What are the sacroiliac (SI) joints?
The sacroiliac (SI) joints are made up of three bones; the sacrum and the right and left iliac bones. The sacrum is the keystone of the low back and the pelvis. The alignment of the SI joint is very important to the structure of the low back. The iliac bones are the two large bones that make up the pelvis. As a result, the SI joints connect the spine to the pelvis. The sacrum and the iliac bones (ileum) are held together by a collection of strong ligaments (see below). There is relatively little motion at the SI joints. Most of the motion in the area of the pelvis occurs either at the hips or the lumbar spine. These joints need to support the weight of the upper body when we are erect, which places a large amount of stress on them. This can lead to wearing of the SI joints and associated cartilage, creating arthritis in the joint.
What is sacroiliac joint dysfunction?
If the SI joint is misaligned (seen below), it gives a “pinching, sharp” pain 1-2 inches on the left or right side of the spine just over the buttocks. There are many different terms for sacroiliac joint problems; including SI joint dysfunction, sacroiliac joint disease, SI joint syndrome, SI joint strain, and SI joint inflammation. Each of these terms refer to a condition that causes pain in the SI joints from a specific cause.
What are sacroiliac joint dysfunction symptoms?
The most common symptom of SI joint dysfunction is pain. Patients often experience pain in the lower back or the back of the hips. Pain may also be present in the buttocks, thighs and sometimes into the groin. It is important to determine the exact source of the pain. Your physician can perform specific tests to help determine the source of the pain and best possible treatment options. The pain typically increases from any motion that moves or stresses the joint such as; going from sitting to standing, with prolonged standing or sitting and walking. SI joint pain is often relieved by lying down.
SI Joint Symptom
Symptoms and signs associated with joint pain can include:
• local pain, possible low back and buttock radiation
• pain may be sharp and stabbing with a sprain
• pain may increase with weight bearing, moving from sitting to standing
• painful motion and walking
• pain with flexion and or extension of the pelvis
• locking of the joint
• loss of range of motion in the joint
• relieved with decreased weight bearing (lying down)
What are the causes of sacroiliac joint dysfunction?
There are many factors that can initiate SI joint dysfunction. A number of the causes are postural or behavioral issues that induce SI joint dysfunction. Youth have increased mobility in the joints that at times may induce SI joint pain. Aging is also a factor. As we age the SI joints gets narrower and is more able to “lock up” or become dysfunctional. A person’s lifestyle habits often contribute to this condition. For example a sedentary office worker that has tight and stiff legs, hips and back, is prone to this condition. Often poor sitting postures, sitting with legs crossed, sitting on a wallet, poor furniture or office chair, leaning toward the car armrest or door while driving, can apply uneven pressure to the pelvis and induce SI joint dysfunction. Often sleeping in poor positions that turn the hips and low back for prolonged periods of time may cause SI joint pain. Excessive bodily weight also adds more weight to the SI joint, which may cause dysfunction or other conditions in the joint such as arthritis.
The SI joints have a cartilage layer covering the bone. If this cartilage is damaged or worn away, the bones begins to rub on each other and degenerative arthritis (osteoarthritis) occurs. This is a common cause of SI joint dysfunction. Degenerative arthritis occurs commonly in the SI joints, just like other weight-bearing joints of the body.
SI joint dysfunction is common with pregnancy. During pregnancy, hormones are released in the woman’s body that allow ligaments to relax. Relaxation of the ligaments allows for increased motion in the SI joints and can lead to increased stresses and abnormal wear. The additional weight and walking pattern (altered gait) associated with pregnancy also places additional stress on the SI joints. Post-pregnancy is frequently a time for women to have pain in the SI joints if the joints are not aligned properly as the relaxation hormones leave the body and the ligaments firm up to hold the SI joint.
