SACROILIAC JOINT DYSFUNCTION

What is the Sacroiliac Joint?

The Sacroiliac Joint (SI) is a large, C-shaped joint that connects the pelvic bones (the ilia) to the sacrum at the base of the spine. The Sacrum is considered the "Keystone" of our bodies like a central stone at the summit of an arc, locking the whole together.

There are two Sacroiliac joints, one on either side of the tailbone. Serving as shock absorbers for the pelvis and low back, the SI joints move constantly when the body is in motion, helping to provide stability and structural support to the lower part of the body.

What can go wrong with it?

The most common cause of SI joint dysfunction is from traumatic injury, whether from a fall or traffic accident or from repetitive rotation of the lumbar spine and pelvis during sports and work-related activities. Stretching, straining, and tearing of the primary Sacroiliac joint ligaments then cause weakening and abnormal motion of the joint, resulting in painful ligaments and joints as well as spasm. Postural imbalances as well as leg length inequalities can also cause SI dysfunction. As a result of this, there is a disruption of movement in the joint (either too much or too little).

What are the symptoms of SI joint dysfunction?

Most patients experience low back pain that is worsened by sitting, standing, and bending at the waist.  Frequent changes in posture are needed. In severe cases, pain may also be felt in the hip, groin, and leg.  These symptoms are the result of movements that are disrupted and overall dysfunction in the SI joint.

How is SI joint dysfunction diagnosed?

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.
Therefore, 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.

In addition, the physician must be familiar with the signs of hypo-mobility and hyper-mobility of the SI joints and their role in low back pain.  Your physician may also conduct fluoroscopic intra-articular injection and injection of the supporting ligaments in order to determine the diagnosis.

How is SI joint dysfunction treated?

Treatment can include a combination of the following:

• Physical Therapy rehabilitation techniques that include flexibility, core strengthening/stabilization, and joint manipulation, postural retraining gait retraining education and management.
• Osteopathic manipulation techniques
• Mechanical support (obtained by using an SI joint belt, back pillow, pelvic or lumbar orthotics)
• SI Joint Injection with a steroid and anesthetic injections to help decrease inflammation in the SI Joint.
• Prolotherapy (excellent for resistant or chronically recurring cases), which increases the strength of the SI joint ligaments and helps restore normal motion
• Surgical fusion of the SI joint, which is a last resort, performed only in cases of severe debilitating instability.

Although the SI joint is a frequent source of pain in the low back and legs, SI joint dysfunction can be successfully treated by re-establishing normal positioning and function of the joint and the supporting structures through the conservative yet specialized approach outlined above.

SACROILIAC JOINT INJECTION

How is the procedure done?

You will receive a local anesthetic before a small spinal needle is inserted under fluoroscopic guidance into the Sacroiliac joint. The procedure takes approximately 15 minutes. The arrow shows the needle within the Sacroiliac joint.