What Is The Treatment For Sacroiliac Joint Pain?

When you get up from a chair after being seated for a long time, do you feel a sharp pain in the lower back area?

Have activities like gardening, jogging, and even walking become difficult?

Does your lower body feel a little bit like it might “give away” or buckle slightly under pressure?

If so, it may be an issue with your SI (Sacroiliac Joint). If this type of pain – in your buttocks and lower back – happens regularly, we recommend you don’t ignore it and seek treatment immediately because it could be a sign of a degenerative disease that can be improved, cured, or even prevented.

What Is The Sacroiliac Joint?

The SI (sacroiliac) joints (there are two of them) are located at either side of the spine inside your lower back area. Their function is to bear the upper body’s weight while walking or standing and distribute your weight evenly to the legs. 

But what happens when something goes wrong?

Here are some of the most common issues that affect the Sacroiliac Joints and cause pain in the lower back and buttocks:

  • Sacroiliitis

When one or both the sacroiliac joints get inflamed, it is medically termed sacroiliitis. This term is because the joints are placed in the area where the sacrum and ilium join. Sacroiliitis is among the more common causes of pain in the lower back, legs, or buttocks. However, diagnosing the condition is quite challenging because several other medical conditions present similar symptoms. 

What Causes Sacroiliitis?

The symptoms of sacroiliitis manifest mainly due to inflammation of one of the sacroiliac joints. Several medical conditions can cause this type of inflammation in the joint, for example:

  • Psoriatic arthritis: is a condition characterized by swelling and pain in the joints accompanied by psoriasis (a skin condition) breakout. In addition, psoriatic arthritis may lead to the spinal joints getting inflamed, which includes the SI joints.
  • Ankylosing spondylitis: This condition is another form of inflammatory arthritis of the spinal joints. Sacroiliitis is often considered to be a prelude to developing ankylosing spondylitis. That’s why you must get it checked out if you have pain in the SI Joint. 
  • Osteoarthritis: is a degenerative disease that mainly occurs with aging and wear and tear. The ligaments and sacroiliac joint can get damaged and cause pain as it progresses.

What Are The Other Causes of Sacroiliitis And Sacroiliac Joint Pain?

  • Pregnancy: Pregnant women produce additional hormones that make the pelvis and linked joints more flexible during childbirth, resulting in the SI joint’s rotation. Also, the extra weight usually gained during pregnancy can strain the SI joint and cause it to wear out. 
  • Pyogenic sacroiliitis:  One of the rarer instances, when the SI joint gets infected and painful is the presence of the Staphylococcus aureus bacteria. 
  • Trauma: Any type of accident, fall, or injury to the pelvic region can damage the ligaments and the SI joint and give rise to the symptoms of Sacroiliitis.

What Are The Symptoms of Sacroiliitis And Sacroiliac Joint Pain?

The most common symptoms of Sacroiliitis are:

  • Pain in the thigh, buttock, hip, or lower back 
  • Pain that is aggravated when you get up from a seated position, or you’ve been standing for a long time. 
  • Pain that gets worse when you rotate your hips. 
  • The pain can be sharp and intense or throbbing and dull. It differs from person to person. 

How is Sacroiliitis Diagnosed?

To make a diagnosis of Sacroiliitis. First, your doctor or physical therapist will go through your complete medical history and ask you about any pre-existing conditions that you may have. Then, they will perform specific medical tests to confirm their suspicions of a problem with the sacroiliac joint. These tests may include:

  • Physical tests: Your doctor will scrutinize your spinal cord to check its range of motion and whether it is appropriately aligned. During this physical examination, you will be asked to sit in a particular position and make specific movements that allow us to see how your SI joints function. We may also apply pressure to your spine, the SI joints, legs, and hips. If more than one of these tests causes pain (are positive), we are likely to arrive at the conclusion of Sacroiliitis.
  • Imaging tests: Depending on the outcome of your physical examination, we may also recommend MRI/ CT scans/ X-rays to examine any damage to the SI joints or check for any injury. 
  • Blood work: In rare cases, there may be a need for a blood test to look for inflammation and/or infection markers – as is the case in Pyogenic Sacroiliitis. 

