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Definition
Sacroiliac joint pain is discomfort in the lower back, in the area where the base of the spine meets the pelvis. This pain is simply a symptom that may come from a number of conditions or diseases.
Sacroiliac Joint
2008 Nucleus Medical Art, Inc.
Causes
Doctors may be unsure if the pain starts in the joint or in its surrounding ligaments. Ligaments are bands of tissue that connect one bone to another bone. It is also very difficult to tell if the pain is coming from the sacroiliac joint or the small joints in the lower spine (facet joints).
The sacroiliac joint has many nerve endings, which send pain signals to the brain. Pain in this region may be caused by many factors:
- Twisting, bending, or moving in a way that triggers sacroiliac joint pain
- Infection of the joint
- Osteoarthritis of the joint (more common in older adults)
- Trauma , such as auto accidents
- Stress fractures in athletes
- Inflammation of the joint, such as with ankylosing spondylitis
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for sacroiliac joint pain include:
Poor postureWeak musclesBending or twisting the backImproper liftingAnkylosing spondylitisPsoriatic arthritis Symptoms Symptoms may include: Mild to severe low back painPain in the buttocksPain that seems deep in the pelvisPain in the hip or groin or back of the thighPain that radiates down the leg on the affected sideStiffness of the lower spine Certain activities may increase the pain, including: WalkingTwistingBendingStoopingRolling over in bedGetting up from a chairClimbing the stairsCoughingSneezing DiagnosisThe doctor will ask about your symptoms and medical history, and perform a physical exam. Finding the source of sacroiliac joint pain is often difficult. Tests depend upon your medical history and the suspected cause. Tests may include: X-rays of the pelvis and lower back. Bone scan injection of radioactive material into the body, followed by scanning with a machine that will find areas with higher concentrations of the injected material; these are areas of abnormal bone activity. CT scan a type of x-ray that uses a computer to make pictures of the inside of the pelvis and sacroiliac joint. MRI scan a test that uses a strong magnetic field and radio waves to make pictures of the sacroiliac joints and the ligaments. Biopsy or aspirationremoval of a sample of tissue from the joint for examination in the lab. Joint injections or nerve blocksinjection of a drug that blocks nerve signals into the joint to determine if the pain starts in the joint. TreatmentTreatment depends upon the cause of the pain. Any underlying condition would receive treatment specific for that disease. For stress fractures, doctors recommend limited weight-bearing. Regardless of the cause, short-term rest is often advised.
Other treatment may include: Medication Your doctor may recommend or prescribe any of the following: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as: AspirinIbuprofen (Motrin, Advil)Pain medication: acetaminophen (Tylenol)Steroid injections into the sacroiliac jointAntibiotics for infected joints Physical Therapy Physical therapy may include: Exercises to stretch the muscles of the lower backExercises to strengthen the muscles which support the areaExercises to affect the motion of the sacroiliac jointIce applied to the painful areaApplication of deep heat to the sore area Back Care Prevent stress to the painful area with the following: Proper bendingProper liftingNo twisting of the body Prevention Practicing good back care may help you avoid sacroiliac joint pain. This includes: Exercise regularly to keep muscles strong.Maintain good posture.Use proper techniques for bending or lifting. RESOURCES: American Academy of Orthopaedic Surgeonshttp://www.aaos.org Arthritis Foundationhttp://www.arthritis.org CANADIAN RESOURCES: Canadian Orthopaedic Associationhttp://www.coa-aco.org/ The Arthritis Societyhttp://www.arthritis.ca References:
Campbell's Operative Orthopaedics . 9th ed. Mosby, Inc.; 1998. Cohen SP. Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment. Anesth Analg NOV-2005; 101(5): 1440-53. Dreyfuss P, Dreyer S, Griffin J, et al: Positive sacroiliac screening tests in asymptomatic adults. Spine 1994; 19(10):1138-1143. Harrison's Principles of Internal Medicine . 14th ed. The McGraw-Hill Companies; 2000. Kelley's Textbook of Rheumatology . 6th ed. WB Saunders Co.; 2001. Nadler SF. Frontera: Essentials of Physical Medicine and Rehabilitation . 1st ed. Philadelphia; Hanley and Belfus; 2002. Ch. 50. Pediatric and adolescent sports injuries, back injuries in the young athlete. Clinics In Sports Medicine 2000 Oct. The assessment of athletic hip injury. Clinics In Sports Medicine . 2001 Oct. Last reviewed January 2008 by John C. Keel, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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