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Sacroiliac Joint Pain (SI Joint Pain)

Introduction

The Sacroiliac joint dysfunction causes pain in the back and the lower extremities. It can also cause inflammation in the joints also known as sacroiliitis. The sacroiliac joints are located in between the sacrum and the pelvis or the iliac crest. These joints serve as shock absorbers. When there is pain in these joints, it is due to either hyper-mobility which means there is excess motion in the joints, or hypo-mobility which means there is limited motion in the joints.

Hypermobility can be caused by different reasons such as pregnancy and injury. Hypomobility can also be caused by degenerative joint conditions such as arthritis. Sacroiliac joint pain can also be caused by previous spinal lumbar fusion surgeries because this can cause more movement in the joints due to limited movement in the lumbar section of the spine.

There are varying symptoms for this condition and can sometimes be misdiagnosed for herniated disc condition.

Causes

The causes for sacroiliac joint pain can be categorized into two namely, hyper-mobility and hypo-mobility.

Hypermobility refers to excess movement in the joints. The following are possible causes for hypermobility:

  • Pregnancy

It is a common cause due to weight gain, hormonal changes and pelvic changes. After pregnancy, sometimes the ligaments remain loose as they were from child bearing and can result to sacroiliac joint pain.

  • Injury

Injury that causes torn ligaments can lead to sacroiliac joint pain. It can either be a spinal trauma of one blow such as high impact sports where an athlete falls heavily on his/her buttocks or due to repetitive stress on the joints from labour intensive jobs that require things such as prolonged sitting.

  • Previous Lumbar surgery

It’s been evidenced that sacroiliac joint pains are more likely to follow after Lumbar spinal fusion surgeries due to limited movement in the Lumbar spine therefore increasing motion in the joints.

Hypomobility refers to limited movement in the joints. The following are possible causes for hypomobility:

  • Aging

As a person grows older the joints become subject to deterioration. In fact in a person’s 30’s or 40’s, changes in the joints will happen such as the formation of crevices and clumping of cells in the ligaments. Eventually later in the years, there will be plaque formation and erosions. These changes can cause limited movement in the joints which can cause pain in the lower back and lower extremities.

  • Overweight

Obesity can add more pressure on the joints because sacroiliac joints are responsible for support of the entire upper body weight. The increased pressure may cause inflammation and degeneration. This too will cause limited movement in the joints due to degeneration.

Symptoms

Symptoms associated with the sacroiliac joint pain commonly take place in the buttocks, groin, hips, lower back, pelvis and thighs. Hence, the following are example of what a person might experience in these areas due to sacroiliac joint pain:

  • Lower back pain

Usually lower back pain is only felt on side but can be experienced in both sides. It usually consists of a dull, aching feeling that have varying degrees of severity.

  • Radiating pain

Radiating pain is usually felt in the buttocks, groin and hips. It can occurs on both sides but often occurs only on one side. 

  • Tingling sensations

Stabbing pains can be felt in the buttocks or behind the thighs and can also include numbness.

  • Stiffness

This means that there is limited ability to move specifically the lower back, groin, hips and pelvis. This makes it difficult to perform ordinary actions such as bending and climbing the stairs.

  • Localized pain

This means that when there is increased pressure in the joints, it makes it more difficult to perform day to day movements. The sacroiliac joint is responsible for basic actions such as standing and walking. Without this joint, a person is rendered immobile.

  • Instability

Instability in the pelvis or the lower back causes it feel like it will give away and can cause uneasiness in simple movements such as standing and walking.

Risks

There are several risk factors that may increase the chances of sacroiliac joint pain. The following are example of these risk factors:

  • Aging

The older a person is, the more prone they will be to developing sacroiliac joint pain due to degeneration that comes with aging. Overtime, ligaments and muscles will deteriorate and movement can easily cause inflammation in the joints and pain.

