Where Is My SI Joint and Is it the Cause of My Pain?
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An Overview of Sacroiliac Joint Pain
The sacroiliac joint, commonly referred to as the “SI joint” is the joint bridging the lowest segment of the spinal column called the sacrum (just above the tailbone) to the bones of the pelvis known as the ilium. The sacroiliac joints are the two joints that connect the iliac bones to the sacrum, providing support and stability to the body during movement. The sacrum is the triangular bone near the bottom of the spine. The ilium is one of the three bones of the hip at the uppermost point of the pelvis.
It’s useful to think of the SI joint as the joint where weight and forces transfer from the upper body to the legs. The integrity of the SI joint depends on the strong ligaments that encase and cover it, both in the front and the back. These ligaments compress and stabilize the joint, keeping it together and limiting its motion. The SI joints support the upper body when we are standing.
What happens when the SI joint stretches due to injury or degenerates due to age? It destabilizes and when this occurs it allows the joint to have excessive motion. This excessive motion may inflame and disrupt the joint, stimulating nerves that cause pain in the buttocks or low back, and it may even radiate down one or both legs. The pressure on the joint caused by excessive weight is also a potential cause of pain.
Over time, the SI joint can develop arthritis and become painful. Triggers for sacroiliac joint pain may include physical activities that involve the lower back, hips, pelvis, and legs moving together such as walking, climbing stairs, and standing can stress the SI joint.
Some occupations requiring frequent standing, walking, or sitting (for example, teachers or store clerks) may contribute to stress on the SI joint. Activities that include heavy manual labor also strain the SI joint. Your physician may refer to sacroiliac joint pain by other terms like sacroiliitis, SI joint degeneration, SI joint inflammation, SI joint syndrome, SI joint disruption, and SI joint strain/sprain.
Typically, SI joint pain can be caused by ligament problems or inflammation in the joint. These include:
- Sacroiliac Joint Dysfunction: This happens when the ligaments around the joint are either too loose (hypermobility) or too tight (hypomobility) leading to sacroiliac pain in the low back and buttocks.
- Sacroiliitis: Inflammation of the SI Joint can be caused by various factors, making it essential to consult an expert for proper diagnosis to differentiate it from other conditions causing similar sacroiliac pain.
- Conditions Affecting the SI Joint: Autoimmune conditions like rheumatoid arthritis and ankylosing spondylitis can impact the SI Joint, often resulting in sacroiliac pain.
Table of Contents
Symptoms
Diagnosing
Treatments
The Five Common Causes of Sacroiliac Joint Disfunction
- Traumatic: lifting, falling, accidental injury
- Biomechanical: leg length discrepancy, prior lumbar fusion
- Hormonal: Pregnancy / childbirth
- Inflammatory Joint Disease (sacroiliitis): associated with a generalized arthritic condition
- Degeneration: age-related wear and tear
Patients Ask:
What Causes SI Joint Pain?
Texas Back Institute Responds: SI joint dysfunction can be caused by a variety of conditions, including osteoarthritis (OA), ankylosing spondylitis (AS), trauma, repetitive stress to the joints, old age, pregnancy, abnormal walking patterns (gait), leg length differences, and scoliosis (abnormal curvature of the spine).
How is SI Joint Pain Diagnosed?
To diagnose the sacroiliac joint as the pain generator, a spine specialist at Texas Back will start with a medical history and a physical examination. During the physical examination, the physician may determine if the SI joint is the cause of pain through movement of the joint.
Patients Ask:
How do I know if it’s my Sacroiliac, Hip or Lower back that is Hurting?
Texas Back Institute Responds: The most common symptom of sacroiliac joint disorder is pain in the low back, buttock, and sometimes in the same side leg. This can present sciatica–like symptoms (leg pain, burning, numbness, and tingling) that mimic lumbar disc or radicular low back pain – pain that radiates down the leg.
