Spinalogy Blogs

A countless number of individuals globally experience lower back pain, which makes it one of the most common concerns among adults. Even after the numerous studies mostly pain in the low back is mostly associated with spinal conditions such as herniated discs, muscle strain, or degenerative disorders, and sacroiliac (SI) joint dysfunction is mostly overlooked.

The stability and stress absorption between the upper and lower extremities are the essential characteristics of the SI joint, which is a diarthrodial synovial joint connecting the sacrum to the ilium.

Chronic pain that is frequently misinterpreted as a lumbar spine condition, whose origin may be the SI joint, causing the pain.

So, in simple terms, we can understand that pain in the SI joint is known as sacroiliac joint dysfunction, and it usually happens because of the misalignment of the sacroiliac joint or improper mobility, such as hyper- or hypo-mobile. Most of the time, SI joint dysfunction is misdiagnosed as sacroiliitis. 

It is a condition caused by abnormal motion or slight misalignment of the SI joint, whereas sacroiliitis is specific to an inflammatory process present in the SI joint, and the pain experienced by the patient is a direct result of those inflammatory processes. No matter if both conditions have similar symptoms.
A lot of orthopedic doctors, spine surgeons, and neurologists understand that the disc is not only a factor causing low back pain, but the disc is still the main focus of most spinal treatments. And it is often difficult to recognize sacroiliac joint syndrome.

Anatomy and Function

The sacroiliac joint is strong and stable, allowing minimal movement. Even though it allows a minimal range of motion but it plays a very important role in shock absorbing during activities such as running, walking, sitting, etc.

The sacroiliac joints are located on either side of the spine between the two pelvic bones, attaching them to the sacrum. Shear, torsion, rotation, and tension forces may impact the SI joint. The SI joint possesses an important effect on ambulation as it is the only musculoskeletal joint linking both the upper and lower bodies. The joint is relatively stiff and filled with synovial fluid. The sacrum and ilium bones are coated in hyaline cartilage at their articular surfaces, with abundant fibrous tissue connecting the ilium and sacrum.

So, basically, SI Joint dysfunction occurs only when there is either hypermobility or hypomobility, leading to pain.

Causes of SI Joint Dysfunction

There are several factors contributing to SI Joint Dysfunction, including:

1. Trauma: A large number of patients who have SI Joint dysfunction are mostly due to repetitive trauma such as accidents, falls, or direct impact to the pelvis, which impacts the basic changes in the mechanics of the SI Joint, leading to pain.
2. Pregnancy and Childbirth: Female hormones get released during pregnancy, which relaxes the sacroiliac ligaments. This pulling of ligaments creates changes in the sacroiliac joints, leading to them becoming hypermobile. Hormonal changes and the physical demands of pregnancy make the SI joint more susceptible to instability.
3. Degenerative Changes: One of the most common causes of SI Joint Dysfunction is degenerative changes, leading to wear and tear of the joints. Mostly in conditions such as osteoarthritis or degenerative disc disease, leading to pain and limited range of motion.
4. Repetitive Stress: Activities that involve repetitive bending, twisting, or lifting may lead to microtrauma, leading to inflammation, pain, stiffness, and abnormal joint movements over the period of time.  
5. Leg Length Discrepancy: Differences in both legs alter the pelvic alignment, resulting in uneven weight distribution and poor biomechanics. This leads to stress and will lead to SI joint pain and degeneration.
6. Postural Imbalances: Poor posture and prolonged sitting non ergonomically may also be one of the factors to cause SI joint dysfunction by creating uneven pressure on the joint.

Symptoms of SI Joint Dysfunction:

Mostly SI joint dysfunction presents with symptoms that are very much similar to other lower back issues, leading to misdiagnosis. Some of the most common symptoms include:

1. Pain on one side of the low back or buttocks
2. Pain radiating to the groin, hip, or thighs
3. Difficulty in standing, walking, or standing after prolonged sitting to standing and vice versa
4. Pain after prolonged sitting or climbing up stairs
5. Lower back stiffness or Reduced range of motion
6. Feeling of pelvic instability
7. Sharp, stabbing, and/or shooting pain radiating towards the thigh but not till the knees
8. No neurological deficit noticed
9. Lying on the ipsilateral side of pain
10. Local tenderness of the posterior aspect of the sacroiliac joint
11. Repetitive forward bending

As seen above, most of the symptoms of SI joint dysfunction and Low back conditions are relatively the same, which makes an accurate diagnosis crucial. Only if the patient’s history and clinical examinations are done in a proper manner then only the correct diagnosis be possible. Common diagnostic methods include:

1. Physical Examination: Specific SI Joint provocative tests, such as the FABER test, Gaenslen’s test, distraction, Compression, and thigh thrust tes,t are some of the tests that help in identifying the SI joint pain.
2. Imaging Tests: Imaging plays a very important role as it helps in differentiating between low back pain and SI joint pain. Tests such as X-rays can show joint space narrowing, sclerosis, or osteophytes, whereas MRI is useful for detecting inflammation, bone marrow edema, or early sacroiliitis and for detecting joint degeneration.
3. Diagnostic Injections: Injecting a local anesthetic into the SI joint can confirm the diagnosis if the pain temporarily subsides.

Treatment:

In the case of SI joint dysfunction, treatment completely depends on its severity and underlying cause. Some of the following approaches are commonly used:

Conservative Treatments

1. Physiotherapy: Physiotherapy helps in SI Joint dysfunction by improving core strength and correcting joint misalignments. It helps in strengthening the deep abdominal and back muscles.
2. Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and ice packs and hot packs can help in alleviating pain.
3. Ergonomics: Following proper posture helps in reducing strain in the SI Joint.
4. Bracing: SI brace helps in supporting the SI Joint, which helps in reducing hypermobility and pain.

Interventional Treatments

1. SI Joint Injection: Corticosteroid injections mostly help in reducing inflammation and provide pain relief.
2. Radiofrequency Ablation: This procedure targets the nerve supply to the SI joint by reducing pain by disrupting pain signals.

Conclusion
SI joint dysfunction is a frequently overlooked reason for lower back discomfort, regularly mistaken as lumbar spine conditions. Understanding its causes, symptoms, and treatment options is critical for an accurate diagnosis and effective management. Individuals suffering from SI joint dysfunction might have significant pain alleviation and a higher quality of life with correct treatment. Raising awareness of this condition among healthcare professionals and patients may result in earlier diagnosis and improved treatment outcomes.