The sacroiliac (SI) joint is at the junction of your spine and pelvis, where the sacrum (the triangle bone at the bottom of your spine) meets with two flat iliac bones that make up a large part of your pelvis. If you have ever suffered from pain in your back and buttocks, which could proceed to one or even both legs, then there is a possibility that your problem can be related to SI joint pain. This condition frequently interferes with quality of life and the capacity to carry out everyday activities.
Anatomy and Function of the SI Joint
It is one of the strongest and widest joints in your body as it supports transfer loads between your upper body (pelvis) and lower extremities. Unlike most joints in the body, it gives strong stability but lacks mobility. Irregular, interlocking joint surfaces give the sacrum an arrowhead shape and ensure a tightly bound connection between it and the iliac bones. The SI joint is supported by multiple ligaments like anterior and posterior sacroiliac ligaments, sacrotuberous ligaments and, interosseous sacroiliac ligament.
This provides stability to the ankle and helps control abnormal movements of the foot.
Causes of SI Joint Pain
There are several SI joint pain causes, some of which are explained below:
1. Traumatic Injury
SI joint pain is quite common and most often develops from traumatic injury. Some traumatic injuries are:
- Sudden Impacts: If you fall the wrong way, this could cause an injury or inflammation in your SI joint.
- Car Accidents: Collision accidents can impact and damage the pelvis and lower back, which can cause SI joint pain.
- Injuries during Sports: The acute twisting or lifting movements associated with many sports can put stress your the SI joint and give rise to pain if overdone.
Acute pain is the result of traumatic injuries and should be treated before it becomes a chronic symptom.
2. Pregnancy and Postpartum Changes
When pregnant, your body starts releasing hormones that loosen the ligaments in your pelvis to increase its mobility for delivery. This extra laxity can cause the SI joint to become unstable, which can create more pain. Specific factors include:
- Hormonal changes: When you are pregnant, the hormone relaxin rises and it softens your ligaments in the pelvis, loosening joints once a couple of weeks before delivery.
- Weight Gain: Extra weight during pregnancy can stress the SI joints.
- Change of posture: As pregnancy advances, your centre of gravity changes and this may change the way you walk or stand which can contribute to increasing strain on SI joint.
- Delivery: The birthing process can also produce SI joint movement as extreme physical stress is placed on the body.
3. Arthritis
Arthritis is another significant cause of SI joint pain. Several types of arthritis can affect the SI joint, including:
- Osteoarthritis: This degenerative joint disease results from wear and tear on the cartilage and can result in pain and stiffness in the SI joint.
- Rheumatoid Arthritis: Rheumatoid Arthritis An autoimmune condition which causes inflammation in various joints, including the SI joint.
- Ankylosing Spondylitis: A type of inflammatory arthritis that primarily affects the spine and results in SI joint pain.
- Psoriatic Arthritis: This condition can also affect the SI joint, causing pain and inflammation.
Inflammatory arthritis can cause sacroiliitis, characterised by inflammation of the SI joint, which can result in significant pain and dysfunction.
4. Structural Abnormalities
Certain structural abnormalities can predispose individuals to SI joint pain:
- Leg Length Discrepancy: A noticeable difference in leg length can cause uneven stress on your SI joint, leading to pain.
- Pelvic Tilt: An abnormal pelvic tilt can affect the alignment and function of the SI joint.
- Scoliosis: This curvature of the spine may lead to imbalances in the pelvis and increased pressure on the SI joint.
These structural issues may result in chronic SI joint dysfunction and pain if not addressed.
5. Systemic Inflammatory Conditions
Conditions that cause systemic inflammation can also lead to SI joint pain. Examples include:
- Systemic Lupus Erythematosus (SLE): An autoimmune disease that can cause inflammation in various joints, including the SI joint.
- Infectious Conditions: Infections affecting the SI joint, although rare, can cause significant pain and inflammation.
- Other Inflammatory Diseases: Conditions like Behçet’s disease and hyperparathyroidism may also lead to sacroiliitis.
6. Repetitive Strain and Overuse
Repetitive activities that put pressure on the SI joint can cause pain. Common examples include:
- Heavy Lifting: Frequent lifting of heavy objects can strain the SI joint.
