The Sacroiliac Joint: An Often Overlooked Cause of Back Pain

Sacroiliac Joint large

That huge pothole you hit a few weeks ago could be the cause of your low back pain. When something happens that puts uneven pressure on your pelvis, you could be overloading one of your sacroiliac (SI) joints.

Max Berdichevsky, MD, with Premier Orthopedic Spine Center, notes that even simple activities like snow shoveling, gardening and jogging can aggravate your SI joint because of their rotational or repetitive movements. 

The purpose of your SI joints is to provide stability by connecting the bottom of your spine, known as the sacrum, with your pelvis. The two SI joints are where the hip (iliac) bones meet the sacrum. 

“The benefit of having your SI joint formally diagnosed and treated by a physician is that it lays the groundwork for what you should do when it happens again.”

Causes and Symptoms of SI Joint Pain

Although SI joint pain can be caused by trauma, it more often develops over a long period and typically is more common in young and middle-aged women. It’s also sometimes called SI joint dysfunction.

Common causes of SI joint pain include:

  • Pregnancy 
  • Degenerative diseases such as arthritis
  • Difference in leg lengths
  • Poor body mechanics and posture during sports, weightlifting or work activities
  • Wearing away of the cartilage (cushion) between the bones
  • Trauma from impact, such as landing hard on buttocks
  • History of pelvic fractures or injuries
  • Muscle tightness
  • Past spine surgery

Symptoms of SI joint pain include:

  • Low back pain, usually only on one side 
  • Pain also may occur in hip, buttocks or upper leg 
  • Discomfort with bending over or standing after sitting for long periods
  • Pain that gets worse with movement or standing for a long time
  • Improvement of pain when lying down
  • Inability to move as freely as usual
  • Muscle spasms in the low back

Call your doctor if you have any of the following symptoms. These can be an indication of a more serious issue:

  • Sudden numbness or tingling in your lower back and hips
  • Weakness or numbness in your legs
  • Difficulty controlling your bowel or bladder
  • Sudden increase in pain or discomfort
  • Slower than expected healing
  • Fever 

SI Joint Pain Diagnosis

Sacroiliac Joint small

Since SI joint pain can mimic more than a handful of other conditions, diagnosis can be difficult and often is delayed. Delayed diagnosis also occurs when people accept back pain as part of life and don’t seek care. 

Dr. Berdichevsky recommends a visit to your doctor if your pain persists for two to three weeks despite home therapy that includes pain and anti-inflammatory medications. 

“The benefit of having your SI joint formally diagnosed and treated by a physician is that it lays the groundwork for what you should do when it happens again,” he explains.

Diagnosis techniques vary and may include:

  • Clinical assessment of movements that isolate the SI joint and reproduce pain
  • Anesthetic injection block (if the pain goes away, doctors can infer the SI joint as the source of pain)
  • Elimination of other causes through diagnostic imaging

SI Joint Pain Treatment and Prevention

Most people obtain relief with non-surgical treatment, according to Dr. Berdichevsky. One or more of these treatments may help:

  • Rest and reduction of activity that worsens pain 
  • Prescription or over-the-counter pain and anti-inflammatory medicines 
  • Cold packs or heat packs applied to lower back or upper buttocks (avoid heat until acute phase of pain subsides)
  • Stretching, yoga and other exercises to improve flexibility and strength
  • Physical therapy to help relieve pain and strengthen muscles around the SI joint 
  • Low-impact aerobic exercise to help increase blood flow to the SI joint and stimulate healing
  • An SI joint belt or lumbar brace to help stabilize a joint that’s too loose
  • Medication injections to help relieve chronic pain and inflammation 
  • Additional therapies such as massage, acupuncture and chiropractic manipulations (for fixed joints) also may help.

Treatment is highly individualized. What works for you may not work for someone else. Keep your doctor involved as your back pain issues change or progress. And always consult your doctor regarding use of pain and anti-inflammatory medications, which can cause organ damage with long-term use.

You may want to seek a pain intervention specialist who offers radiofrequency ablation if you’re struggling to manage pain issues. 

Preventing SI joint pain starts with understanding what aggravates your SI joint. Dr. Berdichevsky advises a slower pace with such activities. 

“When spring comes, don’t go out and garden for five hours,” he says. “When shoveling snow, don’t go from zero to 60 right away, and break up the activity into multiple rounds if possible.” He says to also take breaks from prolonged sitting.