SI Joint Pain
Some people develop pain in the sacroiliac joint (SI joint), where the spine attaches to the pelvis in the lower back area. If you have irritation or pain in your SI joint, it is important to come in for spinal imaging and evaluation. This often-missed problem in the lower back can be treated to alleviate your symptoms and improve your quality of life.
- Pain, potentially significant or debilitating, in the lower back
- Pain may feel dull and aching or sharp and stabbing
- Pain is typically felt on one side of the lower back, but may sometimes be felt on both sides
- Pain may radiate down into the buttocks and upper back of the leg (“sciatica”)
- Pain may spread to the hips and groin
- Burning, tingling, and numbness
- Stiffness or muscle tightness in the lower back, hips, pelvis, and groin, which may reduce range of motion
- Pain may worsen when putting pressure on the SI joint with movements like climbing stairs, running, jogging, lying on your side, or bearing weight unevenly when standing
- A feeling of instability in the pelvis and/or lower back, which may feel as though the pelvis will buckle when standing, walking, or sitting down
- Symptoms may worsen slowly, go through cycles of remaining stable or rapidly worsening, and flare during certain activities or physical movements
- Too much movement in the SI joint (hypermobility)
- Too little movement in the SI joint that leads to muscle tension and pain (hypomobility)
- Inflammation of the SI joint
- Arthritis in the SI joint
- Gait issues (such as discrepancies in leg length, taking uneven strides, or scoliosis) that place uneven pressure on the hips
- Weight gain
- Pregnancy or recent childbirth, which causes hormonal changes, pelvic changes, and ligaments relaxing in the SJ joint
- Previous lower back surgery (especially fusion surgery)
- Previous hip joint replacement surgery
- Overstressing the SI joint due to heavy lifting, contact sports, or labor-intensive work
- Poor conditioning of the pelvic and lower back muscles before engaging in labor-intensive activities
- Injury trauma, such as a fall
- Rarely, an infection can cause inflammation in the SI joint that leads to pain
- Conservative Treatment: Nonsurgical treatments are usually the best way to treat SI joint pain. These include lifestyle modifications, physical therapy, stretching, muscle conditioning, manual manipulation (such as with a chiropractor), weight management, posture management, wearing a pelvic brace, anti-inflammatory medications, resting, applying heat or ice, and/or SI joint injections. These treatments can manage pain, build endurance and strength, reduce swelling and inflammation, and increase flexibility. Usually, these treatments will provide sufficient relief, but if not, minimally invasive surgery may be recommended.
- Minimally Invasive Fusion Surgery: If all nonoperative forms of treatment have failed to provide relief, surgery may be advised. This procedure uses a bone graft and surgical implant to fuse the bones together in order to relieve SI joint pain.
Frequently Asked Questions
The sacroiliac joint (SI joint) is the area of the lower back that attaches the lumbar spine to the pelvis. It is a large joint on both sides of the sacrum (tail bone).
SI joint pain is an often-missed diagnosis because other conditions can cause similar symptoms. The first indicator is most commonly pain that is isolated to one side of the lower back, near the hips, and especially pain that continues down the buttocks into the back of the leg. If you have this pain, you should come in for spinal imaging and evaluation by an orthopedic spine surgeon; as an expert in this area, your surgeon will know what to look for and how to reach a conclusive diagnosis. A combination of a detailed medical history, physical examination, MRI, CT scan, X-rays, and other evaluation methods may be used to diagnose your condition and ensure that you get the treatment you need.
Most patients will not need surgery to alleviate SI joint pain. The various conservative treatments should be tried for several months (8 to 12 weeks minimum) before considering surgery. Surgery may be recommended if non-surgical treatments have failed to relieve significant pain.
The risks of minimally invasive fusions can be significantly lower than the risks of open spine surgery. Some of the risks of SI joint fusion are that the surgery may not significantly alleviate pain, the fusion may be unsuccessful, and the pressure may be displaced to the pelvis or lower back and cause pain in these areas. The risks and the potential benefits of your procedure will be discussed with you in detail beforehand in clinic prior to scheduling.
Depending on your condition, you may be discharged the same day or up to two days after your surgery. You can resume eating your normal diet as soon as you have recovered from the anesthesia. Many patients notice an improvement in pain levels immediately after the surgery. Postoperative pain is normal, but the pain is usually short-term and can be controlled with pain medications. Applying heat and ice is usually recommended to provide relief as well. You will be instructed how to modify your activities during recovery. You may also be given a pelvic brace and/or physical therapy. While most patients are able to resume many normal activities within a few weeks, the full recovery period typically lasts between three and six months.