- High-Impact Sports: Activities such as running, jumping, or other high-impact sports can exacerbate SI joint pain.
- Poor Body Mechanics: Improper lifting techniques or body mechanics can increase strain on the SI joint.
7. Obesity
Additional factors contributing to SI joint dysfunction include excess body weight that can put more stress on the joints and cause pain. The pelvis starts bearing the extra load, which can cause joint dysfunction leading to pain and inflammation.
8. Previous Surgeries
Surgery, especially lumbar spine or pelvis surgery, can change how your SI joint moves. For example:
- Lumbar Fusion: This surgery can alter the forces going across, changing it to go into SI joint causing increased stress on one side of your back.
- Hip Surgeries: Changes following surgeries on the hip joint are similar.
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Symptoms of SI Joint Pain
The main SI joint pain symptoms are back, buttock, and leg pain. The pain can be dull and aching or sharp and may spike quickly when you perform certain activities, such as sitting for a prolonged time, climbing stairs, or rolling over in bed.
Other common symptoms to help with the diagnosis of SI joint pain:
- Pain or stiffness in the natural curve of your lower back.
- Problems with walking or standing for extended periods
- In some cases, a person may have pain that goes down the back of their thigh or into the groyne.
- Tenderness over your SI joint
- Pain, swelling, or bruising over the site of your SI joint
Diagnosis of SI Joint Pain
Although the diagnostic test for SI joint pain can be challenging, some tests can be done to indicate its source:
- Physical exam: A physician may press on your hips and buttocks or gently move them in a different position to stress the SI joints. In addition to this, they may ask you to perform some movements so that you can check your range of motion.
- X-ray: An X-ray of the pelvis may show changes that we call degenerative or arthritic, related to damage at the SI joint.
- Injections: A local anaesthetic is injected into the SI joint to determine whether or not it’s causing your pain. You may have SI joint pain if your pain is reduced by at least 75% after the injection.
- CT scan: The CT scan is used when MRI is not available.
Treatment of SI Joint Pain
Treatment of SI joint pain usually requires a blend of conservative and interventional options, depending on the severity as well as the response to treatment in every individual.
1. Conservative Treatment
- Activity modification: avoiding activities or movements that cause pain and engaging in low-impact exercises like walking. It can be beneficial, if you are putting less stress on the sacroiliac joint.
- Physical Therapy: A physical therapist can create a personalised exercise program that focuses on strengthening the muscles surrounding the SI joint.
- Medicines: Painkillers (anti-inflammatory drugs) or prescription drugs might be taken to control pain and decrease inflammation.
- Physical/Occupational Therapy: Once the immediate post-injury pain calms down, therapists can help work on core strength to prevent future and chronic issues.
2. Interventional Treatment
- Injections: Corticosteroid injections can be inserted near the inflamed sacroiliac joint to decrease swelling and pain when no other form of treatment suffice.
- Radiofrequency Ablation: A minimally invasive procedure that breaks the pain signals from the SI joint using heat which can offer long-lasting relief.
- Surgery: In some cases, surgery might be necessary to stabilise the SI joint or fuse the joint if conservative and interventionist treatments have not worked.
Prevention of SI Joint Pain
Although it is not possible to avoid all SI joint pains, people can take some steps to prevent its occurrences:
- Good posture and body mechanics: Correct lifting techniques, avoiding slouching, and using ergonomic furniture can minimise the stress on your SI joint.
- Involve in Regular Exercise: With the help of regular exercise strengthen your core muscles and hips to provide additional support to SI joint which in turn reduces chances of injuries.
- Avoiding obesity: Being overweight can add a lot of stress to the SI joint and can cause pain.
- Getting prompt treatment for Injuries: Early intervention of SI joint injuries may prevent the onset of chronic pain and dysfunction.
Conclusion
SI joint pain is a common complaint and can be debilitating, affecting individuals from all walks of life. If we understand the SI joint anatomy, realise common pain causes, and learn how to handle these symptoms correctly, then we can effectively control their discomfort levels, thereby increasing quality of life. The combination of conservative and interventional techniques can help most patients get better. Maybe they haven’t achieved 100% results, but they have enough relief to carry on daily activities.
