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Are you experiencing low-back pain?
It could be sacroiliac (SI) joint dysfunction.

90%

of the adult population will experience lower back pain at some point in their lives.

25%

of these individual’s pain will be caused by sacroiliac (SI) joint dysfunction.2

This may be the type of pain you are experiencing. In most cases, there are certain health factors that may have contributed to this condition. The information provided here will help you learn more about SI joint dysfunction and present options that could help you get back to your life.

What is the SI joint and its primary function?

The sacroiliac joint or SI joint is the connection point between the sacrum (triangular bone at the bottom of the spine) and the pelvis (iliac bone or hip bone). Unlike most joints that slide and glide, the SI joint is considered somewhat static, although it does allow for a few millimeters of motion. This joint is often referred to as the body’s shock absorber, providing stability and load-bearing characteristics by transferring body weight and downward forces through the pelvis to the legs while engaging in physical activities like walking, running, climbing, jumping, etc. This unique functionality can eventually lead to the SI joints becoming strained, injured, or affected by a chronic condition. It can also become unaligned, exposing or pinching nerves and generating pain in your lower back and extremities.

Pain standing or sitting for long periods

Common SI Joint
Pain Indicators

Pain and difficulty sleeping on one side or both

Pain while exercising or stretching

Pain and difficulty walking up or down stairs

Symptoms and Pain locations related to SI joint dysfunction:

  • Lower back pain
  • Sensation of pain, numbness, tingling, weakness in lower extremities
  • Pelvic/buttock pain
  • Hip/groin pain
  • Leg instability (buckling, giving way)
  • Disturbed sleep patterns due to pain
  • Pain from sitting and/or standing from the seated position

Pain in the lower back can originate from several pain generators, so it is essential to determine the source of your pain. Your physician may accomplish this through physical examination, radiographs, MRIs, and analgesic injections. Time spent with your physician reviewing the location of your pain and how you experience your pain is crucial.

symptoms-and-pain-locations-illustrations

What caused my SI Joint Pain?

There can be many causes of SI joint dysfunction, including but not limited to:

Like most other joints in the body, the SI joints have a cartilage layer covering the bone. This cartilage allows for some movement and acts as a shock absorber between the sacrum and iliac bones. When this cartilage becomes damaged or is worn away by age, the bones begin to rub on each other, and degenerative arthritis (osteoarthritis) occurs.

DEGENERATIVE ARTHRITIS

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During pregnancy your hip and sacroiliac joints will begin to naturally loosen. This is your body preparing to give birth. Add to that a change in the way some women walk as a result of pregnancy and that can cause your sacroiliac joints to become inflamed. This kind of pain can last through delivery and into the postpartum period.

PREGNANCY & NATURAL CHILD BIRTH

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Trauma caused by a series of small, repetitive injuries that accumulate over time, such as in the case of an athlete, or it could be the result of a sudden impact such as a pelvic fracture from a motor vehicle accident or fall.

TRAUMA

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Fusion of the lumbar spine alters its natural movement and ability to absorb shock, resulting in increased load or stress on the adjacent lumbar segment and potential for degeneration. Sometimes this “transfers” forces to the SI joints, especially when prior lumbar fusion included the L5/S1 level.

PREVIOUS LUMBAR FUSION

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Diagnosing SI joint dysfunction can be challenging. The lumbar spine, discs, sacrum, ilium and SI joints (your pelvis/hips) all share the transfer of load and stress to and from the legs, so it could be a combination of pain generators. Identifying the exact pain source is why multiple diagnostic tools are used by physicians to determine the cause of your pain.*

DIAGNOSTIC TOOLS

Patient History
Provocative Test
X-Ray/MRI/CT Scan
Dianostic Injection

*Always discuss all options with your physician. Every patient is unique and physicians have preferences to diagnostic tools, conservative care plans, and surgical techniques.

Options for Treating Sacroiliac (SI) Joint Pain

  • Medications
  • Physical Therapy
  • Therapeutic Injections
  • Surgical Intervention

Only you and your physician know what is right for you and your specific diagnosis.

The information provided here is not intended to replace professional medical care.

