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Sacroiliac Joint Pain

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Disease Awareness Page for R3 Stem Cell – Sacroiliac Joint Pain

 

SI Joint Pain

What is it?

SI Joint (also known as the sacroiliac joint) pain is pain felt in the lower back and buttocks. Even though it is named after the sacroiliac joint, the pain is reflected more in the lower back. It is often caused by anomalies in the SI joint, which is located between the spine and the hip.

What is the Sacro Iliac joint?

The sacroiliac joint (SIJ) is the joint formed between the sacrum of the spine and the ilium of the pelvis. The SIJ isn’t like the other joints in the body because it is a synovial plane joint with a very shallow joint articulation. This means that the joint is very prone to abnormal movements that can cause the articulating parts sliding out of place. 

Regardless of this, the SIJ is a very stable joint because it is supported by ligaments all around, keeping it steady. This is particularly important because the joint is responsible for transferring the weight from the upper body to the lower body. This is also why the joint is so prone to dysfunction, as we will see.

Another thing peculiar to the structure of the SIJ is that there is very little movement involved with it. As mentioned earlier, it has a very shallow joint space and is mainly held together by ligaments. This restricts its movement to a bare minimum. In fact, the only movements that occur at the SI Joint are during stretching, and bending motion (forward and backward bending). The network of ligaments and muscles around the joint help absorb the shock and keep it stable.

What is SIJ dysfunction, and how is it different from SI Joint pain?

Sacro Iliac Joint dysfunction is an abnormality in the SIJ, either as a result of abnormal motion (too much or too little).  Other less common causes of Sacroiliac joint dysfunction are trauma and arthritis. Sacroiliac joint dysfunction can lead to moderate to severe pain, depending on the extent of the impairment. The pain usually manifests in the low back and may radiate along the legs.

The pain in Sacroiliac joint dysfunction is what is called sacroiliac joint pain. In this way, there is no difference between the two, except that while one refers to the causes, the other refers to the effects. However, in practice, they are used interchangeably, as they can be said to be caused by the same things, and have the same effects.

What causes SI joint pain?

The most prevalent and most impactful cause of SI joint pain is movement. As mentioned earlier, there is very little involved in the joint and so, any action that interrupts this dynamic can lead to dysfunction, and pain.

The two culprits in SI joint pain are:

Excessive movement of the joint: This is also referred to as hypermobility or instability. Too much movement in the joint will often lead to pain that reflects in the low back. The causes of hypermobility/instability are

  • Ligamentous weakness
  • Muscle weakness
  • Wear and tear of the joint cartilage

Hypomotility or too little movement: Hypomobility in the SI joint is usually about other pathologies. The SI joint has a range of movements. And even though exceeding it can lead to dysfunctions, too little movement is just as harmful. Pathologies that can cause hypomobility in the SIJ include ankylosing spondylitis, osteoarthritis, and other pathologies of that affect the spine and surrounding muscles

How common is it, and who is at risk?

Low back pain is a very common condition, and about 9 out of 10 people will experience it at some point in their life. It is estimated that 10% to 25% of these low back pain cases are as a result of SIJ dysfunction.

The risk factors of SI Joint pain are:

  • Age: Older people are more likely to develop SI Joint pain than younger individuals because of the normal wear and tear and increased ligamentous laxity that comes with ageing. Additionally, it is more common in adults than in children
  • Sedentary lifestyle: A sedentary lifestyle contributes to the hypermobility that should be avoided when considering SI Joint pain
  • Obesity: Obese individuals are more likely to develop this condition because of the extra load on their SIJ.

There is no evidence to show that SI joint pain is more prevalent in women than in men. The evidence seems to suggest that it is equally prevalent in both sexes. 

What are the symptoms?

The symptoms of SIJ dysfunction are mainly pain and reduction in functionality. Because it manifests as low back pain. It may be difficult to diagnose, due to the several other causes of low back pain. Some of them include:

  • Osteoarthritis
  • Osteoporosis
  • Disc hernia and rupture
  • Muscle or ligamentous strain

The pain felt is usually a dull, continuous ache that is often relieved by actions like lying down. It is increased by aggravating movements like bending forward, climbing the stairs, and standing up. Other pain patterns associated with SI joint pain are seen when the individual sits in a cross-legged position. 

