Sacroiliac - SI Joint Dysfunction

The lumbar spine commonly referred to as the lower back, is the part of the spine that curves inwards towards the stomach. The lumbar spine connects with the thoracic spine at the tom and extends down to the sacral spine, and is built for flexibility and power, enabling the body to lift, bend, and twist. The spinal cord stops at the point where the thoracic spine meets the lumbar spine and continues to branch out to form the cauda equina, which is a network of nerves that extend to the lower extremities of the body. Since the spinal cord does not run through the lumbar spine, it is rare that an injury to the lower back would result in paralysis or damage to the spinal cord.

Overview

Just below the lumbar spine lies the sacrum, which is a triangular shaped. The sacroiliac (SI) joint sits between the sacrum and the iliac bone. The SI joint is one of the larger joints in the body, and is held together by several large, strong ligaments. There is very little motion in the SI joint, especially in adults. Sacroiliac (SI) joint dysfunction is a condition where an individual experiences lower back pain due to a painful sacroiliac joint. Sacroiliac joint dysfunction can literally and figuratively be a "pain in the back," but it is rarely dangerous or needs surgery.

Symptoms

Individuals suffering from SI joint dysfunction typically experience pain spread across the lower back and buttock on either one or both sides of the SI joint.

Diagnosis

An SI joint dysfunction is diagnosed with a combination of patient history, physical examination, and imaging studies. The physician will test for sensation, muscle strength and reflexes to rule out other possible cause of pain. Another way of diagnosing an SI joint dysfunction is by performing an injection of the joint where an anesthetic and/or steroid is injected into the joint to numb the joint; if the pain goes away, it is more than likely that the pain is coming from the SI joint.

Treatment

Initial treatment for SI joint dysfunction is conservative, non-operative methods. Sometimes, the physician may simply monitor the patient’s condition to see if the symptoms improve or deteriorate.

Rest - It is advised to decrease or completely stop the activity that makes the pain worse. Often, this is all that is needed to make the symptoms go away in the early stages of an SI joint dysfunction.

Medication - Over-the-counter medication such as NSAID’s usually help reduce pain and swelling.

SI Joint Belt - In some cases, the physician may recommend the use of a special brace called the SI joint belt that wraps around the hips in order to hold the SI joint together tightly.

Physical Therapy - A physical therapist may recommend some positions and exercises to ease the symptoms. The therapy program will include exercises that aim to improve the strength and control of your abdominal and back muscles.

Sacroiliac Steroid Injections - Injecting in and around the SI joint with cortisone, a powerful anti-inflammatory medicine, may aide in decreasing pain. This is done using real-time x-ray imaging (fluoroscopy). Oral or IV sedation may be offered to keep the patient comfortable during this procedure.

Minimally Invasive Sacroiliac Joint Fusion - When conservative, non-operative treatments have failed, but sacroiliac joint injections have provided significant temporary relief, surgery is an option. Minimally invasive SI joint fusion allows outpatient surgery with recovery over a 6 to 12 week period. For select patients, this can restore function and significantly reduce buttock and sacral pain.

Recovery

Recovery will vary based on the severity of the condition as well as the chose treatment approach. Each patient is unique, so the recovery period and therapy program will vary based on his/her level of pain, extent of injury, and desired level of activity they would like to return to.

Disclaimer

CALL 911 IMMEDIATELY IF YOU ARE HAVING A MEDICAL EMERGENCY!

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