Patients Ask:
Why do I have an aching pain in my buttocks?
Texas Back Institute Responds: The most frequent symptom of SI joint pain is pain that radiates to the buttock and thigh. The symptoms of an inflamed SI joint are similar to those associated with conditions like sciatica, bulging discs, and arthritis of the hip. Evaluation by a spine specialist at Texas Back Institute will determine the cause and location of the pain.
Common Preliminary Diagnostic Tests Used to Diagnose SI Joint Pain
Some common preliminary diagnostic tests usted to diagnose SI Joint Pain include:
- Cranial shear test: While you lie on your stomach on an exam table, the doctor puts pressure on your tailbone to check for pain.
- Flamingo test: The doctor asks you to stand on the leg where you have pain and hop.
- Gaenslen’s test: While you lie face up, your doctor bends and presses one knee toward your chest while pressing the other leg, outstretched, off the side of the table.
- Gillet test (one-leg stork test): You stand with your feet about 12 inches apart, one leg raised and bent. The doctor stands behind you and pushes on each side of your tailbone with their thumbs, checking for correct movement.
- Pelvic compression test: While you lie on your side, the doctor presses down on your upper hip.
- Pelvic distraction test: While you lie face up on the table, the doctor presses down on both sides of your pelvis at the same time.
- Patrick’s test (FABER test): You lie face up and put the foot of the side where you hurt against the opposite knee. The doctor presses against the knee and the opposite pelvis at the same time.
- Sacroiliac shear test: While you lie face down, the doctor puts one hand on top of the other over your tailbone and pushes down, looking for motion in your joint.
- Thigh thrust test: While you lie face up on the table, the doctor puts one hand under your buttock while bending your hip and knee at a 90-degree angle.
Patients Ask:
How do I Know if the Way I Walk is Causing My Pain?
Texas Back Institute Responds: When someone has an abnormal gait due to leg length differences, this imbalance can result in uneven pressure on one side of the pelvis. Over time, an abnormal gait can cause wear and tear and lead to misalignment of the SI joint. The way we move can easily affect spinal issues. Likewise, spinal issues can affect the way we move. If you have a stiff or arthritic hip and cannot swing the hip through the full swing phase while walking, your stiff hip forces an earlier and non-symmetrical transfer of force to the spine which can trigger pain in vulnerable patients.
Physicians may also use X-rays, CT-scan, or MRIs to help diagnose the sacroiliac joint as the pain generator. Your spine specialist may request sacroiliac joint injections as a diagnostic test. It’s also important to remember that more than one condition (like a disc problem) can co-exist with sacroiliac joint disorders. This means that even if the sacroiliac problem is addressed, pain could still be present. Your doctor will discuss this with you.
Patients Ask:
Can Scoliosis cause SI joint pain?
Texas Back Institute Responds: Scoliosis is an abnormal curvature of the spine and can indeed contribute to SI joint pain. This abnormal curvature impacts the alignment of the SI joint, which can lead to pain and movement dysfunction in the pelvic area.
SI Joint Injections
SI joint injections involve injecting a numbing medication into the sacroiliac joint to see if the injection temporarily alleviates symptoms. If it does, the SI joint is most likely the source of the pain. Injections may provide temporary pain relief, or the pain may remain reduced for a longer period.
SI joint injections are done in a fluoroscopic suite. The response to the injection may last for hours, days, or weeks, depending on the disease process. What is looked for is a temporary resolution of the pain complaint brought to the doctor. This temporary resolution must be dramatic.
What is the Best Treatment for SI Joint Pain?
The initial step for treatment of sacroiliac joint pain may involve physical therapy and repeated SI injections to manage pain and provide pain relief.
Conservative care for this condition consists of:
- Anti-inflammatory medication
- Physical therapy
- Chiropractic care
- Activity modification
- SI Joint Injections
Treatments such as physical therapy, medication, and injections aim to relieve pain by reducing inflammation and discomfort.