Conditions that alter the normal walking pattern and places increased stress on the SI joints creates a risk factor for SI joint dysfunction. This could include a leg length discrepancy (one leg longer than the other), or pain in the hip, knee, ankle, or foot. Patients with severe pain in the lower extremity often develop problems with either the lower back (lumbar spine) or SI joints. Usually, if the underlying problem is treated, the associated lumbar spine or SI joint dysfunction is improved, so long as the normal motion of the lower body is restored.
There are many disorders that affect the joints of the body that can also cause inflammation in the SI joints. These include gout, rheumatoid arthritis, psoriatic arthritis, reactive arthritis, and ankylosing spondylitis. These are all various forms of arthritis that can affect all joints. Ankylosing spondylitis is an inflammatory arthritis that always affects the SI joints. It can lead to stiffness and severe pain in the SI joints, due to inflammation in the sacroiliac joints (sacroiliitis). As the disease process continues, the SI joints can fuse together and have no range of motion. Once this occurs, there is no further pain associated with the SI joints.
How do health care professionals diagnose sacroiliac joint dysfunction?
The first step in diagnosis is typically a thorough history and physical examination by a physician. The physician will ask questions to determine if there are any underlying disorders that could be causing the patient’s pain. Certain signs can also help differentiate pain coming from the SI joints, lumbar spine, or hips. There are various tests a physician can perform during the physical examination that can help isolate the source of the pain. By placing the patient’s hips and legs in certain positions and applying pressure, the SI joints can be moved or compressed to identify them as a source of pain. Other portions of the examination are to exclude certain possibilities that could mimic sacroiliac disease.
Imaging of the sacroiliac joint is often not needed. A diagnosis and treatment can begin before imaging: however, if change is not seen after initial trial treatment, then imaging can be ordered. The patient may have X-rays of the pelvis, hips, or lumbar spine depending on need. A computed tomography (CAT or CT) or magnetic resonance imaging (MRI) scan also may be helpful if additional imaging is needed. This provides a better evaluation of the soft tissues, including muscles and ligaments. It can also identify subtle fractures that may not be visible on an X-ray. The MRI can identify inflammation in the SI joint by the presence of excessive fluid in the joint.
What is the treatment for sacroiliac joint dysfunction?
Manipulation or a chiropractic adjustment is highly effective for treatment of SI joint dysfunction. As stated before, SI pain is often induced by a misalignment of the sacrum and adjoining iliac bones. This induces pain and inflammation as it alters the surrounding alignment for ligaments and muscle structures. With a chiropractic adjustment the misaligned bones are realigned and relieves pressure and allows the small joint to move more freely with less obstruction. Over time, as the inflammation reduces and the muscle and ligaments return to the normal proper positioning the pain is resolved.
Opiate based pain medication or muscle relaxers should not be taken for this condition. They provide minimal relief and have too many potentially harmful side effects, including addiction or death.
An anti-inflammatory diet and natural anti-inflammatory homeopathic medications or supplements are very effective and safe for treatment of this condition. Bromelain and proteolytic enzymes have been found to reduce inflammation naturally and without harmful side effects. They have also been found in some studies to be as effective as NSAIDS. Arnica is a very common homeopathic pain reliever and anti-inflammatory. (Bio-Zyme, Hevert Pain Relief, Hevert Trauma Roll) Homeopathic injections (Traumeel & Zeel) have been shown to be an effective and safe treatment option to reduce pain and inflammation and is a better option than steroid injections in the early stage of care. Homeopathic injections have been shown to help with pain, swelling, joint stiffness and inflammation associated with arthrosis/osteoarthritis, Rheumatic joint disease as well as other degenerative conditions. Oral anti-inflammatory medications (NSAIDs, ibuprofen [Motrin], naproxen [Naprosyn]) are often helpful for pain relief for a very short period, however they have more side effects than natural alternatives.
Physical therapy, as well as physical modalities, is usually very effective. Pain in the SI joint is often related to either too much motion or not enough motion in the joint. It’s important to learn various stretching or stabilizing exercises that can help reduce the pain. A sacroiliac belt is a device that wraps around the hips to help stabilize the SI joints, which can also help the SI joint pain. Other options to stabilize the SI joints include yoga, manual therapy, and Pilates.
