What Is SI Joint Pain and How Can You Prevent It?
Notoriously difficult to diagnose and often confused with other conditions, sacroiliitis is estimated to cause up to 25% of all cases of lower back pain. But what is sacroiliitis?
Your sacroiliac joint is located where your pelvis connects with your lower spine at the sacrum. Most people probably aren’t even aware that this location is a joint, as it’s not something we consciously bend. Rather, this joint is really more of a shock absorber, designed to flex a bit and absorb some of the impacts if we fall or are struck in the hip area.
Sacroiliitis is the inflammation of these joints. It can manifest as pain in the lower back, leg, hip, and (or) buttock. Pain can increase with prolonged sitting or even just rolling over in bed.
What causes sacroiliitis?
There are plenty of possible causes, including arthritis and rheumatologic diseases, traumatic injury, pregnancy, and childbirth.
Related to sacroiliitis is sacroiliac joint dysfunction, in which the sacroiliac joint either moves too much—due to weakness of supporting muscles and ligaments—or too little.
Young and middle-aged women are more susceptible to sacroiliac joint dysfunction, with pregnancy further increasing the odds.
Additional risk factors include gait issues (scoliosis or differing leg lengths) and lower back surgery history. Contact sports, heavy lifting, and labor-intensive jobs can also stress the SI joint.
Diagnosing sacroiliac issues
A doctor’s visit is needed to definitively diagnose sacroiliitis or sacroiliac joint dysfunction, as other unrelated back issues can cause similar symptoms. The initial evaluation may involve manual manipulation and palpation of the joints. Subsequent diagnostic tests for confirmation could include joint injection or imaging with x-ray, CT, or MRI scans.
Treatment options for SI joint pain
If you’re looking for joint pain relief, you have a few options:
- Rest may be helpful, but not too much. Resting for no more than a day or two if necessary because too much rest can increase stiffness and weaken the muscles necessary to support the joint.
- Ice or heat can reduce inflammation and relax muscles, respectively. Remember, though, that inflammation is often the body’s way of healing itself, so icing too much may actually slow recovery.
- Pain meds are an option, but use caution with highly addictive prescription drugs.
- A physical therapist can show you exercises, and pelvic pain stretches appropriate to your condition that can relieve pain, encourage recovery, and help prevent future problems.
- Joint injections may be necessary in extreme cases, but be cautious of corticosteroids, which can sometimes do more harm than good.
Physical therapy for sacroiliac joint dysfunction
We can’t overstate the benefits of physical therapy for recovery and prevention of a wide array of ailments, SI pain among them. Rehab generally breaks down into a balance of three types of exercise:
- Stretching — A tight or inflamed sacroiliac joint can benefit from all kinds of stretches. Your PT will be happy to show you the ones that will work best for your needs, but candidates include: hamstring stretches; quad stretches; hip adductor stretches; press-up stretches, and knee-to-chest stretches.
- Strengthening — Strengthening is especially to stabilize a hypermobile SI joint, but while you[‘re at it, you should start an overall strength training program for the rest of your muscles, bones, and joints as well.
- Cardio — Get your heart pumping and blood flowing to feed your damaged tissues to encourage healing. You might need low-impact alternatives while you recover. Consider stationary bikes, elliptical machines, and swimming.
What about surgery?
If you’ve run through all the tips for managing chronic pain and nothing seems to help, surgery might become your last resort. But make sure it truly is a last resort because surgery is always risky, and there are no guarantees it will make you better — and it just might make things worse.
For extreme SI joint pain cases that are not responsive to other attempts at healing, sacroiliac joint fusion surgery is sometimes performed. Permanently fusing the sacroiliac joint is a minimally invasive procedure that might put you in the hospital for a couple of days and will then require three to six months of recovery and physical therapy.