Your Health - Sacroiliac Joint Pain

Sacroiliac Joint Pain

(Joint Pain, Sacroiliac)

Definition

The sacroiliac joint is in the low back where the spine meets the pelvis. Sacroiliac joint pain is discomfort in this area. This pain is a symptom that may come from a number of conditions or diseases.

Sacroiliac Joint

Causes

Doctors may be unsure if the pain starts in the joint or in its surrounding ligaments. Ligaments are bands of tissue that connect one bone to another bone. It is also difficult to tell if the pain is coming from the sacroiliac joint or the small joints in the lower spine. These smaller joints are called facet joints.

The sacroiliac joint has many nerve endings. The nerves send pain signals to the brain. Pain in this region may be caused by many factors:

Twisting, bending, or moving in a way that triggers sacroiliac joint pain
Infection of the joint
Osteoarthritis of the joint (more common in older adults)
Trauma , such as auto accidents
Stress fractures in athletes
Inflammation of the joint, such as with ankylosing spondylitis

Risk Factors

Factors that increase your chance for sacroiliac joint pain include:

Poor posture
Weak muscles
Bending or twisting the back
Improper lifting
Ankylosing spondylitis
Psoriatic arthritis

Symptoms

Symptoms include:

Mild to severe low back pain
Pain in the buttocks
Pain that seems deep in the pelvis
Pain in the hip or groin or back of the thigh
Pain that radiates down the leg on the affected side
Stiffness of the lower spine
Certain activities may increase the pain, including:
- Walking
- Twisting
- Bending
- Stooping
- Rolling over in bed
- Getting up from a chair
- Climbing the stairs
- Coughing
- Sneezing

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. Finding the source of sacroiliac joint pain is often difficult. Tests depend on your medical history and the suspected cause.

Tests may include:

X-rays of the pelvis and lower back
Bone scan —injection of radioactive material into the body, followed by scanning with a machine that will find areas with higher concentrations of the injected material (these are areas of abnormal bone activity)
CT scan —a type of x-ray that uses a computer to make pictures of the inside of the pelvis and sacroiliac joint
MRI scan —a test that uses a strong magnetic field and radio waves to make pictures of the sacroiliac joints and the ligaments
Biopsy or aspiration—removal of a sample of tissue from the joint for testing
Joint injections or nerve blocks—injection of a drug that blocks nerve signals into the joint to determine if the pain starts in the joint

Treatment

Treatment depends on the cause of the pain. Any underlying condition would receive treatment specific for that disease. For stress fractures, doctors recommend limited weight-bearing. Regardless of the cause, short-term rest is often advised.

Other treatment may include:

Medication

Your doctor may recommend or prescribe any of the following:

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as:
- Aspirin
- Ibuprofen (Motrin, Advil)
Pain medication— acetaminophen (Tylenol)
Steroid injections into the sacroiliac joint
Antibiotics for infected joints

Physical Therapy

Physical therapy may include:

Exercises to stretch the muscles of the lower back
Exercises to strengthen the muscles which support the area
Exercises to affect the motion of the sacroiliac joint
Applying ice to the painful area
Applying deep heat to the sore area

Back Care

Prevent stress to the painful area with the following:

Proper bending
Proper lifting
No twisting of the body

Prevention

Practicing good back care may help you avoid sacroiliac joint pain. This includes:

Exercise regularly to keep muscles strong.
Maintain good posture.
Use proper techniques for bending or lifting.

RESOURCES:

American Academy of Orthopaedic Surgeons
http://www.aaos.org/

Arthritis Foundation
http://www.arthritis.org/

CANADIAN RESOURCES:

The Arthritis Society
http://www.arthritis.ca/

The Canadian Orthopaedic Association
http://www.coa-aco.org/

References:

Campbell WC, Canale T. Campbell's Operative Orthopaedics . 9th ed. Philadelphia, PA: Mosby, Inc.; 1998.

Cohen SP. Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment. Anesth Analg . 2005 Nov;101(5):1440-1453.

d'Hemecourt PA, Gerbino PG II, Micheli LJ. Pediatric and adolescent sports injuries: back injuries in the young athlete. Clinics In Sports Medicine . 2000 Oct;19(4):663-679.

Dreyfuss P, Dreyer S, Griffin J, et al. Positive sacroiliac screening tests in asymptomatic adults. Spine . 1994;19(10):1138-1143.

Harrison TR, Braunwald E. Harrison's Principles of Internal Medicine . 14th ed. Columbus, OH: The McGraw-Hill Companies; 2000.

Inflammatory arthritis of the hip. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00396 . Updated August 2007. Accessed June 22, 2008.

Nadler SF. Frontera: Essentials of Physical Medicine and Rehabilitation . 1st ed. Philadelphia, PA: Hanley and Belfus; 2002.

Ruddy S, Harris ED, Sledge CB, Kelley WN. Kelley's Textbook of Rheumatology . 6th ed. Philadelphia, PA: WB Saunders Co.; 2001.

Scopp JM, Moorman CT III. The assessment of athletic hip injury. Clinics In Sports Medicine . 2001 Oct;20(4):647-659.

Last reviewed September 2009 by Robert E. Leach, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.