Disclaimer:
The material in this section of the website is intended for educational resource purposes only and is not meant to replace conversations between a patient and their physician or member of their health care team. Please consult with your physician to obtain a complete list of indications, contraindications, precautions, warnings, clinical results and other important medical information that pertains to this procedure. The decision to receive medical treatment is individualized to the patient and the patient’s symptoms. The information presented on this site may not apply to your condition, treatment or its outcome, as surgical techniques vary and complications can occur. It is important to discuss the viability of any surgical procedure with your physician to decide the right treatment option.

2. Bernard TN, Jr, Kirkaldy-Willis WH. Recognizing specific characteristics of nonspecific low back pain. Clin Orthop Relat Res. 1987;217:266–80.

We can help you find doctor if you don’t have one and you think SI fusion might be right for you.

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DIAGNOSTIC TOOLS

Patient History
Provocative Test
X-Ray/MRI/CT Scan
Dianostic Injection

DIAGNOSTIC INJECTIONS

A helpful method of diagnosing SI joint dysfunction is by performing an injection that can numb the irritated area, thereby helping to pinpoint the pain source. An anesthetic material (for example, lidocaine [Xylocaine]) can be injected along with a steroid (cortisone) directly into the SI joint. This is usually performed with the aid of an X-ray machine to verify the injection is in the SI joint. The anesthetic and steroid can help relieve the pain from inflammation that is common with SI joint dysfunction. The duration of pain relief is variable, but this is very useful to determine that the SI joint is the source of the pain.

Injection

DIAGNOSTIC TOOLS

Patient History
Provocative Test
X-Ray/MRI/CT Scan
Dianostic Injection

X-RAY / CT SCAN / MRI

The next step in diagnosis is often plain radiographs (X-rays). The physician may want to have X-rays taken of the pelvis, hips, or lumbar spine depending on what he finds during the history review and physical examination. A computer generated tomography (CAT or CT) scan may also help in the diagnosis. A CT scan gives a more detailed look at the joint and bones. Both X-rays and CT scans can help identify sacroiliitis, which can appear as sclerosis in the joints. More severe wear in the joints can appear as eroded bone around the SI joints. These tests can also look for fusion of the SI joints. A magnetic resonance imaging (MRI) scan can also be helpful by providing an even better evaluation of the soft tissues, including muscles and ligaments. It can also identify subtle fractures that may not be visible on an X-ray. The MRI can identify inflammation in the SI joint by the presence of excessive fluid in the joint. A bone scan can be obtained to help isolate the source of the pain and identify bony abnormalities as well as areas of increased activity in the bone.

X-ray and CT Scan

DIAGNOSTIC TOOLS

Patient History
X-Ray/MRI/CT Scan
Dianostic Injection

PROVOCATIVE TESTS

There are various tests a physician can perform during the physical examination that can help isolate the source of the pain. The most widely used and best for diagnosing SI joint dysfunction is the Provocative SI Joint Tests. By placing the patient's hips and legs in certain positions and applying pressure, the SI joints can be moved or compressed to identify them as a source of pain. Other portions of the examination are to exclude certain possibilities that could mimic sacroiliac disease.

Provocative Tests

DIAGNOSTIC TOOLS

Patient History
Provocative Test
X-Ray/MRI/CT Scan
Dianostic Injection

Patient History

The first step in diagnosing Sacroiliac (SI) Joint Dysfunction is typically to do a thorough run through of the patients medical history and physical examination by a physician. The physician or their medical assistant will ask questions to determine if there are any underlying disorders that could be causing the patient's pain. Certain signs like where the patient is experiencing their pain, what kind of activities exaggerate this pain and if there are any incidents from their past that could be contributing to their pain can also help differentiate if the pain is coming from the SI joints, lumbar spine, or hips.

Patient History Doctor Consulting with Patient

X-Ray/MRI/CT Scan

 

DIAGNOSTIC TOOLS

 

 

Patient History

The first step in diagnosing Sacroiliac (SI) Joint Dysfunction is typically to do a thorough run through of the patients medical history and physical examination by a physician. The physician or their medical assistant will ask questions to determine if there are any underlying disorders that could be causing the patient's pain. Certain signs like where the patient is experiencing their pain, what kind of activities exaggerate this pain and if there are any incidents from their past that could be contributing to their pain can also help differentiate if the pain is coming from the SI joints, lumbar spine, or hips.