses to the spine.

3) Psoriatic Arthritis

Psoriatic arthritis is a condition in which joints are inflamed and painful with scaly skin patches, termed as psoriasis. Psoriatic arthritis involves the whole body joints but affect more the spinal joints including sacroiliac joint.

4) Gout

Gout is caused by excessive accumulation of monosodium urate crystals in the joint spaces resulting from increased uric acid. The big toe is the most frequently involved joint, but the sacroiliac joint is also affected.

5) Trauma

The sacroiliac joints or its supporting ligaments may be injured by trauma. It can result from a small trauma, e.g. from stepping on a chair or from a big trauma, e.g. a fall or in a vehicle or motorbike injury.

6) Laxation of Ligaments during Pregnancy

The hormones relaxin and progesterone are secreted in the body of the mother during pregnancy which causes the relaxation of muscles and ligaments, especially in the pelvic region. Sometimes, due to excessive laxation, sacroiliac joint is displaced and causes severe pain. Symptoms are relieved after pregnancy.

7) Mechanical Stress

Some people have stiffed joints due to surgical spinal fusion or arthritis. Additional stress is exerted on SI joint due to stiffness which may lead to pain and degenerative changes.

8) Obesity

SI joint has to support extra weight in the obese persons who cause weakening of ligaments and wear and tear changes in the bone. This causes swelling and pain of the joint.

9) Leg Length Discrepancy

If the length of one leg is more than the other one, alteration of the normal walking pattern occurs. Thus pain is felt in the foot, ankle, knee and hip. Patients feeling severe pain in the leg often suffer from the problems of lower back pain or sacroiliac joint dysfunction.

10) Hypermobility Disorders

Hypermobility disorders due to increased contractions of transversus abdominis muscle and oblique abdominals muscles which support the SI joint through their attachments through iliac bones.

Symptoms of SI Joint Dysfunction

Here are some symptoms of sacroiliac joint dysfunction:

  • Pain in the lower back is the most frequent symptom.
  • Feeling of tingling sensations, numbness and weakness in the lower extremity.
  • Pain in the pelvic region or buttock.
  • Pain in groin
  • Buckling of leg
  • Insomnia due to severe pain
  • Unable to sit for a long time. Unstable sitting pattern.
  • Difficulty in driving a car.
  • Pain is going to worse with transitional movements (sitting from standing or vice versa), climbing stairs or standing on one leg.
  • Sometimes feeling pain in the lower back while crossed legs.

Pain exaggerates during sexual intercourse or during menstruation in the women.

How Doctors Diagnose the Problem?

The doctor made the diagnosis after taking a complete history and performing a general physical examination. The doctor can feel tenderness over the joint. Certain investigations are required to know either the SI joint is the source of pain. Imaging studies, e.g. X-ray, CT scan or MRI are required to be performed to see joint erosion and condition of the spine. Sometimes, a diagnostic injection is given using X-ray fluoroscopy. If the level of pain is not changed after the injection is given, the SI joint is not the cause of pain.

Surgeon explaining Sacroiliac Joint.

How to Prevent Sacroiliac Joint Dysfunction?

Sacroiliac joint dysfunction can be avoided by certain lifestyle modifications. You should consider the following tips in this regard.

  • Always adopt proper and good lifting techniques.
  • Maintain good posture while sleeping, moving, standing and sitting.
  • Take regular exercises with stretching movements of the body and strengthening exercises.
  • Take proper nutrition with adequate calcium and vitamin D intake.
  • Maintain your weight within the normal range of BMI.
  • Avoid smoking.
  • Adopt stress management and relaxation techniques.
  • If you are suffering from depression, go to a psychologist.
  • If you are a weight lifting worker, do not lift the load beyond your capacity and wear back support belt during working hours.

Treatment Modalities

The first treatment modality is to treat the underlying cause of sacroiliac joint pain or dysfunction. Some treatment options are the following.

Physical Therapy

Exercise strengthens the muscles and makes the body more flexible. The therapist may also try heat and cold fomentation, ultrasound, massage and stretching techniques to relieve pain.

Injections

Corticosteroid injections are the best modality for the reduction of inflammation of joints.

A mixture of normal saline and numbing drugs are also used for injecting in the joints to relieve pain. It also causes the tightening of loose ligaments which cause pain.

Chiropractic Treatment

Chiropractic treatment is about spinal manipulation and treatment of surrounding structures. Muscles and joints are moved in such a way that pain is reduced. Click to read more about Chiropractic treatment.

Nerve Treatment

In this technique, the nerve that sends the signals of pain from SI joint to the brain is permanently damaged by a needle. The doctor can also freeze the nerve with injection, but it is not commonly practised.

Topical Therapy

Sometimes topical patches, salves or creams are also used for pain relief. These are NSAIDs formulations.

Surgery

If the nonsurgical modalities fail to treat sacroiliac joint dysfunction, the doctor may also recommend minimally invasive sacroiliac joint fusion surgery. Through a small incision, titanium implants are placed also bone graft material for the joint stabilisation and promotion of bone growth. The person undergone surgical procedure is allowed to go home after a few days of surgery. For many weeks, the patient is unable to carry heavy weight and uses crutches for support.

Non-invasive Non-surgical Treatment Modality

If you want to avoid harmful side effects of drugs and invasive surgical intervention, we recommend you Backrack™ device. It’s a spinal decompression device is designed to treat and prevent all forms of back pain. The design of Backrack™ device mirrors the natural curvatures of the spine. It decompresses the spine removing extra stress from it. You will have to lye on it in a central position with knees flexed. There is no side effect of using this device, and you will feel an improvement in your lower back pain after the 5 days of its use. It’s a non-invasive way of treating the lower back pain due to sacroiliac joint dysfunction and other causes.