Anatomy and Role of the Sacroiliac Joint
The sacroiliac (SI) joint is between the sacrum (the base of the spine) and the iliac, commonly called the hip bones. Collectively the two iliac bones and the sacrum form the pelvis. The SI joint serves as a shock absorber for the spine and torso when we stand and walk. Strong ligaments and muscle support this synovial joint that is filled with fluid.
Pain in the lower back and hip that radiates into the abdomen and groin can be caused by SI joint dysfunction. Too much motion or too little motion can lead to joint inflammation and lead to joint dysfunction. According to some reports, the sacroiliac joint is responsible for 15% to 30% of low back pain. Women often experience SI joint pain during and following childbirth due to changes that occur in the pelvis during pregnancy. There is strong evidence that people who have had a lumbar spinal fusion are more likely to develop SI joint pain.
Diagnosis of SI Joint Pain
Because of the intricate function of the lower spine, pelvis, and hips, identifying the sacroiliac joint as the source of back pain can be challenging. As a result, the diagnostic procedure for sacroiliac joint pain can be lengthy, usually consisting of the following steps:
– A comprehensive medical history, including information on recent or past injuries that may be causing pain, as well as when the pain began and a description of symptoms.
– Orthopedic tests are given as part of the physical exam. An example of this is if one applies pressure to the sacrum and iliac to stress the joint. This can temporarily relieve or worsen the source of pain. A single test should never be used to make a diagnosis, but a combination of tests will help to narrow down the potential causes of the pain.
– Since CT or MRI mostly proves to be inconclusive, these types of tests are mainly used to rule out other causes of lower back pain. A sacroiliac joint dysfunction may not show up as easily on imaging the same way that a disc prolapse, a bone spur, or an arthritic joint may. In addition, an imaging test should only be used to confirm a suspected diagnosis, not to make a diagnosis.
– Usually, after an ultrasound, an injection test is needed to locate the SI joint as the pain source. The needle is inserted into the patient’s buttock area with a local anesthetic in the joint space between the spine and hip. There is a strong correlation between an injection in the SI joint and pain being reduced if the pain is significantly decreased. This scoring system (often referred to as the P50-P75 rule) recommends that most patients with shoulder pain need to have a 50- to 75% reduction in their pain before they can definitively say that it is in the shoulder joint.
The diagnostic process for SI joint pain must consist of multiple methods that inform each other. There is no single technique or method that has been shown to pinpoint the sacroiliac joint with certainty
What Are Treatment Options for Sacroiliac Pain?
The key to proper treatment of the SI joint is to determine if the cause of the pain is due to a lack of motion, too much motion, or a trauma. You then want to do the opposite and reduce any inflammation that is present. A combination of the techniques and therapies described below may be utilized to help create short-term relief and a long-term solution.
Chiropractic Manipulation: Can help restore motion to the SI joint with specific adjustments using either the hands or instrument-assisted techniques. A series of adjustments over the course of a few weeks is usually needed.
Physical Therapy: If the source of pain is due to a lack of motion, then specific stretches are used to relax tight muscles and ligaments. Weak opposing muscles may be strengthened to provide more stability if the problem is created by too much movement. Every person and problem is unique and a skilled therapist can design a specific plan to appropriately address the problem.
Laser Therapy: A class IV laser uses multiple wavelengths of light to reduce inflammation and promote healing. This is particularly important if the SI Joint pain is due to an injury. This will significantly speed up the healing process by increasing blood flow, reducing inflammation, and reducing nerve pain.
Sacroiliac Belt: In some situations where there is excess motion within the SI joint a compression belt may be used to temporarily stabilize the joint to promote healing between rehab sessions.
Rock Tape: This is a therapeutic tape used by athletes to provide support, while still allowing for movement. The tape stimulates nerve endings in the skin and helps down-regulate pain and reduce inflammation.
Injections: A number of injections have been shown to be helpful for SI joint pain. A skilled medical provider has to weigh the risks verse benefits of various therapeutic approaches. While a Cortisone injection provides an anti-inflammatory effect and will temporarily reduce pain, it also breaks down cartilage and will eventually destabilize the joint. This is why Cortisone injections are given sparingly. A better option may be Platelet Rich Plasma (PRP) and Stem Cells. This provides much-needed nutrients to a damaged joint and can encourage healing and regeneration of new tissue. Depending on the severity of the joint damage PRP, Stem Cells or a combination of both may be administered.