Sacroiliac Joint Injury
The sacroiliac joints are found where the sacrum meets the left and right iliac bones, below the lumbar (lower) spine and above the coccyx (tailbone). The sacrum is made from five bones fused together into a triangular shape. The iliac bones are the two large bones that form the pelvis. Between these bones are small, strong joints that act as shock absorbers and carry the entire weight of a standing person. Strong ligaments connect the bones and keep the joints in the correct position. The range of motion in the sacroiliac joints is very small, about 2-4 mm for men, and only slightly greater for women.
A sacroiliac (SI) joint injury can be called SI joint dysfunction, SI joint syndrome, SI joint strain, SI joint inflammation, or sometimes facet syndrome. They all mean that the joint has suffered some damage that is causing sacroiliac joint pain.
Sacroiliac Joint Injury Causes:
It is generally believed that an injury to this joint, and the resultant si joint pain, is caused by either too much motion in the joint, or too little.
The most common cause of injury is normal wear and tear due to aging. The ends of the bones that form the joint are covered with cartilage, a smooth and slippery connective tissue that allows the bones to slide over each other with minimal friction. As we age, the cartilage thins through usage, or becomes damaged, which results in the bones starting to rub against each other. This can lead to osteoarthritis, otherwise known as degenerative arthritis.
During pregnancy, in order to ready the body for childbirth, hormones are released that relax ligaments. Loose ligaments do not hold bones together tightly enough and can cause problems with the sacroiliac joint. After childbirth, the ligaments tighten up again, and in some cases tighten too much, again leading to pain in the joint. Also, the extra weight being carried by a pregnant woman, and the different way of walking involved, add stress to the joints and might cause difficulties.
In fact, any altered manner of walking, perhaps as a result of having a bad knee, or hip, increases stress on the SI joints. Poor posture can also be responsible for abnormal wear on the joints, as can lots of bending and twisting while playing sports, or lifting and twisting while holding a heavy weight.
Some disorders such as ankylosing spondylitis or rheumatoid arthritis are known to produce pain in the SI joints.
Sacroiliac Joint Injury Symptoms:
It can sometimes be difficult to pinpoint the exact location of the pain, but generally it is felt in the lower back or back of the hips, sometimes radiating out into the groin or down into the legs.
It is thought that if there is too much movement in the joint, the pain will be felt mostly in the lower back, hip and the groin.
If the problem is not enough movement in the joint, the pain will still be felt in the lower back, but also on one side of the buttocks, and down into the leg with a sensation similar to that of sciatica. There may also be a feeling of wanting to stretch the back at that point.
If the cause is inflammation or arthritis in the sacroiliac joint, stiffness or a cold, burning sensation in the pelvis might be felt.
Coughing, sneezing or bending may make the SI joint pain worse. Standing up and walking may also make it worse, while lying down will generally make it better.
If any nerves have been pinched or otherwise impaired, weakness in the legs might be experienced.
A fracture of any of the bones may produce a grinding feeling in the joint and the inability to bear any weight on the leg.
Sacroiliac Joint Injury Diagnosis:
One reliable and simple way of determining that your pain is caused by an injury to the sacroiliac joint is by pressing on the site of the pain. If that corresponds with the position of the joint, it is the source of your discomfort. Of course, any of a number of conditions might be responsible, and your health care provider will try to determine which it might be.
A medical history will be taken, and you will have a physical examination as well. Your doctor is likely to place your hips and legs in certain positions and then apply some pressure, in an attempt to reproduce the conditions that cause you pain.
An x-ray might be taken, and possibly a CT or MRI scan. CT and MRI scans are more detailed and show the soft tissues of muscles and ligaments as well as bones. It is also possible that a bone scan might be needed.
The only non-invasive test that will definitively confirm that the SI joint is the source of your pain is an injection of a numbing agent, such as lidocaine, into the area. If the SI joint is numbed, and your pain disappears, then the joint is responsible.
Sacroiliac Joint Injury Treatment:
Non-surgical options are usually successful.
Avoid activities that provoke sacroiliac joint pain.
Apply ice, crushed in a bag and wrapped in a towel, to the site of the pain for 15 minutes at a time, every 4 hours.
Once the acute pain has eased, heat can be applied.
Acetaminophen (Tylenol) or NSAIDs such as ibuprofen (Motrin, Advil) or naproxen.
Your doctor may prescribe Prednisone, which is an oral steroid. This can be taken for a short time to help reduce inflammation. If you have been given lidocaine during the diagnostic tests, this might have included a steroid. These injections can relieve pain for several months, and can be given up to 3 times a year.
A physiotherapist may want you to wear a sacroiliac belt, which stabilizes the joint while it heals. Use of this belt would be gradually reduced over time. You would probably also be taught exercises to build muscle strength and increase flexibility. Yoga and Pilates can be very helpful practices.
If the pain persists, despite treatment, surgery is an option. The joints would be surgically fused together to prohibit any movement in them at all.
What to look for in a sacroiliac belt:
The most important function the belt has is to prevent movement of the joint, so you need to look for one that stays in position. Good cushioning is important for comfort.
Sacroiliac Joint Injury Prevention:
It is not possible to completely prevent damage to the SI joint due to aging, but there are some things that will help to minimize the risk.
Maintaining a healthy weight and staying fit will reduce stress on the joints.
Always warm up properly before exercise.
Do exercises to strengthen muscles and improve flexibility.
Develop and keep good posture.
Take care to use proper techniques when lifting.
Avoid activities that are known to provoke sacroiliac joint pain.