For patients who are no longer responding to conservative care, spine specialists may recommend a Sacroiliac Joint Rhizotomy Surgery. A rhizotomy involves placing a cautery probe into the joint, then heating the tip of the probe. This procedure cauterizes the tiny nerve fibers in the joint. Relief from pain may not be permanent, but generally, lasts much longer than injections.
If the pain is severe, an SI joint fusion may be suggested as a minimally invasive surgical option. Sacroiliac treatment will depend on the nature of the diagnosis, the severity of the condition, and the overall health of the patient. If SI fusion is indicated, the iFuse® Implant System is used and is designed to provide fusion for the sacroiliac joint by inserting small titanium implants across the joint. It is less invasive than traditional SI joint surgery and it is specifically designed to stabilize and fuse the heavily loaded SI joint.
Home Care and Lifestyle Modifications for Sacroiliac Joint Pain
If symptoms are manageable, gentle stretching may help to loosen tight muscles that put excessive strain on the SI joint and help bring relief. Other home treatments to alleviate pain and discomfort include pain relievers, rest, and alternating hot and cold therapy. Patients should avoid activities that worsen the pain.
Lifestyle changes can play a significant role in managing sacroiliac joint pain. Regular exercise, such as walking or swimming, helps maintain joint flexibility and strengthen surrounding muscles. A healthy diet that is rich in Omega-3 fatty acids may help fight inflammation. Maintaining a healthy weight reduces strain on the SI joints. Ergonomic adjustments, like attention to posture, chairs with lumbar support, and avoiding crossing the legs reduces strain on the SI joints. Both limiting alcohol and quitting smoking should be considered, since both contribute to inflammation and overall health.
Are You Ready to be Pain Free?
Many people who are in daily pain from an SI joint condition. Often, they simply deal with the pain, thinking there is no other way. The spine specialists at Texas Back Institute have helped thousands of patients become pain free and it started with a call to set up an examination. If you are ready to get your life back, click here and get started.
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Frequently Asked Questions
SI joint dysfunction can be caused by a variety of conditions, including osteoarthritis (OA), ankylosing spondylitis (AS), trauma, repetitive stress to the joints, old age, pregnancy, abnormal walking patterns (gait), leg length differences, and scoliosis (abnormal curvature of the spine).
The most common symptom of sacroiliac joint disorder is pain in the low back, buttock, and sometimes in the same side leg. This can present sciatica–like symptoms (leg pain, burning, numbness, and tingling) that mimic lumbar disc or radicular low back pain – pain that radiates down the leg.
The most frequent symptom of SI joint pain is pain that radiates to the buttock and thigh. The symptoms of an inflamed SI joint are similar to those associated with conditions like sciatica, bulging discs, and arthritis of the hip. Evaluation by a spine specialist at Texas Back Institute will determine the cause and location of the pain.
When someone has an abnormal gait due to leg length differences, this imbalance can result in uneven pressure on one side of the pelvis. Over time, an abnormal gait can cause wear and tear and lead to misalignment of the SI joint. The way we move can easily affect spinal issues. Likewise, spinal issues can affect the way we move. If you have a stiff or arthritic hip and cannot swing the hip through the full swing phase while walking, your stiff hip forces an earlier and non-symmetrical transfer of force to the spine which can trigger pain in vulnerable patients.
Physicians may also use X-rays, CT-scan, or MRIs to help diagnose the sacroiliac joint as the pain generator. Your spine specialist may request sacroiliac joint injections as a diagnostic test. It’s also important to remember that more than one condition (like a disc problem) can co-exist with sacroiliac joint disorders. This means that even if the sacroiliac problem is addressed, pain could still be present. Your doctor will discuss this with you.
Scoliosis is an abnormal curvature of the spine and can indeed contribute to SI joint pain. This abnormal curvature impacts the alignment of the SI joint, which can lead to pain and movement dysfunction in the pelvic area.
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