Sacroiliac Joint Dysfunction

What is Sacroiliac Joint Dysfunction?

Dysfunction in the sacroiliac joint, also called the SI joint, can sometimes cause lower back and/or leg pain. Leg pain from sacroiliac joint dysfunction can be particularly difficult to differentiate from radiating leg pain caused by a lumbar disc herniation (sciatica) as they can feel quite similar.

The sacroiliac joint connects the hip bones (iliac crests) to the sacrum, the triangular bone between the lumbar spine and the tailbone (coccyx). The primary function of the sacroiliac joints is to absorb shock between the upper body and the pelvis and legs.

The sacroiliac joint typically has little motion. Small movements at the joint help with shock absorption and forward/backward bending. The joint is reinforced by strong ligaments surrounding it, some of which extend across the joint in the back of the pelvis. This network of soft tissues provides support, limits movement at the joint, and assists with absorbing pressure.

Other muscles that support sacroiliac joint function include the gluteus maximus and the piriformis muscle.

What Causes Sacroiliac Joint Dysfunction?

The primary mechanisms of SI joint dysfunction include:

Too much movement (hypermobility or instability) in the sacroiliac joint can cause the pelvis to feel unstable and lead to pain. Pain from too much motion is typically felt in the lower back and/or hip, and may radiate into the groin area.
Too little movement (hypomobility or fixation) can cause muscle tension, pain, and may inhibit mobility. Pain is typically felt on one side of the low back or buttocks, and can radiate down the back of leg (similar to sciatica pain).

Inflammation of the sacroiliac joint (sacroiliitis) can also produce pelvic pain and stiffness. Sacroiliac joint dysfunction may cause inflammation, or inflammation may occur with normal function of the joint from an infection, rheumatoid condition, or other cause.

Sacroiliac joint dysfunction is more common in young and middle-aged women. Women who are pregnant or have recently given birth may be more susceptible to sacroiliac joint pain.

What are the symptoms of Sacroiliac Joint Dysfunction?

Symptoms experienced with sacroiliac joint dysfunction commonly include:

Lower back pain that feels dull, aching, and can range from mild to severe. Lower back pain is typically felt only on one side, but in some cases may be felt on both sides.
Pain that spreads to the hips, buttocks, and/or groin. One of the most common areas to feel SI joint pain is in the buttocks and upper back or side of the thigh. Pain is typically felt only on one side, but may be felt on both sides.
Sciatic-like pain in the buttocks and/or backs of the thighs that feels hot, sharp, and stabbing and may include numbness and tingling. Sciatic-like pain from sacroiliac joint dysfunction rarely extends below the knee.
Stiffness and reduced range-of-motion in the lower back, hips, pelvis, and groin, which may cause difficulty with movements such as walking up stairs or bending at the waist.
Worsened pain when putting added pressure on the sacroiliac joint, such as climbing stairs, running or jogging, and lying or putting weight on one side.
Instability in the pelvis and/or lower back, which may cause the pelvis to feel like it will buckle or give way when standing, walking, or moving from standing to sitting.

Aggravation of the sacroiliac joint can commonly result in inflammation, also called sacroiliitis. This condition may be the primary cause of pain, stiffness, and other symptoms.

Diagnosing Sacroiliac Joint Dysfunction

Diagnosing sacroiliac joint dysfunction can be difficult because the symptoms mimic other common conditions, such as leg pain from a lumbar herniated disc or back pain from facet joint arthritis. A diagnosis is usually arrived at through a physical examination and/or an injection (utilized to block the pain). If the injection relieves pain, the sacroiliac joint can be confirmed as the pain source.

SI Joint Pain After ADR (Artificial Disc Replacement)

If the patient recently underwent Artificial Disc Replacement surgery and the original source of back pain from a herniated or damaged disc was replaced, it’s fairly common to experience some sacroiliac joint pain as the body is getting used to it’s new disc height and new anatomy (everything is connected). A general way to help diagnose this is to focus on the location of the pain in the lower lumbar. If the pain is 2 inches to the left or 2 inches to the right of the center of the spine as shown in the red area of the diagram below, this is typically a result of sacroiliac joint dysfunction.

