Pain in the lower back, lower limbs, buttocks and/or groin is often attributed to sciatica. Sometimes, however, the cause of discomfort isn’t sciatica at all, but rather problems associated with the sacroiliac joint, or SI joint.
The sacroiliac joint is a large joint in the pelvis connecting the sacrum and the iliac bone in the hip. It provides shock absorption to the spine and bears weight on both sides of the pelvis with strong ligaments both inside and outside the joint.
Causes of Sacroiliac Joint Inflammation
Sacroiliitis is a term used to describe inflammation in the SI joint (it may also be called sacroiliac joint dysfunction). Pain associated with the SI joint is often caused by an inflammatory condition of the spine. These conditions are known as spondyloarthropathy and include ankylosing spondylitis, psoriatic arthritis and rheumatologic diseases such as lupus and rheumatoid arthritis.
Other causes of sacroiliac joint inflammation include:
- Osteoarthritis, or degenerative arthritis, of the spine resulting in the degeneration of the SI joint
- A car accident, fall or other trauma affecting the lower back, hip or buttocks
- The widening of the pelvis and relaxing of surrounding ligaments during pregnancy and childbirth
- Stress to the SI joint from another cause or procedure, such as lumbar spinal fusion
- Infection of the sacroiliac joint
- Urinary tract infection
- Osteomyelitis (spinal infection)
Pain in the sacroiliac joint ranges from mild to severe. It may occur suddenly and heal within a few days to weeks, or it may become persistent, chronic pain that is felt at all times. Whether the sacroiliitis is due to arthritis or one of these other causes, symptoms of the joint condition may include:
- Pain located on one side of lower back
- Pain radiating into the buttocks, lower back and groin
- Referred pain into the hip, leg or thigh (which can be mistaken for sciatica)
- Pain that worsens when sitting for long periods of time
- Difficulty turning over in bed, struggling to put on shoes and socks, leg pain while getting in and out of car
- Stiffness in the lower back when getting up after sitting for long periods and when getting up from bed
- Aching on one side of the lower back when driving long distances
Diagnosing sacroiliac joint inflammation
Determining whether the SI joint is the source of pain is the first step to finding appropriate SI joint treatment. A physical exam along with imaging such as X-ray, CT or MRI scans may be used to identify the source of SI pain and rule out other spine or hip problems. A diagnostic SI joint injection may be used to confirm the cause of the pain. If pain decreases by at least 75 percent in the days following the injection, it can be confirmed that the sacroiliac joint is the cause of low back or leg pain.
SI joint treatment
In many cases, patients experiencing SI joint pain are able to receive conservative, non-surgical treatment such as physical therapy, anti-inflammatory medications, topical patches or creams, bracing, stretching or SI joint injections of steroids to reduce inflammation in the joint. If these non-surgical therapies for sacroiliac joint inflammation do not relieve pain or discomfort, surgery may be necessary.
A minimally invasive procedure called SI joint fusion is one technique that may be used to stabilize the SI joint, reducing movement in the joint and thereby relieving pain in the lower back and leg. During the SI joint fusion procedure, the orthopedic spine surgeon places metal implants in the SI joint to stabilize the joint. The joint implant then allows for the introduction of bone graft in the joint, promoting fusion of the bones.
The procedure takes about one hour and is typically an outpatient surgery. Healing from SI joint fusion does take some time, and the patient must not bear full weight on the joint until healing is complete.
Do you suffer from pain in your low back, hips, buttocks or legs? Perhaps you’ve been diagnosed with sciatica but aren’t getting relief from common treatments for sciatica. The sacroiliac joint may be the source of your pain. To find out if you are a candidate for SI joint treatment, contact Houston’s spine doctor, Dr. Vivek Kushwaha, today.