Sacroiliac Joint Pain

WHAT IS SACROILIAC JOINT PAIN?

If your back pain is below your belt and off to the side, feels like it’s in your back pocket, then the issue may not be your back. It could be your sacroiliac joint. The sacroiliac joint, sometimes called the SI joint, connects the tail bone to the pelvis. We all get two, one on the left and another one on the right. The sacroiliac joints live just below the low back, off the side and under your butt cheek. In fact, if you put your hand in the back pocket of your jeans then your palm is over your sacroiliac joint on that side. Although a true joint, they don’t move much in everyday life except for one important exception. The sacroiliac joint opens up substantially in women during childbirth, to help make room for the baby’s head to leave the pelvis.

Low back pain due to the sacroiliac joint occurs when the joint is inflamed, injured, or arthritic. Like any other joint, the sacroiliac can become inflamed from excessive wear and tear. The table lists conditions which often lead to Sacroiliac joint pain. Low back fusion causes heavy force transmission across the sacroiliac joint, often leading to sacroiliac pain. This occurs whether the fusion was done by a surgeon, or occurred on its own, as often happens in patients with ankylosing spondylitis. Accidents and injuries in which you’ve broken your tailbone, or pelvis, are also a common cause of this type of pain. Arthritis of the joint often occurs in women who’ve had multiple pregnancies, or given birth to big-headed babies, presumably due to the joint being forced open during childbirth.

SYMPTOMS OF SACROILIAC JOINT PAIN

Pain that is below the belt, off to the side, at the level of your back pocket is characteristic of SI joint pain. The pain is made worse by climbing stairs and vacuuming. Sacroiliac pain is also worse when sitting on the side of the injured joint, so that people usually sit by shifting their weight to the buttock on their good side, away from the painful joint. The pain is not always just in the back: it can spread out from the back and go either down the leg, or into the groin. Even doctors sometimes confuse sacroiliac pain with pain coming from the hip, a hernia, low back or even a pinched nerve.

CAUSES OF SACROILIAC JOINT PAIN

Sacroiliac pain is famous for being hard to pin down. Since the right solution depends on solving the right problem, its crucial to start by confirming the sacroiliac joint as the cause of pain. At Phoenix Spine & Joint we have a system for identifying people with sacroiliac pain. The diagnosis is suspected when you have the typical symptoms and imaging, confirmed by physical examination, and then really proven with a block. During physical examination, our doctors look for tenderness to pressure on your SI joint, and perform several special tests that help us localize your pain. MRI, CT and X-ray images are also helpful in showing the presence of inflammation, or signs of old injuries. Ultimately, if the pain is suggestive, and the exam supports it, then we inject numbing medicine to block the pain fibers going into your sacroiliac joint under X-ray guidance. If your sacroiliac joint is the source of your pain, the numbing will relieve the pain temporarily. Because the numbing only lasts a few hours the injection is not a treatment, it’s a test to prove your pain is coming from the sacroiliac joint.

TREATMENTS FOR SACROILIAC JOINT PAIN

In the first month or two sacroiliac pain often responds to Alleve or ibuprofen, moist heat, and stretching (yoga). If you try these three things and they fail, then give a chiropractor a try. Most people also get relief while wearing a sacroiliac brace. If else fails at you’ve had the pain for 3 months or so, then surgical intervention is an option.

There are two distinct approaches to surgical treatment of sacroiliac pain: denervation or fusion. In denervation, we either burn or cut directly the pain fibers coming out of the joint. Burning can be done through a needle, but is often temporary. Alternatively, we can place an endoscope along the side the pain fibers, and cut them under direct vision. This is called Direct Visual Rhizotomy, or DVR. Both from RFA and DVR take less than 30 min, and the recovery is the same day. In some people the pain fibers reach the sacroiliac joint through the pelvis, and we can’t get relief using denervation. In those cases, fusion of the SI joint is recommended. Fusion surgery takes around an hour, and can be done in our surgery center so you don’t have to go to a hospital. The recovery involves staying off your leg while the joint heals, usually up to 16 weeks.

OUR APPROACH TO SACROILIAC JOINT PAIN

Our doctors and staff are well educated about SI joint pain, and our 3 step process confirms the source of your pain before we begin any treatment. In this way, we pay it safe, and give you the best chance of a perfect result. We are experts at endoscopic denervation and minimally invasive fusion. These are the two techniques that are at the core of curing your SI pain in the least invasive way possible. Our surgery centers also makes your evaluation very efficient: we have an injection suite in our clinic, enabling us to inject and examine you to really localize your pain, before going to the operating room. We are also experienced at doing minimally invasive fusion, under X-ray guidance. As a result, we can do your sacroiliac fusion without having to go to a hospital. Our results are outstanding.