Patient Guide

Sacroiliac Joint Pain

Anatomy

Where is the Sacroiliac Joint? The sacroiliac joint (SIJ) is located at the bottom end of your spine, where the "tailbone" (sacrum) joins the pelvis (ilium). It is about where the dimpled area of your back is, below your waistline. The SIJ is a somewhat large joint that moves very little. It is a common source of low back pain.

What is Sacroiliac Joint pain like, and how does it start? SIJ pain can vary substantially in both quality and severity. It may be sharp and stabbing, or dull and aching. It may start all of a sudden, or it may come on slowly over time. Many people describe a feeling like the low back suddenly "gives way and causes stabbing or knife-like pain when bending over or twisting at the waist. Others describe a feeling of the lower back slowly getting stiffer and aching over time. A lot of people feel increased pain when standing up from sitting, or when moving from lying down to sitting.

Where does SIJ pain occur? You may feel pain from the sacroiliac joint in many places: 1. In your low back, right over the joint (most common) 2. In your buttock, thigh, or groin (common) 3. In your lower leg (less common)

Causes

What causes SIJ pain? There are four main categories (causes) of SIJ pain: 1. Mechanical - The joint doesn't move as well as it used to, or it moves in the wrong way. 2. Traumatic - The joint gets injured or damaged by some type of trauma. 3. Degenerative - The moving parts of the joint wear out and may even become adhered together. 4. Inflammatory - The joint is put under pressure by swelling inside or near the joint. Many times SIJ pain has more than one of these causes. Let's look at each category a little more closely. 1. Mechanical SIJ pain The most common cause of SIJ pain is a change in the way the joint moves. Even though this joint never moves very much, some kinds of stresses on the joint may cause it to buckle a little, or to move in the wrong way. The joint may be stressed by abnormal alignment (lining up) of the pelvis and lower extremities. This can happen with flat feet, when your legs are uneven in length, or when the muscles that support your low back are too tight, too weak, or out of balance with each other. Things you do (or don't do) in your everyday life and work can also stress the SIJ. Some examples include a poorly supportive chair, poor posture, or when you sleep in a position that puts stress on your back. 2. Traumatic SIJ pain The two most common types of SIJ trauma (injury) occur (1) during childbirth, and (2) in falls that land you on your buttocks. These injuries can damage the joint, and make it less stable. If you have an unstable SIJ, you may hear or feel a "clunk" in your low back when you squat or when you move your legs in certain ways. During childbirth, the SIJ acts as a hinge to widen the pelvis and let the baby pass through. Sometimes this can over-stretch the joint and cause damage, leading to pain in the low back or pelvis following childbirth. If you fall onto your buttocks, the force of your landing may overload and damage the SIJ. You may not feel pain caused by this damage for weeks or months after the fall. 3. Degenerative SIJ pain As you get older, most of your joints break down a little (degenerate). As the SIJ degenerates with age, it becomes less mobile and the joint surfaces may actually adhere together. Over time, the joint surfaces may solidly fuse. Mechanical stresses, injuries (traumas) to the lower back, and swelling can also cause or increase degeneration of the SIJ.

4. Inflammatory SIJ pain. Certain classifications of arthritis cause swelling (inflammation) that can affect the SIJ. For example, some gastrointestinal disorders such as Crohns disease and ulcerative colitis, may cause swelling in the tissues that support the SIJ. If you have inflammatory SIJ pain you will probably need medical care. Chiropractic care may be helpful when combined with medical care.

Diagnosis
How will we make your diagnosis? It is important to correctly diagnosis the cause of your pain, because it is the best guide for treating you. Your chiropractor will ask you a number of questions, give you a physical exam, and test some movements of your back, hips, and legs. All of this helps to determine the source of your pain and what kinds of motions and stresses make it better or worse. This is the key to diagnosing whether the SIJ is the source of your problem. In the physical exam your doctor will feel and press on your low back to find areas of tenderness, and may examine your lower abdomen. We will also test the SIJ and lower back vertebrae with some movements and gentle pressure to find out about your flexibility, muscle strength, and alignment stresses that can affect the function of the SIJ. You will usually not need to have x-rays or an MRI immediately, unless you have a history of serious injury, infection or cancer. How do we know your diagnosis is correct? The way you respond to early treatment helps us to be sure about your diagnosis and the causes of your problem. For example: If you get relief from spinal manipulation, then the cause of your pain is probably mechanical. If exercise helps you, then muscle weakness is at least part of the problem. If anti-inflammatory medications help you most, the problem is caused by swelling. What if we need to know more? If your treatments do not give you enough relief over time, you may need x-rays or other images later on. Sometimes, lab tests are necessary. These will help to show whether or not you have a systemic (whole body) condition, such as rheumatoid arthritis.

