Sacroiliac Joint Pain

In this post I’m going to be discussing low back pain, but a slightly different type of low back pain than the previous post addressed.  I want to talk about the sacroiliac joint, which often times gets overlooked as a cause for low back and buttock pain.

The sacroiliac joint, also called the SI joint, occurs where the hip bones (ilium) connect to the tailbone (sacrum). The joint has much less mobility than a joint like the knee or the shoulder, but it does move slightly as the back turns and flexes. The joint is supported by soft tissue and muscles surrounding it.  

Pain can occur when the sacroiliac joint has too much motion, too little motion, and when it gets inflamed. Sometimes the sacroiliac joint pain is a secondary issue, meaning, it is painful as a result of strain put on it from something else, like arthritis in the back.  A lot of times I will treat someone for a low back issue from arthritis or a herniated disc, and then discover that there is some residual pain in the sacroiliac joint too.

Pregnancy is a time when the sacroiliac joint is especially vulnerable to becoming irritated.  Hormones secreted during the pregnancy, like relaxin, help to loosen the ligaments in the pelvis, which makes sense because extra space is needed for the baby to come out.  But sometimes this extra mobility can cause pain and irritation in the SI joint. Also, depending on how the baby’s head is positioned, this can put even more pressure on the joint.  

The pain from the sacroiliac joint is usually low down in the back, just around the buttocks, and is often right around where a person wears a belt.  There are certain additional tests that I can perform during the physical examination that puts extra stress on the joint, and allows me to test whether it is a cause of the patient’s pain.

How do we treat the pain from irritation or inflammation of the sacroiliac joint? I use a combination of medications, other modalities, and injections. (I find breaking the plan down like this is helpful to keep all the treatment options organized). Medications that are beneficial include anti-inflammatory medications like ibuprofen and numbing medications that are applied as an ointment or a patch, like lidocaine.  

Other modalities include physical therapy to help with muscle imbalances that might be contributing to the pain and using an SI joint support belt, which is a skinny belt that wraps around the waist and helps to offload some pressure from the joint.  I also often send people for osteopathic manipulation of the joint, which is performed by an osteopathic physician with special training in hands-on therapy.

Interventions can be very helpful in alleviating this pain.  I usually start with a sacroiliac joint injection of steroid, which is performed using X-ray guidance to ensure the needle is in the joint.  If patients get good relief from this but it does not last for a long enough time, then I consider doing radiofrequency ablation, which is a treatment that turns off the tiny nerves that feel the sacroiliac joint.  

If you think you might have pain coming from your sacroiliac joint, the best way to figure that out is to see a pain management doctor in person! As you can see, once the joint is identified as a cause of pain, there are many different ways to treat it.

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