What Is SI Dysfunction and How Can It Be Treated?
At the bottom of the spine is the sacrum (or tailbone) that connects to the pelvic girdle. In this bony structure are the iliac bones. Where these bones meet are the sacroiliac or SI joints. Although the SI joints do not normally move independently because of the snug interface and strong ligaments surrounding the joints, the joints can become more mobile due to injury or disease.
Not only can this hypermobility produce pain because of misalignment and abrasion, but other inflammatory conditions like arthritis may also cause SI joint pain. The joint may also degenerate which can lead to pain symptoms. If the condition produces inflammation, then this is called sacroiliitis.
What Does Sacroiliac Joint Dysfunction Feel Like?
Sacroiliac joint dysfunction is most commonly experienced as low back pain. It may express itself like sciatica in which there is shooting pain down the back of one leg since sacroiliac joint dysfunction is more likely to affect just one side. The pain may also appear in the groin or feet.
This condition is more likely to appear in young or middle-aged women. Pain symptoms may worsen after sitting for long periods or rolling over in bed. Pain may also appear after standing for a long time, climbing stairs, running, or taking long strides. There may be stiffness in the lower back and hips upon waking. If there is inflammation in the joint, you may also experience a low-grade fever.
In rare cases where the sacroiliac joints have severely deteriorated, the patient may feel instability in the pelvis. They may feel like their pelvis or lower back could give way when standing or walking.
Common Causes of Sacroiliac Joint Dysfunction
The most common causes for sacroiliac joint dysfunction include
- Injury—a sudden impact like a fall or a car accident may damage these joints producing irritation, inflammation, and discomfort.
- Pregnancy—in childbirth, the sacroiliac joints must stretch to accommodate the passage of the infant. During the pregnancy, the added weight and altered gait can overly stress the sacroiliac joints and damage them.
- Spinal misalignment—there is a higher risk of sacroiliac joint dysfunction among people with misaligned spinal issues like scoliosis or leg length differences. These issues can put undue pressure on one sacroiliac joint or the other.
- Previous back surgery—patients that have undergone procedures like spinal fusion are at a greater risk of sacroiliac joint dysfunction. This also applies to people who underwent hip replacement surgery.
- Repetitive stress—people who engage in contact sports, heavy labor or repeated lifting are more likely to develop sacroiliac joint dysfunction. Similarly, the risk is higher for those that who must sit or stand for long periods of time.
In rare cases, it has been shown that sacroiliac joint dysfunction can arise without an obvious cause.
Diagnosing Sacroiliac Joint Dysfunction
It can be difficult to diagnose SI joint dysfunction because it often has the same symptoms as other chronic pain conditions like a herniated disc or facet joint arthritis. The initial steps of diagnosing this condition involve taking a thorough medical history and performing a comprehensive physical examination. This should reveal any risk factors in your diet, sleep, or daily activities as well as any injuries that could have led to damage of the sacroiliac joints.
Some diagnostic tests that may be performed include
- Sacral thrust—if pressure is applied to the back of the hips of someone lying face down and produces pain, that is a strong indicator of sacroiliac joint dysfunction.
- Distraction test—pressure on the front of the hips that produces pain is often indicative of sacroiliac joint dysfunction.
- FABER test—the patient lies on their back with one leg extended straight while the other foot rests against the inside of the other knee. The bent knee is gently pushed down and out. Pain in the hip is a positive sign for sacroiliac joint dysfunction.
- Palpation test—if a thumb is pressed firmly over the sacroiliac joint, resulting in pain, then it is a strong sign of sacroiliac joint dysfunction.
- Imaging tests—an MRI, CT or x-ray may be used to rule out issues like a herniated spinal disc.
- Sacroiliac joint injection—a numbing agent is injected into the sacroiliac joint. If the pain is blocked, this is taken as reliable proof of a sacroiliac joint dysfunction.
Treatments for Sacroiliac Joint Dysfunction
There are several therapies for sacroiliac joint dysfunction:
- Posterior SI Arthrodesis—this minimally invasive procedure involves a small bone graft that is placed in the sacroiliac joint to stabilize the joint. This procedure requires only a small incision and can be completed in a very short period, allowing the patient to return home on the same day.
- Rest—some patients merely need 1 or 2 days of bed rest to allow inflammation to subside. More than a couple of days of bed rest is not recommended as that may lead to stiffness and worsening pain symptoms.
- Ice and heat—applying heat and ice can ease discomfort while promoting blood flow to the problem areas. You should not apply ice or heat for more than 20 minutes at a time.
- Medications—in many cases of sacroiliac joint dysfunction, over-the-counter pain relievers like Tylenol or Motrin may be used to mitigate discomfort. In cases of more severe pain, muscle relaxants or opioid pain killers may be prescribed.
- Manual manipulation—if the sacroiliac joint dysfunction is a result of too little joint movement, then a clinician may try to restore joint mobility by massaging the surrounding muscles and the joint itself.
- Braces—if the sacroiliac joint is too loose, it may be reinforced by wearing a pelvic brace. This additional support may also prevent pain by reducing abrasion of bony surfaces.
- Sacroiliac joint injection—an injection of an anti-inflammatory like a corticosteroid along with a local anesthetic can reduce the pain and swelling of sacroiliac joint dysfunction. Although the pain should diminish initially after the shot, it may return for a few days before the steroid takes effect.
Article written by: Dr. Robert Moghim – CEO/Founder Colorado Pain Care
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