The Sacroiliac (SI) joint is a synovial (diarthrodial) joint that connects bilaterally ilium to central sacrum forming left & right SI joint in the tailbone. The joint is supported by multiple ligaments & muscles which contribute to pelvic stability & force transfer. It serves as shock absorbers for the pelvis and low back. The SI joints move constantly when the body is in motion, provide stability and structural support to the lower part of the body.
Painful SI conditions can be traumatic, infectious, metabolic, inflammatory, neoplastic, degenerative. Nonbacterial, acute sacroilitis can be associated with ankylosing spondylitis, gout, RA, psoriasis & trauma. The most common painful SIJ presentation seen in a clinic is a mechanical lesion associated trauma, as well as adjacent lumbar arthropathy and/or fusion. The other most common cause is degenerative arthritis of the joint. Stretching, straining, and tearing of the primary SI joint ligaments then cause weakening and abnormal motion of the joint, resulting in painful ligaments and joints as well as spasm.
Patients complain of painful catching and increased pain with lower extremity loading, such as unipodal standing or landing and propulsion with gait. Parasthesias,numbness or weakness is not commonly associated with painful mechanical SIJ states. Most patients experience low back pain that is worsened by sitting, standing, and bending at the waist. Frequent changes in posture are needed. Muscle insertions near the area, such as gluteus maximus & hamstrings, refer pain to the hip & ischial area, respectively, when stressed.
Identifying SI joint dysfunction requires obtaining a detailed medical history, analyzing the mechanism of injury, and conducting a comprehensive examination of the spine and pelvis. SIJ evaluation also includes manual provocation tests & diagnostic injections.
Not all patients show obvious signs of SI joint dysfunction, and X-rays, MRIs, CT scans, and bone scans of the pelvis will generally be normal.
What is sacroiliac joint dysfunction?
The sacroiliac (SI) joints are formed by the connection of the sacrum and the right and left iliac bones. The SI joints connect the spine to the pelvis. The sacrum and the iliac bones (ileum) are held together by a collection of strong ligaments. There is relatively little motion at the SI joints.
Different terms for sacroiliac joint problems:
Each of these terms refers to a condition that causes pain in the SI joints from a variety of causes.
When this cartilage is damaged or worn away, the bones begin to rub on each other, and degenerative arthritis (osteoarthritis) occurs. This is the most common cause of SI joint dysfunction. Degenerative arthritis occurs commonly in the SI joints, just like other weight-bearing joints of the body.
Another common cause of SI joint dysfunction is pregnancy. During pregnancy, hormones are released in the woman's body that allows ligaments to relax. This prepares the body for childbirth. Relaxation of the ligaments holding the SI joints together allows for increased motion in the joints and can lead to increased stresses and abnormal wear.
Any condition that alters the normal walking pattern places increased stress on the SI joints. This could include a leg length discrepancy (one leg longer than the other), or pain in the hip, knee, ankle, or foot. Patients with severe pain in the lower extremity often develop problems with either the lower back (lumbar spine) or SI joints. In most cases if the underlying problem is treated, the associated lumbar spine or SI joint dysfunction will also improve
gout, rheumatoid arthritis, psoriasis, and ankylosing spondylitis
The most common symptom of SI joint dysfunction is pain. Patients often experience pain in the lower back or the back of the hips. Pain may also be present in the groin and thighs. In many cases, it can be difficult to determine the exact source of the pain. Your physician can perform specific tests to help isolate the source of the pain.
The pain is typically worse with standing and walking and improved when lying down.
Inflammation and arthritis in the SI joint can also cause stiffness and a burning sensation in the pelvis
Injections into the SI joint can provide both diagnosis and treatment.
The duration of pain relief - from injection can last from one day to much more long term. The injections can be repeated each month for a total of three each year. Oral anti-inflammatory medications.
Physical therapy/ physiotherapy can be very helpful.
Other options to stabilize the SI joints include yoga, manual therapy.
If other treatments fail and pain continues to interfere with normal activities, --- surgery is advised