Treatment Options for Sacroiliac Joint Dysfunction

By Matthew Hellman, M.D.

 Firstly, what is sacroiliac (SI) joint dysfunction?

That large bone you’re probably sitting on right now as you read this? That’s your sacrum. It’s where the tailbone at the end comes together with the hip bones– the ilium– to create the iliac crest. Hence, the sacroiliac joint!

You’ll find this joint on the side where the lower back meets the buttocks as a fairly large weight-bearing joint that, for many, goes unaddressed for a long period of time. Recently, though, it’s been gaining more notoriety as a cause of lower back pain, buttocks, thigh, groin, or even lower abdominal pain.

Most people will start getting arthritis or inflammation over time, which tells us that SI joint dysfunction might be the root cause of it.

The problem is that many medical school doctors are taught that a patient feeling lower back and leg pain is automatically related to the sciatic nerve. And in fact, it does present itself quite similar to sciatica, at least at first!

But doctors making this assumption and patients going along with the treatment will soon find that even after 3 or 4 injections, the pain isn’t going away. And that’s because a common treatment for SI joint dysfunction is really outside of the spine, lower down where the SI joints are.

If a patient is being treated for sciatica, though, they won’t find the pain relief they need/

How can we differentiate the symptoms between SI joint dysfunction and sciatica?

For something as musculoskeletal in origin as sacroiliac joint dysfunction, you can often press on the area and a patient will jump right away, identifying the pain.

We also see patients who tend to rub the sides of their backs, rather than the center, which is where the pain from sacroiliac joint dysfunction lives. Pain in the back, buttocks, back of the thigh, or groin is typically SI joint dysfunction.

Alternatively, with sciatica, patients will likely feel a shooting pain past their knee, going into their feet or toes, which helps us determine that it’s a nerve issue and not a musculoskeletal issue.

Everything, including talking to the patient, doing physical exam findings, and doing x-rays can help us uncover what’s going on.

What are your steps when approaching sacroiliac joint dysfunction?

We work to solve SI joint dysfunction with conservative care first– particularly, physical therapy!

Many times, people will subconsciously change the way they’re doing everyday movements like walking to accommodate the pain they’re having, which can cause other issues in other areas of the body if they’re not careful.

It can start on one side, but because of the overcompensation, it can go over to the other side because of particular weight-bearing shifts.

Related: Your Pain Care Plan to Occupational Pain Management

Physical therapy and chiropractic care can help retrain how to walk in the correct fashion, anti-inflammatory medications can help relax the muscles, especially if they’re tight or spasming, and, if needed, we’ll go to injections right into the joints.

Another option we have when we see that injections are having good results but the pain keeps coming back is sacral radiofrequency ablation, which burns sensory nerves that run to the SI joint from the sacrum, easing the pain.

As a last resort, there are also some newer procedures where you can actually fuse the SI joint together, which can be done when our doctors are 100% confident that the pain is coming from the SI joint.

Is there a common cause of SI joint dysfunction in the patients you see at APC?

We see this happen with many repetitive lifting motions and not keeping your back straight. Those forces will have to go somewhere, and when you’re not lifting properly, it’s going to go in your knee and SI joints rather than your legs where they should be going.

We also see this in athletes, runners, bikers, and other avid exercisers, particularly ones who do excessive squats and deadlifts, which will usually trigger this type of pain through the repetitive, intense motion it brings.

With physically-demanding jobs (that often ignite this pain), it can be tough dealing with this SI joint pain, as they tend to not have a huge span of time to rest and recover, the vacation or sick days to be able to take time off, or even the benefits to help cover the procedures they need. They’ll end up working through the pain, because they can’t afford to take 10 days off to recover from surgery, which just makes it even more difficult to fully heal.

We’ll also see SI joint dysfunction in patients who have gotten hip or knee replacements. Even years after their surgery, they sometimes develop leg discrepancy or simply shift the way they’re walking, and oftentimes develop SI joint dysfunction from that overcompensation.

Related: Patient Spotlight: Two Very Different Total Joint Replacement Surgeries

What would you recommend to patients who want to avoid experiencing SI joint dysfunction?

A lot of it comes down to posture and body anatomy!

If you’re at work and feel like you’re straining your body, don’t be afraid to ask for some help! There’s no reason to take on more than you can, especially if it’s going to be at the expense of your body.

For athletes, I recommend having a stretching regimen before starting any workouts, especially if your workout is hyper-fixated on the back and leg area. Loosening up your muscles before and after a workout session will also help prevent injuries of all types, especially sacroiliac joint-related ones.

I usually send people to our physical therapy department, where our doctors can answer questions about stretching, posture, and so much more. What’s great about our multidisciplinary approach is that I can see everyone’s notes on a patient as soon as I log on, making it a hundred times easier to get their information than waiting for things to be emailed or faxed in.

What happens after helping SI joint dysfunction?

Our goal is to help a patient’s sacroiliac joint dysfunction get as manageable as possible, where they can get to a point where it’s not noticeable or affecting the quality of life.

We can’t guarantee that it’ll never come up again, but we always strive to make the pain as manageable as possible and empower our patients with everything they need to use their bodies to their fullest!