SI Joint Problems: An Unexpected Source of Lower Back Pain
It’s often assumed that lower back pain is related to a herniated disc or irritation of the sciatic nerve, a long nerve running from the lumbar spine into the legs. An unexpected source of discomfort affecting the same area is the sacroiliac (SI) joints. Located on either side of the iliac bones in the pelvis, SI joints are the body’s shock absorbers, meaning they’re primarily responsible for keeping excessive stress off of the lower spine. Structural problems or inflammation can affect one or both of the SI joints.
SI Joint Inflammation
Linked to arthritis of the spine (osteoarthritis), SI joint inflammation is a similar wear-and-tear condition referred to as sacroiliitis. Abnormal wear on SI joints may also be caused by excess weight from pregnancy or a sudden injury, such as a hard fall or car accident. Sometimes triggered by prolonged periods of standing or when climbing stairs, jogging, or running, symptoms associated with sacroiliitis include:
- Numbness and tingling sensations extending to the buttocks, thighs, and legs
- Visible tenderness and swelling in the affected area
- Difficulty walking
- Pain that’s more noticeable when going from sitting to a standing position
SI Joint Dysfunction
It’s estimated that SI joint problems affect anywhere from 15 to 30 percent of patients with chronic low back pain. Approximately 40 percent of patients that have surgery for lower back pain have ongoing discomfort post-surgery due to SI problems, which aren’t always related to arthritis. SI joint dysfunction is a broader description of the many problems that can affect either one of these joints, including sacroiliac joint disease and SI joint strain. SI joint dysfunction may contribute to:
- Loss of range of motion
- Increased lower back pain
- Muscle weakness and stiffness
- Disturbed sleep patterns due to discomfort
Diagnosis and Treatment
During an initial physical exam, a patient may be asked to walk or move their legs into different positions to get a better idea of what’s triggering symptoms. A positive diagnosis of SI joint-related problems typically involves various image tests. A more accurate assessment may be made by injecting a local anesthetic into the affected area with CT or X-ray guidance. If symptoms noticeably decrease, it can be assumed that an SI joint is the source of the problem.
Treatment usually starts with conservative options like anti-inflammatory medications, physical therapy, and injections for therapeutic purposes. If these treatments aren’t effective, minimally invasive surgery that sometimes includes an SI joint fusion may be discussed.
SI joint problems can be difficult diagnosis since symptoms can be similar to what’s experienced with other sources of lower back pain and radiating nerve pain. For this reason, patients are often referred to an orthopedic specialist to rule out other possible conditions and make a positive diagnosis. Maintaining a proper weight, getting regular exercise, and opting for green, leafy vegetables and other foods that naturally fight inflammation can help keep SI joints healthy.