Sacroiliac Joint Disorders

The sacroiliac (SI) joints are located between the tailbone (sacrum) and each hip bone (ilium) in the pelvis. These joints are cushioned by cartilage and allow just a small amount of movement between those bones. The SI joints absorb the shock of the upper body onto the hips and legs. Degenerative arthritis, an abnormal walking pattern or inflammation can trigger pain on one side of the lower back which can move to the buttocks, groin, or thigh.

• Sharp or dull lower back pain usually on one side
• Pelvis/buttock pain
• Hip/groin pain
• Pain from sitting to standing
• Pain alleviated with walking
• Pain with increased sitting

SI joint pain can usually starts on one side of the back and can radiate to the hips and legs. You may notice pain upon getting out of bed in the morning after laying on one side overnight. Pain usually decreases with walking after initially standing.

• Age: pain is often caused by arthritis.
• Injury: injury, such as a fall or car accident, can knock the joint out of alignment.
• Leg length inequality: legs of different lengths can cause unequal strain on the SI joint.
• Multiple pregnancies: the hormone that loosens this joint near the end of pregnancy to ease childbirth is suspected to increase the chance of arthritis in later life

Diagnosis of SI joint pain is performed by a review of your medical history and a physical examination that includes at least three tests designed to identify the location of the pain.

Faber Test: patient lies on back testing flexion, abduction and external rotation of hip and leg
Gaenslen’s Test: patient lies on back to detect musculoskeletal abnormalities and inflammation
Yeoman’s Test: patient lies on abdomen extending knee and hip to locate source of pain

MRI, CT, or fluoroscopy (live X-ray) tests may be performed to rule out other potential causes for the pain. Alternatively a diagnosis can be reached by performing a diagnostic injection in which an anesthetic is injected into the joint. If the anesthetic causes the pain to subside it can be determined the SI joint is the source of pain.

Many treatment options are available to manage SI Joint pain. The first step after diagnosis is often a conservative treatment. Many times SI pain is unlikely to cause further damage and the pain may subside without treatment. Over-the-counter medications alone can be used effectively to alleviate pain. Additionally a sacroiliac belt can be worn to support and immobilize the joint to relieve pain while the joint heals. Also physical therapy can be used to improve the strength of your back and abdominal muscles.

For patients that have tried a combination of treatments with no relief, our doctors can perform steroid injections to relieve pain immediately. A surgical alternative for severe SI joint pain when all other treatments have been exhausted is fusing the painful joint. The fused joint no longer shifts preventing the nerves from being rubbed or pinched. Although fusing sometimes occurs gradually and naturally with aging, premature surgical fusing should be considered only as a last resort.