Individuals may also experience pain when they lie on their side for extended periods. Reports also show that it is increased during sexual activity in some individuals, as well as during menstruation in women. However, this is very variable. (citation)

Besides low back pain, individuals suffering from SI joint dysfunction may also experience pain running down their legs. This is known as radiculopathy, and it happens when the displaced SIJ pinches on lumbar nerves. The pain ranges from a shooting sensation to burning, shocking and even pins and needles. 

Other symptoms of SI joint pain are stiffness and instability. 

 

How is it diagnosed? 

Because low back pain is the most common symptom of SI joint dysfunction, and because there are so many other cases of low back pain, diagnosing the condition can be quite problematic. The problem is additionally compounded by the fact that the SI joint is deeply buried in the body, and surrounded by ligaments and muscles. However, the diagnosis of the condition usually includes the following:

Physical tests

Physical tests like cranial sheer test and Gaelen’s test are performed to try and elicit the pain present. The tests are positive if the individual feels the same kind of pain

History 

A complete history can help identify risk factors and potential causes of SI joint pain. Factors like age, sedentary living, and osteoarthritis can help differentiate the condition from similar ones.

Imaging scans

X-rays can help identify changes in the SI joint, as well as reduced or increased joint space. Others, like the CT and MRI scans, can also be used to examine the joint and identify the sources of the pain, as well as a rule out other causes.

What treatment options are available

Medication

Analgesics can be prescribed to help manage the discomfort associated with SI joint pain. Additionally, drugs called Disease-modifying anti-rheumatic drugs (DMARDs) like Methotrexate can be prescribed to slow the progression of additional pathologies that may be present; pathologies like arthritis.

Physiotherapy

In addition to exercises, other physiotherapy modalities can also be sued to treat the condition. Modalities like ultrasound and shortwave diathermy can be used to heat the surrounding tissue. They also facilitate the production and release of endorphins, the body’s natural pain killers. These reduce the pain felt by the individual.

Self-treatment

Although self-medication is often ill-advised in most medical conditions, it can be very helpful in this case. This treatment refers to exercises that individuals can perform to reduce the amount of pain felt and even remedy some of the anatomical abnormalities associated with the condition. Self-administered treatments in the management of SI joint pain include different kinds of exercises like stretches, and strengthening routines for the lower back and gluteus muscle.

Manual manipulation

If the dysfunction is caused by too little motion, manual manipulation by a doctor, physiotherapist or other qualified professionals can help relieve the pain. Some studies have shown the restorative effects of manual manipulation on SI joint pain.

Surgery

Research has shown that surgical treatment in appropriately selected individuals is more effective than non-surgical interventions. However, the key phrase here is appropriately selected. Several non-surgical interventions are just as effective.

 

Learn More about ongoing clinical studies sponsored by R3 Stem Cell HERE.

 

References

https://physioworks.com.au/injuries-conditions-1/sacroiliac-joint-pain 

https://www.researchgate.net/publication/45112723_Risks_of_Self-Medication_Practices

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5599847/ 

Solonen, K. A. (1957). “The sacroiliac joint in the light of anatomical, roentgenological and clinical studies”. Acta Orthopaedica Scandinavica Supplementum27: 1–127. PMID 13478452

https://www.spine-health.com/conditions/sacroiliac-joint-dysfunction/sacroiliac-joint-dysfunction-si-joint-pain

https://physioworks.com.au/injuries-conditions-1/sacroiliac-joint-pain

https://www.mayoclinic.org/diseases-conditions/back-pain/symptoms-causes/syc-20369906 

https://www.upmc.com/services/rehab/physical-medicine-rehab/conditions/womens-rehab 

https://www.ncbi.nlm.nih.gov/pubmed/23455949 

https://www.ncbi.nlm.nih.gov/books/NBK470299/ 

https://www.ncbi.nlm.nih.gov/pubmed/28600005 

https://www.ncbi.nlm.nih.gov/pubmed/28600004 

https://www.webmd.com/back-pain/si-joint-dysfunction-diagnosis#1 

https://www.spineuniverse.com/conditions/sacroiliac-joint-dysfunction/sacroiliac-joint-dysfunction-medications 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5599847/ 

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