Oral steroids (prednisone) can be used for short periods of time (occasionally to treat the inflammation) but is not usually recommended at our office unless it’s an extreme case.
What is the prognosis of sacroiliac joint dysfunction?
The prognosis of SI joint dysfunction varies depending on the cause of the dysfunction. However, most often the cause of SI joint dysfunction is biomechanical such as with pregnancy, and in most cases the prognosis is excellent, as the condition usually improves after a period of treatment and once normal biomechanical function is restored. Conditions affecting the sacroiliac joints such as ankylosing spondylitis and psoriatic arthritis are chronic, but excellent treatments are available. These treatments can minimize the SI joint pain and prevent destruction of the joints. Degenerative arthritis affecting the SI joint is also a chronic condition and cannot be reversed, but treatments are generally very effective in improving symptoms.
Is it possible to prevent sacroiliac joint dysfunction?
Unfortunately, SI joint dysfunction is not preventable for everyone. For many, it is an unfortunate part of the normal aging process. However, the severity can be reduced or alieved through treatment with chiropractic care, homeopathic injections, home advice and when needed, over the counter medications. Things that will help to reduce the chances of SI joint dysfunction are maintaining a healthy body weight, stretching, and regular exercise.
If you are have sacroiliac pain or know someone that does, call and schedule a visit at Alta Mountain Chiropractic with Dr. Eldredge. This is a condition that we are very familiar with and will be able to help you with
Information adapted from www.medicinenet.com, www.emersonecologics.com and written by Nathan Eldredge DC
1. Cirelli MG. Five years experience with bromelains in therapy of edema and inflammation in postoperative tissue reaction, skin infections and trauma. Clin Med 1967;74(6):55-9.
2. Trickett P. Proteolytic enzymes in treatment of athletic injuries. Appl Ther 1964;6:647-52.
3. Sweeny FJ. Treatment of athletic injuries with an oral proteolytic enzyme. Med Times 1963:91:765.
4. Boyne PS, Medhurst H. Oral anti-inflammatory enzyme therapy in injuries in professional footballers. Practitioner 1967;198:543-6.
5. Deitrick RE. Oral proteolytic enzymes in the treatment of athletic injuries: A double-blind study. Pennsylvania Med J 1965;Oct:35-7.
6. Rathgeber WF. The use of proteolytic enzymes (Chymoral) in sporting injuries. S Afr Med J 1971;45:181-3.
7. Buck JE, Phillips N. Trial of Chymoral in professional footballers. Br J Clin Pract 1970;24:375-7.
8. Tsomides J, Goldberg RI. Controlled evaluation of oral chymotrypsin-trypsin treatment of injuries to the head and face. Clin Med 1969;76(11):40.
9. Holt HT. Carica papaya as ancillary therapy for athletic injuries. Curr Ther Res 1969;11:621-4.
10. Blonstein JL. Oral enzyme tablets in the treatment of boxing injuries. Practitioner 1967;198:547.
11. Baumüller M. Therapy of ankle joint distortions with hydrolytic enzymes—results from a double blind clinical trial. In Hermans GPH, Mosterd WL, eds. Sports, Medicine and Health. Amsterdam: Excerpta Medica, 1990, 1137.
12. Craig RP. The quantitative evaluation of the use of oral proteolytic enzymes in the treatment of sprained ankles. Injury 1975;6:313-6.
13. Lozada C et al. A Multi-Center Double-Blind, Randomized, Controlled Trial (db-RCT) to Evaluate the Effectiveness and Safety of Co-Administered Traumeel® (Tr14) and Zeel® (Ze14) Intra articular (IA) Injections Versus IA Placebo in Patients with Moderate-to-Severe Pain Associated with OA of the Knee ACR Annual Meeting, Abstract Number: 2896. 2014.