Are There Any Complications Linked to Sacroiliitis and SI Joint Pain?

If neglected, Sacroiliitis could cause loss of mobility in some patients. Besides, constant pain can also lead to long-term sleep deprivation and ultimately to psychological issues such as depression and anxiety.

In cases where sacroiliitis and sacroiliac joint pain is linked to ankylosing spondylitis, the condition deteriorates progressively. Then, over a more extended period, it can result in the spinal vertebrae stiffening and fusing. Sometimes, without proper treatment, ankylosing spondylitis can eventually lead to disability, so it pays to consult with a physical therapist at the earliest possible point. 

What Are The Treatments for Sacroiliac Joint Pain and Sacroiliitis? 

There are several treatment options for sacroiliitis and sacroiliac joint pain. First, we find the source of your pain, and if it is your Si joint, we take steps to relieve the pain as quickly as possible. Next, we recommend modifications to your daily routine to reduce the symptoms and pain. 

If you go to your doctor about Sacroiliac Joint Pain, they’re likely to just send you away with instructions to take over-the-counter painkillers, but if your pain is severe, they make also write you a prescription for more potent, opioid-based painkillers. We don’t recommend this strategy unless it is 100% necessary. We always recommend that you try Physical Therapy first because it is infinitely more effective. 

However, there are some other treatment options, like:

  • Nerve treatment: Your doctor might suggest treating the nerves that run through the SI Joint to help reduce your pain. This treatment prevents the pain signals from traveling from the joint to your brain and vice versa. Another option is an injection to freeze the nerve. However, this treatment option only provides one to two months of pain relief before it returns with a vengeance. 
  • Injections: Your doctor may also administer cortisone to relieve the SI joint inflammation or further deaden the surrounding nerves to give you pain relief.  You may also receive other drugs or saline at the same time to help ease the pain in your sacroiliac joint. Plus, they may use prolotherapy to treat any loose ligaments if that is the cause of the pain in your SI joint. Finally, steroid injections may be given into the SI joint to diagnose and relieve the symptoms. This procedure is usually done using an X-ray to check that the injection is provided in the correct location. 
  • Chiropractic treatment: Visiting a chiropractor helps alleviate the pain for some patients. Still, many patients experience no relief when they have chiropractic treatment for SI Joint pain. It’s very individual. Chiropractors usually manipulate the joints and muscles of the entire body to realign spinal joints, etc., so the treatment doesn’t necessarily treat the presenting issue because it’s not specific. 

If Conventional Treatments Do Not Offer Relief

While most of the abovementioned conventional treatment options aid in reducing pain and inflammation, there may be chronic cases where they are not as effective. Your doctor might suggest surgery to treat the condition in the most severe cases. In addition, they might also resort to a procedure known as SI joint fusion, where implants and pins are used to join the bones. But this is even more reason why you should book an appointment with a Physical Therapist ASAP if you have pain around your SI joints. 

Physical therapy For Sacroiliac Joint Pain

Physical therapy is one of the most effective treatments to improve flexibility and strengthen the muscles around the sacroiliac joints. At Intecore Physical Therapy, we identify how your body moves. We can spot where you might have adopted compensatory movements that may be contributing to your pain – like leaning or limping. We rectify these imbalances to realign your SI joints. We also use a combination of stretching movements, massage, joint, and muscle manipulation, hot and cold therapy, and ultrasound to cure your SI joint pain. 

Not sure whether Physical Therapy is right for you?

We offer a free appointment to patients with sacroiliac joint pain for you to talk through your symptoms with one of our physical therapists. We answer your questions on what may be causing your pain and advise you on the best way forward – with zero obligation to book treatment. Book here now. 

Andrew Vertson