Treatment for Sacroiliac Joint Dysfunction

Treatments for sacroiliac joint dysfunction (SI joint pain) typically focus on alleviating pain and restoring normal motion in the joint. Most cases of SI joint pain are effectively managed using non-surgical treatments. Initial treatments for sacroiliac joint pain typically include:

Brief rest period. A rest period of 1 to 2 days may be advised. Resting for longer than a couple days is not recommended, as doing so may worsen stiffness and cause increased pain and generalized deconditioning.
Applying ice or heat. Ice applied to the low back and pelvis can reduce inflammation and alleviate pain and discomfort. Heat applied around the joint may help relieve pain by reducing muscle tension or spasms.
Pain medication. Over-the-counter pain relievers (such as acetaminophen) and anti-inflammatory medications (NSAIDs, such as ibuprofen or naproxen) may be recommended for mild to moderate pain relief. Prescription medications such as muscle relaxants or narcotic painkillers may be used during episodes of severe, acute pain. These medications must be used with caution, as they are highly addictive and can cause severe side effects.
Supports or braces. When the SI joint is too loose (hypermobile), a pelvic brace can be wrapped around the waist and pulled snugly to stabilize the area. A pelvic brace is about the size of a wide belt and can be helpful when the joint is inflamed and painful.
Sacroiliac joint injections. A local anesthetic (such as lidocaine or bupivacaine) is injected with an anti-inflammatory medication (such as a corticosteroid) to reduce inflammation and help alleviate pain. The pain relief from a joint injection can help minimize pain when starting a physical therapy program and returning to normal activity levels.
Physical therapy.
- Stretching to reduce muscle tension and spasms in the lower back, hips, and pelvis, including the piriformis, gluteus maximus, and hamstring muscles. Tension in these muscles caused by sacroiliac joint dysfunction can be the primary cause of pain. Tension in the soft tissues of the pelvis, groin, lower back, and thighs can put excess pressure on the sacroiliac joint, causing or exacerbating pain. Stretches targeted for specific muscles or muscle groups can help alleviate SI joint pain and restore some range of motion to the legs, pelvis, and lower back. Stretches for the Sacroiliac Joint include:
  - Hamstring stretches (see how)
  - Quadriceps stretch (see how)
  - Hip adductor stretch: The hip adductor muscles in the inside of the thighs help pull the legs in toward the middle of the body, and connect to the thighs from bones in the pelvis. To stretch these muscles and reduce tension on the SI joint, sit with the legs straight and apart to form a triangle, then gently lean forward toward the toes. Hold this stretch for 5 to 10 seconds, and gradually build up to holding for 15 to 30 seconds.
  - Press-up stretch (see how) IMPORTANT: If you’ve had Artificial Disc Replacement surgery within the last 6 months, do NOT do this stretch or any other stretch that puts your back into extension. Putting your spine into extension (bending backwards) can put you at higher risk for migration of the artificial disc if the disc has not yet developed a strong bond with the bone.
  - Single knee-to-chest isometric stretch (see how)
- Strengthening exercises to better support the sacroiliac joint and pelvis/lower back. Better support for the joint can come from strengthening the abdominal muscles, lateral trunk muscles, and low back muscles.
- Aerobic exercise. Any well-rounded exercise program should include aerobic exercise to elevate blood flow and bring nutrients and oxygen to damaged tissues, which can facilitate the healing process. Low-impact aerobics may be needed for SI joint dysfunction to minimize pain from exercise, and can include stationary cycling, running on an elliptical, or water aerobics.
Manual manipulation. Manual manipulation provided by a chiropractor, osteopathic doctor, or other qualified health professionals can be highly effective if sacroiliac joint pain is caused by too little motion. This therapy consists of physical adjustments applied to the hips SI joint, and lower back region with the goal of reducing joint fixation and muscle tension, and restoring normal range of motion. IMPORTANT: If you underwent Artificial Disc Replacement surgery in your lumbar within the last 6 months, use extreme caution with manual manipulation and be sure to check with your surgeon first to get this cleared before trying this.

There is no single approach to managing SI joint pain that will work for everyone. A combination of nonsurgical treatments is usually necessary for effective pain relief. Additionally, a period of trial-and-error may be needed to find treatments that address specific symptoms.