Sacroiliac Dysfunction


What Is Sacroiliac Dysfunction?

The sacroiliac joint is located in the pelvis, linking the iliac bone (pelvis) to the sacrum (lowest part of the spine above the tailbone). This joint transfers weight and forces between your upper body and legs. It is an essential component for shock absorption to prevent impact forces during walking from reaching the spine.

Like any other joint in the body, the sacroiliac (SI) joint can become arthritic or its support ligaments can become loose or injured. When this happens, people can feel pain in their buttock and sometimes even well above their buttock and higher on the skeleton. This is especially true with lifting, running, walking or even sleeping on the involved side.

The typical patient is often a woman in her 30s or 40s who has had children. Another contributing cause of sacroiliac dysfunction is prior lumbar spine surgery. The condition also occurs in men, but less frequently and usually from more severe injuries, often involving lifting while the trunk is in torsion.

It common for pain from the SI joint to mimic disc or low back pain. To avoid unnecessary lumbar spine surgery, SI joint disorders should be strongly considered on any patient with low back, buttock or leg pain.

What are Symptoms of sacroiliac (SI) joint pain or SI joint dysfunction?

Pain from sacroiliac joint disorders can be felt anywhere in the low back, buttocks, or in the legs.

  • Low back pain (below L5)
  • Pelvis/buttock pain
  • Hip/groin pain
  • Lower extremity pain (numbness, tingling, weakness)
  • Poor sleep habits
  • Leg instability
  • Pain while sitting

How is sacroiliac dysfunction diagnosed?

Pertinent patient history is the first clue that sacroiliac dysfunction may be present. If physical exam elicits (+) provocative testing, and hip or lumbar imaging does not reveal any other significant pathology to cause the specific pain, a diagnostic SI joint injection may be an appropriate next step.

The most widely used method to accurately determine the cause of SI joint pain is to inject the SI joint with a numbing agent. The injection, typically performed by our pain management physician, is done under XR or CT guidance to ensure that the needle is accurately placed in the sacroiliac joint. If, following the injection, your pain is decreased a significant amount, then it can be concluded that the SI joint is either the source, or a major contributor, to your low back pain. If the level of pain does not change after the injection, the SI joint is likely not the primary cause.

Treatment for sacroiliac dysfunction

Some patients respond to physical therapy, chiropractic manipulations, use of oral medications, as well as injection therapy. Intermittent use of a pelvic belt may provide symptomatic relief as well. These treatments are performed repetitively, and frequently symptom improvement using these therapies is temporary. Once non-surgical treatment options have been tried and do not provide relief, surgery may be indicated.