  • Obesity

Obesity is simply unhealthy for the body, and even so for the sacroiliac joints. The sacroiliac joints are weight bearing joints responsible in supporting the upper body weight. Increased pounds can result to increased pressure on the joints that can eventually cause inflammation and degeneration.

  • High-impact sports

Athletes who participate in high impact or contact sports are more likely to develop sacroiliac joint pain due to traumas that can occur in the joints such as an improper landing of a gymnast, getting shoved in a hockey game or being tackled in football. These are examples of situations where the sacroiliac joint can potentially be damaged.

  • Intensive labor jobs

Jobs that require constant sitting, standing, lifting, etc. can cause ad pressure in the sacroiliac joints especially if the lower back and pelvis are not accustomed to it.

Prevention

Although sacroiliac joint pain can be caused by things that are simply unavoidable such as aging and pregnancy, there are still plenty of things that one can do in order to prevent increasing the chances of sacroiliac joint pain development.

  • Low impact exercises

Examples of this kind of exercise are pilates, swimming, walking and yoga. Exercises that strengthen surrounding muscles in the hips will lift some pressure from the sacroiliac joint from constantly supporting the person’s upper body weight. If one has stronger muscles, tendons and ligaments, one is less prone to cause pain the joint. It will help in the joint’s shock absorption by transferring it.

  • Maintain a well-balanced diet

This will help a person avoid obesity or adding unnecessary pounds to the body that could potentially increase the pressure on the sacroiliac joints. Acting as supports for the upper body weight, a well-balanced diet will keep the joints from incurring damage.

  • Avoid Smoking or Tobacco products

Smoking releases toxins in the body that blocks nutrients that are needed for the joints in the body. With the natural process of aging already causing gradual deterioration in the joints, smoking can aggravate this condition and cause the development of sacroiliac joint pain to come early in life.

  • Proper posture

Proper posture is good for overall body health. Strain in the muscles in the spine can result to pain in the sacroiliac joint. Also, a misalignment in the spine can add pain in the sacroiliac joint too.

  • Avoid chronic injury causing activities

The older a person is the more prone are the joints in deteriorating therefore causing pain in the sacroiliac joints. Hence, it becomes imperative to avoid activities that require repetitive motion or can eventually lead to chronic injury such as golfing and improper lifting.

  • Stretching and Warming Up

Warming up before participating in high-impact sports will allow better shock absorption support for the joints. Stretching will help avoid chronic injuries.

Treatment

Conservative Treatment

Before resorting to surgical procedures, there are several conservative treatments that can be done in order to alleviate the pain in the sacroiliac joint. The following conservative treatment options are discussed:

  • Physical Therapy

Physical therapy usually includes stretching, strengthening exercises and low-impact aerobic exercise. Tension in the lower back, hips and pelvis can be the main cause of pain in the joints. This can be addressed through stretching to remove the tension here. Also, strengthening exercises will allow more support for the joint from all the weight bearing duties it has had to do. Aerobic exercises are perfect for healing damaged tissues since they assist in better circulation of nutrients and oxygen in the damaged areas.

  • Medication

Over-the-counter medications that help address the inflammation in the joints such as NSAIDs (Non-steroidal anti-inflammatory drugs) are the usual prescriptions. Examples of these are ibuprofen and naproxen. In the case of severe pain, the physician may prescribe narcotic drugs but only for a certain period of time since these can be highly addictive and can cause worse side effects.

  • Hot/Cold Therapy

Application of ice and heat can help in removing pain from the sacroiliac joints. Ice or cold therapy can reduce inflammation and decrease pain and discomfort. This can be applied in the lower back and the pelvis areas. Heat or hot therapy can alleviate the pain by decreasing the tension and spasms in the muscles which can be the main cause of pain the joints.

  • Chiropractic Care

Chiropractic practice refers to the manual manipulation by an expert chiropractor. It will involve the physical manipulation in the hips, joints and lower back in order to decrease the muscle tension and restore normal mobility in the joints where there would’ve just been hypo-mobility.

