Understanding SI Joint Pain

Sacroiliac (SI) joint pain occurs in the lower back and hips and can sometimes be difficult to diagnose. Today, Dr. Michael Zeringue discusses what causes SI joint pain and how the physicians at Pontchartrain Orthopedic and Sports Medicine can help treat it.

The SI joints are located in the pelvis, linking the iliac bone (pelvis) to the sacrum (the lower vertebrae just above the tailbone). As we discussed in our page defining sacroiliac joint pain The SI joints are highly specialized joints that permit stable, flexible support to the upper body. They are essential for effectively transferring loads between our spine and legs. The SI joints play a major role in absorbing impact when we are walking and lifting.

SI joint pain can originate in the ligaments or the SI joint itself. It can sometimes be caused by osteoarthritis of the SI joint. It can also come from the loss of cartilage in the joint space, or it can be a tear in the supportive ligaments that surround the joint. Small tears or movement of the joint -- such as dislocation or rotation -- can cause an irritation. The degree of pain will vary, but it all centers around those three things.

An SI joint injury can happen from something obvious, like a fall, pregnancy, traumas such as hip fractures, or, obesity. However, SI joint issues can also occur from overuse or underuse. SI joint pain often happens because of the underuse of certain gluteus muscles from sitting all day long or not varying your exercise routines. If you do just inline biking, for example, without other rotation or abduction exercises, it overuses certain muscles and underuses others, so you can get an imbalance. Like most things in the back, it’s commonly a postural or overuse condition. As you start getting later in life, it can be more of an osteoarthritis issue.

SI joint pain is somewhat common in people who have had fusions of the lumbar spine. Fused vertegra create a loss of motion at the point of the fusion. This loss of flexibility can result in stress being transferred to the SI joint. It could also occur in someone with a femoroacetabular impingement (FAI), an issue with the ball and socket joint in the hip. Because these complex structures all work together, a problem with the hip may affect the next joint, which is the sacroiliac joint.

It’s very difficult to diagnose between SI joint issues, sciatica and facet pain. The referral pattern for all of these conditions is in the same area. They all cause pain in the area of the SI joint and down the back of the leg. While there are certain maneuvers that are more common in each of the syndromes, it doesn’t necessarily rule the other ones out. 

If you begin to feel pain in your back beneath the “dimples of Venus” in the lower back after a fall or overuse, you may try anti-inflammatory medications and core exercises. If the pain doesn’t go away in a few days, then you should see a physician for an in-depth evaluation and diagnosis.

We would start the patient on anti-inflammatories and specific physical therapy exercises for their condition. The exercises will vary, depending on the location of the pain, the patient’s history and the physical exam findings. Sometimes we will prescribe exercises that treat all possible issues.

If physical therapy, medication and anti-inflammatories do not provide relief, we would try an injection of steroids and an anesthetic into the SI joint. 

If the injection helps but doesn’t give long-term relief, we would do a diagnostic injection of numbing medicine to confirm that, for those few hours that the numbing medicine is working, they get relief. If that’s the case, they may be a good candidate for Radiofrequency Ablation (RFA), a process in which the nerves that go to the joint are cauterized to block pain signals.

In very resistant cases, we may recommend a fusion of the SI joint as a last resort.

Today’s post covers the basic questions Dr. Zeringue hears about SI joint pain, but each case is unique. If you have other questions or concerns or think that you may have an SI joint problem, contact us today to schedule an appointment. We have two convenient locations available to see you.