Treatments
What are the goals of treatment? The goals of treatment are to: Relieve your pain Return your joints to their best mobility Make your SIJ stable Find and get rid of stresses on your SIJ Teach you how to prevent new injury to your back What treatments are available? Some of the components to the treatment plan may include: Spinal manipulation In this hands-on treatment, the doctor will move your sacroiliac joint to help you gain more mobility. Muscle Therapies These treatments use machines, like TENS and ultrasound that use electrical impulses and sound waves to help relieve muscle tension and pain. Cardiovascular exercises Mild aerobic exercise gives you better overall blood flow to your spine and body. This helps to improve your general health and supports the healing process in your back. Stretches The doctor may prescribe stretches for you to do at home and in the doctor's office. We choose these stretches to give you better overall flexibility in your lower body and spine. Home exercises You will be prescribed a set of exercises chosen especially to help you get better. Doing these exercises regularly is the most important thing you can do to get better and heal your back! Sacroiliac joint bracing Sometimes your SIJ can't be stabilized quickly enough with exercises. When this happens, you may be helped by a brace or belt that supports your pelvis for a while. Custom shoe orthotics You may have poorly aligned hips or legs that contribute to your SIJ problem. If you do, custom-made foot orthotics (supports that you put in your shoes) can help. Will I need surgery? SIJ problems rarely need surgery to get better. Only severe joint instability caused by injury usually needs to be treated with surgery. Are there other treatments I might want to try? One option is to wait and see if the pain will go away on its own. This is usually safe because most SIJ problems are not life-threatening. But waiting can sometimes make the symptoms last longer or make your condition worse.

Over-the-counter pills like Ibuprofen (Motrin, Advil) and Naprosyn (Aleve), called "non-steroidal anti-inflammatories" (NSAIDs) can help because they relieve swelling. Some people get relief with acetaminophen (Tylenol). These medicines may help you with pain relief, but they will not fix any mechanical problems that may be causing your pain in the first place. Follow directions carefully with all medicines. Sometimes a sacroiliac joint block can help. In this treatment, a medical doctor will inject anti-inflammatory and pain-control medications directly into the joint space. We recommend that you have chiropractic SIJ manipulation within 48 hours of a "block."

Sacroiliac joint injection administered through an x-ray guided needle

Self-Care
What can I do to help heal and protect my own back? Do:

Do stay active. (A lot of rest may make it worse.) Do put ice on the places where you hurt (several times daily, for 15-20 minutes). Do use a wedge-shaped cushion to help hold your spine in a healty position while sitting. Do get up from sitting or lying down in a way that supports your SIJ. (Ask your chiropractor to teach you how.) Do sleep on a supportive bed. Do sleep in position(s) that support your back. (Ask your chiropractor to show you.) Do all of your prescribed stretches every day. Do follow the recommended home exercise program. Do wear an SIJ brace, if one has been prescribed for you. Do follow all parts of your recommended treatment plan.

Don't: Don't sit in chairs that put your buttocks lower than your knees (even by a little bit). Don't sit in soft chairs that you "sink into." Don't sit with one foot tucked under your buttocks. Don't bend forward at the waist with your knees straight. Don't stand on one leg with your hip stuck out to one side. Don't sleep on your stomach. How long will it take for me to get better? Different people respond in different ways to treatment for SIJ problems. Some people feel relief from their pain after one or two treatments. Others take a longer time. If your SIJ problem is fairly basic, you will probably feel much better in one or two weeks. More complicated sacroiliac joint problems may take 4 to 8 weeks of treatment to get better. A lot of factors can affect how you respond to treatment. These include your age, how severe your injury is, how long you have been disabled or in pain, how much you can avoid putting more stress on your SIJ, and how closely you are able to follow your recommended treatment plan.