Sacroiliac (SI) Joint Dysfunction | How is it Treated?

Sacroiliac (SI) joint dysfunction is a common cause of low back and buttock pain, impacting up to 25% of individuals suffering from chronic low back pain. Understanding the anatomy, causes, symptoms and both conservative and advanced treatment options for SI joint dysfunction empowers patients to find the relief they need.

Causes of SI Joint Dysfunction

The sacroiliac (SI) joint connects the sacrum at the base of the spine to the pelvis. Though it has limited mobility, it transfers forces from the upper body to the legs and supports our weight when sitting, standing, and during activity. Several issues can cause SI joint dysfunction.

Traumatic Causes

Sudden traumatic events that strain the SI joint can lead to pain and dysfunction, including:

• Fractures – Breaks in the sacrum or pelvis from major trauma
• Falls – Landing hard on the buttocks strains SI joint ligaments
• Heavy Lifting/Twisting – Excess spinal twisting with weight transfers uneven, excessive load
• Whiplash/Vehicle Collisions – Flinging motion strains SI joint structures

Atraumatic Causes

Over time, mechanical issues and medical conditions can also irritate the SI joint, such as:

• Leg Length Discrepancy – Uneven leg lengths shift pelvic alignment, overloading one SI joint
• Pregnancy – Weight gain, posture changes, and delivery strain the SI joint
• Spinal Fusion Surgery – Alters biomechanics, increasing stress on SI joints
• Arthritis – SI joints commonly develop osteoarthritis and inflammatory arthritis
• Infection – Though rare, direct SI joint infection causes inflammation/damage
• Tumors – Benign bone tumors like osteoid osteomas cause remodeling/weakness

Symptoms of SI Joint Dysfunction

Individuals with an irritated SI joint develop pain in the low back, buttocks, and possibly radiating symptoms:

• Low Back Pain – Deep, dull achy pain over the SI joints just above the tailbone
• Buttock Pain – Pain over the back of pelvis/hips, usually one-sided
• Groin/Thigh Pain – SI joint inflammation can refer pain along the sciatic nerve distribution
• Worse with Activity – Sitting, standing, stairs, transitional movements aggravate joint
• Radiating Leg Pain – Numbness, tingling, weakness may shoot down legs due to nerve inflammation

Diagnosing SI Joint Dysfunction

Since SI joint irritation causes non-specific pain that may mimic other back issues, identifying dysfunction requires a multi-pronged approach:

Medical History & Exam

A detailed history and physical helps determine the likelihood of SI joint issues:

• Onset – Recent trauma or repetitive strain make joint irritation more likely
• Pattern – One-sided low back/buttock pain matching joint location
• Provocative Tests – Special maneuvers that stress the SI joints reproduce symptoms
• Range of Motion – Reduced spinal/hip flexion due to pain suggests joint irritation

Imaging Studies

Though findings lag behind symptoms, imaging like x-rays, CT scans, and MRI help confirm issues:

• X-ray – Helps detect fractures or arthritis causing SI joint problems
• CT Scan – Better defines joint integrity and surrounding bone changes
• MRI Scan – Detects subtle injury/inflammation of ligaments/nerves

Diagnostic Injections

Injecting numbing medication alongside steroids into the joint confirms the culprit:

• Fluoroscopy Guidance – Uses live x-ray to precisely place needle into joint space
• Local Anesthetic – Numbing medication immediately reduces pain from joint
• Steroid Injection – Powerfully reduces inflammation for ongoing relief

Conservative Treatment Options

Most patients with SI joint dysfunction experience significant relief through nonsurgical treatments:

Lifestyle Changes

Altering activities and positions that aggravate the SI joint speeds healing:

• Activity Modification – Avoiding running/twisting prevents further injury
• Ergonomic Changes – Supportive chair and proper lifting technique reduces strain
• Postural Correction – Aligning pelvis/spine decompresses irritated joint

Physical Therapy

Stretching tight structures while strengthening support muscles optimizes recovery:

• Manual Therapy – Massage, mobilization improves muscle/joint dynamics
• Muscle Stretching – Lengthens tight hamstrings/hip rotators pulling on pelvis
• Core/Glute Strengthening – Supports SI joint, reduces load
• Joint Mobilization – Gentle motions helps restore normal mechanics
• Movement Retraining – Corrects posture/gait patterns that lead to dysfunction

Medications

Oral and injectable medications help manage inflammatory pain pathways:

• NSAIDs – Oral anti-inflammatories ease irritation/discomfort
• Muscle Relaxants – Reduces spasm from strained muscles
• Steroid Injections – Directly treats joint inflammation for temporary relief

Alternative Therapies

Other treatments offer additional options to reduce SI joint irritation:

• Chiropractic – Helps improve alignment and joint mobility
• Massage – Reduces muscle tension near the SI joint
• Acupuncture – May deactivate pain signaling and ease discomfort

Interventional Procedures

If conservative treatment fails to adequately reduce symptoms after 6 months, more advanced options can help:

Steroid Joint Injections

Repeated injections avoid frequent oral anti-inflammatory use:

• Reduces Inflammation – High dose steroids decrease joint irritation
• Avoids GI Issues – Limits impact on stomach/intestines
• Lasts Months – Pain relief can persist for 6 months before repeating

Nerve Ablation

Burning local sensory nerves with radiofrequency stops pain signaling:

• Precise Targeting – Fluoroscopy visualizes joint nerves
• Heat Treatment – Cauterizes nerves to prevent pain signaling
• Reduces Discomfort – Lowers irritation without numbness

Prolotherapy

Injecting growth factors may help stabilize damaged ligaments:

• Promotes Healing – Dextrose/PRP stimulates tissue repair
• Tightens Ligaments – Fortifies overstretched structures
• Reduces Laxity – Decreases painful joint motion

Pulsed Radiofrequency

Electrical pulses alter nerve signaling without burning nerve fibers:

• Non-Destructive Option – Treats nerves without permanent damage
• Disrupts Pain Signals – Changes pain signaling temporarily
• Avoids Numbness – Prevents sensory loss from nerve injury

Surgery

If conservative treatments and interventional options fail over 12-18 months, surgery may be appropriate for some patients.

Minimally Invasive SI Joint Fusion

Placing implants stabilizes the joint using small incisions:

• Stops Painful Motion – Immobilizes joint to ease irritation
• Promotes Fusion – Allows bones to grow together over time
• Outpatient Surgery – Patients go home same day, recover in weeks

Though stabilization surgery helps many, some don’t improve or require repeat surgery. Thorough discussion of potential risks and benefits with the care team determines if surgery is right for an individual patient.

Prognosis and Prevention

With appropriate treatment guided by skilled practitioners, most patients see significant improvement or resolution of their symptoms:

• Positive Outlook – Committing to consistent care ensures the best results
• Core Strengthening – Supports joints, prevents future strain
• Proper Body Mechanics – Using correct movements and alignments during activity prevents wear
• Healthy Lifestyle – Lean body mass and cardiovascular exercise aids recovery
• Ergonomic Modifications – Supportive beds, chairs and workstations reduces irritation

There is no one-size-fits-all treatment for SI joint dysfunction. The most effective approach involves tailoring plans to each patient’s unique situation. Typically, conservative therapies like physical therapy and medications are tried first. If those fail to adequately relieve symptoms over an appropriate period, more advanced interventions may be added. The goal is to systematically adjust the treatment plan based on the patient’s response until daily function is regained and quality of life improved. Most patients find relief through aligning personalized therapies to match the specifics of their case over time.