Back pain from the sacroiliac joint is a common problem that I see in our clinic at Southwest Pain Management. Patient sometimes refer to this area as hip pain. It can mimic disc herniation or a pinched nerve, back arthritis, trigger points, and hip arthritis.
What are the symptoms of sacroiliac joint pain (sacroiliitis)?
- Pain usually in the low back area, leg pain in the back of the buttocks or thigh or hip pain. It can rarely cause groin pain.
- Sciatic-like pain in the buttocks and/or backs of the thighs that feels hot, sharp, and stabbing and may include numbness and tingling. Sciatic-like pain from sacroiliac joint dysfunction rarely extends below the knee.
- Pain that is worse with prolonged sitting. Often, I see patients not able to sit straight and raise one butt cheek off the chair.
- Pain is worse when rolling over in bed.
- Pain is worse with prolonged standing.
- Stiffness felt in the hips and low back, especially after getting out of bed in the morning or after sitting still for a prolonged period.
Activities that can aggravate sacroiliitis?
- Prolonged standing
- Standing on one leg
- Stair climbing
- Taking large strides
- Contact sports, regular heavy lifting, or labor-intensive jobs
- Prior lumbar fusion especially involving L4 to S1 level
Most Sacroiliac Joint Pain is Not from Arthritis but from Joint Dysfunction. This condition generally refers to pain in the sacroiliac joint region that is caused by either too much motion or too little motion.
- Too little motion: can cause muscle tension, pain, and may stop mobility. Pain is typically felt on one side of the low back or buttocks, and can radiate down the back of leg (similar to sciatica pain).
- Too much motion: can cause the pelvis to feel unstable and lead to pain. Pain from too much motion is typically felt in the lower back and/or hip, and may radiate into the groin area.
How is Sacroiliac Joint Pain Diagnosed?
There is no single test that can diagnose sacroiliac joint dysfunction. For this reason, it is important that a combination of diagnostic test results is taken into consideration together to form an accurate diagnosis. A diagnostic image guided injection with a local anesthetic into the sacroiliac joint can help make the diagnosis.
How is Sacroiliac Joint Pain Treated?
- Rest, specifically a recliner or laying on your back.
- Pain medications including OTC medications such as ibuprofen, acetaminophen, or naproxen
- Manual manipulation.Manual manipulation provided by a chiropractor, can be highly effective if sacroiliac joint pain is caused by too little motion.
- Supports or braces. When the SI joint is too loose (hypermobile), a pelvic brace can be wrapped around the waist and pulled snugly to stabilize the area. A pelvic brace is about the size of a wide belt.
- Sacroiliac joint injections. A local anesthetic can be injected with an anti-inflammatory medication (such as a corticosteroid) to reduce inflammation and help alleviate pain. The pain relief from a joint injection can help minimize pain when starting a physical therapy program and returning to normal activity levels. This is usually done under image guidance with fluoroscopy or ultrasound. It is not possible to accurately inject the sacroiliac joint with a blind injection.
- Surgical joint fusion