  • Sacroiliac Joint Injections

Sacroiliac joint injections are common ways of conservatively treating pain in the joints. Aside from reducing pain in the joints, it is also used in diagnosis and locating the source of pain. It is often a corticosteroid injection that relieves inflammation in the joint, and also a local anesthetic such as lidocaine or bupivacaine. This is sometimes administered before physical therapy sessions to minimize pain during the therapy.

The following are other examples of conservative treatments:

  • Ultrasound Therapy
  • Massage Therapy
  • Muscle Relaxants
  • Supports or Braces

Surgical Treatment

Surgical Treatment is often a last resort. The physician is more likely to prescribe the patient to conservative treatments for several months such as physical therapy, chiropractic care, medications and sacroiliac injections. In the case where after several months the symptoms still persist, then surgical treatment will be considered.

SI Joint Fusion

A sacroiliac joint fusion is a minimally invasive procedure which means fairly minimal incisions are made during the surgery. A fluoroscope is used during the procedure to guide the surgeons performing the surgery. A small incision is made through the buttock and then, the pelvis and sacrum are joined together. It uses implanted screws or rods, or even bone grafts across the affected joint. This is process is done through the two to three centimeter incision through which implant instruments are introduced. After the fusion is successful, the incision is irrigated and closed using standard sutures.

Over the years, the procedure has been enhanced and evidenced to alleviate excruciating symptoms. However, there is still the risk that despite surgery the fusion won’t be successful or will be unable to remove the pain. Other complications could include transferring the pressure and pain to the lower back. These kind of complication however, has only appeared in about 5% of the surgeries conducted in the country.

Open SI Joint Fusion

Unlike most spinal procedures, an open surgery is usually the traditional procedure. However, open sacroiliac joint fusion is a rarely performed surgery now since the minimally invasive procedure guarantees fewer complications such as blood loss, infection and muscle disruption. It also has a longer recovery period compared to the minimally invasive surgery because it requires larger incisions.

It has been evidenced that more benefits and positive outcomes are experienced with minimally invasive procedures. Although both will alleviate pain from excruciating symptoms as a result from the sacroiliac joint dysfunction, the minimally invasive procedure has resulted to better improvement with its patients.

Recovery

After the surgery, the patient may be required to stay for more than one night. For full recovery, the physician will be providing certain instructions in order to ensure optimum rehabilitation. It is important to follow the physician’s instructions to the letter. No matter how a patient feels he or she has already recovered, overworking the affected area may result to painful symptoms.

Recovery usually includes pain medications, physical therapy and hot/cold therapy. Sometimes, a pelvic brace is also introduced in order to stabilize the pelvic area and assist in the healing process to relieve the joints from pressure on weight bearing. The recovery plan per patient will vary according to the procedure performed and the severity of the condition. Other factors also include the kind of system that was conducted, either through bone grafts or other instruments.

The recovery period may vary from patient to patient. Some may progress faster than the others, but it is important to simply follow through the recovery plan. Ideally, it lasts for only three to six months.

Physical Therapy

Physical therapy is meant to allow the low back and pelvis to operate normally as before through gradual controlled therapy. It is issued by the surgeon who recommended the surgery. It can be combination of different methods according to the needs of the patient. The following are examples of the methods that can be used during the rehabilitation:

  • Passive Range Motion Stretches

This involves slow, gentle and gradual leg movements to expand the mobility range of the hips. This will reduce tightness or stiffness in the pelvis and hip muscles.

  • Stretching

This involves movement in the low back, hip and leg muscles. Specific instruction swill be given by the therapist to ensure full mobility in these areas.

  • Strengthening exercises

This involves strengthening core muscles to alleviate any pressure from the joints and help the joints in its weight supporting functions.

  • Aerobic exercises

This is usually placed near the end of the recovery program since it is important that the muscles have already been strengthened. This aims to assist in muscle activity and circulation in the hips and lower back.

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