Sacroiliac Joint Pain
Sacroiliac Joint pain is frequently overlooked cause of Low Back Pain
SI joint pain
The sacroiliac joint can be a cause of low back pain, And, a painful, dysfunctional SI joint can also be associated with other causes of back pain as well. And, the SI joint is often overlooked as a contributor to someone’s back problems.
Localized Pain
The SI Joint pain is often localized over the low back, off to one side, at the belt line. This region overlies the joint, and if a joint is damaged, ‘locked up,” or otherwise inflamed, it just hurts.
Pointing right to that part of the back over the joint is actually called “fortons sign.”
Referred Pain
Pain can also be ‘referred’ to other locations in the body. It can be a ‘great mimicker’ of other problems. It can mimic (or be mimicked by) disc hernations, pinched nerves, radiculopathy. facet arthritis, and other causes.
Even pain down the leg, like what Grandma calls “sciatica” could actually be from the SI joint.
Associated back problems
While SI joint problems can occur independently, they often accompany other back and spine problems as well. You can imagine that if someone has an abnormal lower back, that the abnormal forces of the spine can transfer to the SI joint as well, causing SI Joint problems.
Evaluation
Because the SI joint dysfunction can present in so many ways, it can take some time and testing to get the right diagnosis. Imaging studies (e.g. Xrays, MRIs), Physical therapy, Specific physical exam and history findings, and even injections maybe needed to evaluate for the actual cause (or causes) of low back pain.
Causes of Sacroiliac pain
I have seen many patients over the years with Sacroiliac dysfunction. The injury can be caused by widely diverse injuries:
Stepping off a step or curb the wrong way, and ‘jamming’ the back and SI joint.
Being in a car accident, and slamming on the brake with one foot, and the SI joint takes the force.
Being a collegiate Rower, Volleyball player, or Track runner — and putting excessive stress on the joint.
Having bad arthritis in the spine, scoliosis, or even prior Spine surgery, can stress the joint.
Treatment options
Non Operative
The majority of patients with SI Joint dysfunction can be treated nonoperatively:
Physical therapy — can help ‘re-adjust’ the SI joint back into position, and teach you how to do exercises and maneuvers to keep it in place.
Injections — these can include steroid type injections to help decrease inflammation, and are often used in conjunction with P.T.
Regenerative treatments — Such as PRP/PRF, Stem Cells, and other treatments can help the body naturally heal SI Joint ligament damage and often helps with the pain.
Surgical and Minimally Invasive (MIS) treatment
When other treatments fail, often surgery is the best choice for treating a severely dysfunctional and painful SI joint.
Typical surgery now is performed in an MINIMALLY INVASIVE way. I often use Robotic or Image guided procedures to help direct the surgery to place instrumentation in the optimal position, while keeping the incisions to a minimal size.
Minimally invasive surgery has the advantage of causing less collateral tissue damage, it allows for maintenance of good blood flow and thus healing, and it overall hurts less for a faster recovery.