Sacroiliac Joints (SIJ) are held together by some of the strongest ligaments and muscles in your body, but trauma as well as slight biomechanical forces over time can damage or fatigue these supporting structures and cause significant inflammation and pain in one or both of these joints at the base of the spine. Pain can radiate from the SIJs to the lower back, hip, groin or upper thigh. Every step, every bend, and every twist can be painful with SIJ pain, also called Sacroiliitis (Say-kroe-il-e-I-tis). SIJ pain is very common in pregnant and post-partum women, athletes, certain arthritic populations, as well as in post-surgical knee and hip patients.
SIJ pain is almost always one-sided lower back pain that may feel like hip pain at times. Pain can refer into the groin area from the SIJ as well. There is increased pain with sitting or standing for long periods of time, but improvement with lying down. Walking up and down stairs or other inclines tends to aggravate the SIJ. Generally bending forward increases pain symptoms. Tasks such as rising from a chair or getting in and out of a vehicle can become very painful. The pain can vary from simply annoying to completely disabling. SIJ pain often mimics pain patterns usually associated with the lumbar spine and is therefore frequently misdiagnosed.Causes
Wear and tear of the S.I. joint is the number one cause of SIJ pain. Accelerated wear and tear can also be from irregular walk or run gaits. Inflammation results as the cartilage wears thin. Other types of arthritis can be to blame too, such as Rheumatoid Arthritis, Ankylosing Spondylitis, or Gout. Pregnancy is also a common cause of SIJ dysfunction and pain as hormonal changes intended to allow widening of the birth canal also allow abnormal movement to occur in the SIJ.
Unequal leg lengths caused from surgery or from asymmetrical leg bone growth can apply constant and damaging forces to S.I. joint and can result in pain. Often, knee or hip replacement surgeries are the culprit. Leg length differences should be evaluated by x-ray to determine the cause and correction. Often a simple heel lift or orthotic can make the needed adjustment, but sometimes correction is too late and wear and tear has occurred. Understanding the cause of your pain is vital in order to achieve long term relief.Treatment
The good news is there are conservative treatments that can quickly eliminate S.I. joint pain even when physical therapy or chiropractic has not done the trick. An injection of an anesthetic mixed with an anti-inflammatory medication can be injected into the joint and around the joint’s sensory nerves to quickly eliminate the pain in many cases. Other treatments involve applying heat to the joint’s nerves to quiet their pain signals. You have options. Don’t give up! Novocur can help coordinate any of the below listed treatments to get you back to a life without pain:
- Physical Therapy, Chiropractic and Massage Therapy. The SIJ is subject to both too much mobility, particularly following a trauma or pregnancy, as well as too little mobility. When too much mobility is present, physical therapy to strengthen surrounding musculature in an effort to stabilize the joint is indicated. Restrictive movement in the SIJ, however, is often best alleviated through chiropractic manipulation of the SIJ to gently reintroduce proper motion. A chiropractor is usually best to evaluate anatomical or functional short leg syndromes through weight bearing x-ray analysis, which can also be causative for SIJ pain. Myofascial massage treatment to surrounding SIJ soft tissue helps to lengthen tightened tissues and flush toxins from sore muscles.
- Pharmacological Intervention. NSAIDs and muscle relaxers are primarily utilized to control pain temporarily. Sometimes TNF (Tumor Necrosis Factor) inhibitors are utilized when Ankylosing Spondylitis is the source of SIJ pain.
- SIJ Injection. A sacroiliac joint injection bathes a mixture of anti-inflammatory and anesthetic medications into the painful joint and the nerves that transmit the pain from the joint to your spinal cord and eventually to your brain. This injection rapidly diminishes inflammation in the joint and around nerve tissue. When the pain cycle is broken, your body’s own healing mechanisms can now be more effective. Physical therapy or chiropractic care are often more valuable once the acute pain is managed.
- Radiofrequency Ablation. When SIJ injections provide excellent relief, however the effects are very short term, then Radiofrequency Ablation of the sensory nerves to the SIJ is indicated to provide longer term relief. Heat is applied to 3-4 nerves that supply sensory information from the joint. This heat treatment prevents pain signals from being transmitted from the joint to your spinal cord and up to your brain. Pain reduction or elimination usually last for 6-12 months with RFA. The procedure can be performed again after the treated nerves begin to regain pain communication capacity once again. With RFA there is no concern for any adverse effects of medications or over utilization of medications since no none are utilized except to numb the treatment area.
- Neuromodulation Therapy. As a last resort treatment, an electrical generator with tiny electrode leads may be implanted over the sacrum area where the nerves lie that provide sensory pain input to the central nervous system. This peripheral stimulator tricks your nervous system into feeling a pleasant buzzing sensation instead of pain in the SIJ region. This technology represents a giant leap forward in the treatment of severe or recalcitrant SIJ pain cases. Novocur can test the effectiveness of neuromodulation therapy on your condition to determine if a permanent spinal cord implant stimulator would work for your pain.