The triangular-shaped bone in the lower portion of the spine, centrally located below the lumbar spine is the sacrum. The connection of the sacrum and the right and left iliac bones form the sacroiliac joints. The sacrum is made up of five vertebrae that are fused together and do not move, while most of the bones (vertebrae) of the spine are mobile. The iliac bones are the two large bones that make up the pelvis and as a result the SI joints (these being the joint between the sacrum and the ilium bones of the pelvis) connect the spine to the pelvis.
At the SI joints there is relatively little motion as the sacrum and the iliac bones ( the ileum) are held together by a collection of strong ligaments. Normally there are less than 4 degrees of rotation and 2 mm of translation at these joints. Most of the motion in the area of the pelvis occurs either at the hips or the lumbar spine. When we are erect these joints do need to support the entire weight of the upper body and this places a large amount of stress across them. In turn this wear and stress can lead to wearing of the cartilage of the SI joints and arthritis.
Sacroiliac joint dysfunction pain could be a dull or sharp sensation and while it starts at your SI joint, it can move to your upper back, buttocks, thighs, or groin. There are times when standing up triggers the pain, at other times you feel it only on one side of your lower back. Many patients notice that it bothers them more in the morning and gets better during the day. This pain is more common than many people might think as 15%-30% of those who hurt like this have a problem with the SI joint.
Sacroiliac joint dysfunction causes may include traumatic injury such as a sudden impact like that endured in a motor vehicle accident or a fall, these can seriously damage your sacroiliac joints. Osteoarthritis is also known as wear-and-tear arthritis and can occur in sacroiliac joints, and so can ankylosing spondylitis, which is a type of inflammatory arthritis that affects the spine. In rare cases, the sacroiliac joint can become infected and if the sacroiliac joint suffers infection setting in it can become inflamed. During pregnancy a woman's sacroiliac joints must loosen and stretch to accommodate childbirth and the added weight and altered gait during pregnancy can cause additional stress on these joints and can lead to abnormal wear.
In diagnosis the first step is typically a physical examination and thorough history by a physician. A doctor will ask questions to determine if there are any underlying disorders that could be causing the patient's pain. Medical experts know certain signs can also help differentiate pain coming from the SI joints, lumbar spine, or hips. A physician can perform various tests during the physical examination that can help isolate the source of the pain. The SI joints can be moved or compressed to identify them as a source of pain by placing the patient's hips and legs in certain positions and applying pressure. To exclude certain possibilities that could mimic sacroiliac disease there are other portions of the examination which may be performed.
Treatments for Dealing with Sacroiliac Joint Dysfunction
There are various solutions and treatments for dealing with sacroiliac joint dysfunction. Massage, physical therapy and low-impact exercise like yoga can help stabilize and strengthen the SI joints and ease pain. Cold packs can be used to alleviate the discomfort and when the pain is more manageable, you can apply heat with a heating pad or heat wrap, or a soak in a warm bath. A sacroiliac belt can help support the SI joint and this may help ease your pain.
Your doctor may recommend medication and nonsurgical therapies if your SI joint pain can not be managed with physical therapy, exercise, and self-care, or if it is caused by a chronic condition. These solutions may include radiofrequency ablation, which uses energy to deactivate the nerves that are causing your pain, corticosteroid injections into the joint, oral steroids, for short-term use only and muscle relaxants. Your physician might also consider the use of anti-inflammatory medications, including nonsteroidal, as well as anti-inflammatory drugs (NSAIDs) such as naproxin, aspirin, and ibuprofen.
In most cases surgery is the considered the last resort. In the case of sacroiliac joint fusion surgery, small plates and screws hold the bones in the SI joint together so the bones fuse, or grow together. If the pain is chronic and the combination of physical therapy, medications, or minimally invasive interventions hasn’t been effective your doctor may suggest this surgery. Fusing the two bones together with metal hardware can sometimes relieve sacroiliitis pain. Joint pain can be short-term, especially when caused by pregnancy, injury, or strain. In most cases, sacroiliac joint pain can be relieved significantly with treatment.