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Is Your Sacroiliac Joint Causing Your Lower Back Pain?

One of the reasons back pain is such a common medical complaint (most people will experience it at least once in their lives) is because it has so many different potential causes. Most people are familiar with the common ones, like a strained back muscle or a herniated disc. But sometimes, back pain isn’t really back pain–at least not how we generally conceive it. While you might experience pain or discomfort in your lower back, the actual source of the pain might be a little lower, in your sacroiliac joint. Though sacroiliac issues only account for ~ 9% of all low back pain complaints, they do occur and can be overlooked.

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 Sacroiliitis: A Review on Anatomy, Diagnosis, and Treatment

Sacroiliitis is an inflammation of one or both of the sacroiliac (SI) joints, most often resulting pain in the lower back that can extend down the legs. Pain arising from the SI joint can be difficult to diagnose and treat due to the intricate surrounding ligamentous structure, nerve innervation, and its role in transferring weight from the upper body to the lower limbs. SI joint dysfunction accounts for up to 25% of cases of lower back pain and has a debilitating effect on patient functionality.

Articles of Interest

The Back Pain Most Surgeons Won't Find

Studies have found that 20 to 25% of all chronic lower back pain comes not from the spine but from the sacroliac, or SI, joint, which bears and transfers weight and movement from your upper body to your legs. When the ligaments wear out and the SI joint becomes unstable, it can generate a similar kind of sharp back pain -- or sciatica-like pain down your leg -- as a ruptured disc.

79-year-old man with right hip pain

The diagnosis of sacroiliitis is supported by the posterior location of this patient’s hip pain and a positive FABER test, in which the hip is Flexed, ABducted, and Externally Rotated and gentle downward pressure is applied to the knee. This test has a high specificity for sacroiliitis and a somewhat lower sensitivity.

Am I Hip? (Sacroiliitis and Ankylosing Spondylitis)

What a couple of tongue-twisters, eh? I learned about these two conditions recently while looking into possible causes for my recent bouts of pain in my left hip area.

Diagnostics of Sacroiliitis According to ASAS Criteria

Our research confirmed MRI to visualize early inflammatory lesions. Application of MRI in patients not disclosing lesions by radiographs according to the modified NY criteria allowed us to diagnose sacroiliitis in 38% of patients in a pre-radiographic stage and ruled out inflammation in 50% of patients with sacroiliitis by radiographic examination according to modNY criteria.

Sacroiliac Joint Dysfunction in Patients With Low Back Pain

SIJ dysfunction is widely overlooked because of the difficulty in distinguishing it from other similarly presenting syndromes. However, with a detailed history, appropriate physical maneuvers, imaging, and adequate response to intra-articular anesthetic, providers can reach an accurate diagnosis that will inform subsequent treatments. After failure of nonsurgical methods, patients with SIJ dysfunction should be considered for minimally invasive fusion techniques, which have proven to be a safe, effective, and viable treatment option.

Sacroiliitis: Pain in the You-Know-What

Sacroiliitis can be difficult to diagnose because the symptoms often mimic those of lower back pain. A thorough physical exam, including physical manipulation of the legs and hips, will help determine if the SI joints are the source of the pain. In addition, the physician may inject a local analgesic specifically into the SI joint region to see if it relieves the pain. If it does, he or she may recommend other treatment options to treat the sacroiliitis, beginning with the most conservative options first.

Seronegative spondyloarthropathies & inflammatory low back pain - Part 1

If I asked you what percentage of patients with low back pain have a 'mechanical problem' or 'non-specific problem' your answer might be about ~85%. To my knowledge that answer fits with what we know about the prevalence of serious and sinister pathology masquerading as low back pain. What we don't often talk enough about is that remaining ~15%.

Signs That Your Lower Back Pain Stems From Sacroiliac Joint Dysfunction

Globally, up to 84% of the adult population experiences lower back pain at some point in their lives. While there are many causes of lower back pain, sacroiliac joint dysfunction accounts for its fair share of the problem.

Resources

4 Types of Arthritis That Cause Sacroiliac Joint Pain

Symptoms in the SI joints can be the calling cards of several types of arthritis, including the following...

5 Warning Signs of Chronic Sacroiliitis

re you experiencing persistent lower back pain that won't go away? It could be a sign of chronic sacroiliitis. The SI joint, located between the sacrum and the ilium bones in the pelvis, plays a crucial role in providing stability and absorbing shock during movement. When this joint becomes dysfunctional, it may lead to chronic pain and discomfort.

6 Best Sacroiliac Joint Pain Exercises, and 5 to Avoid

While not all instances of sacroiliac injury can be treated, for some, sacroiliac exercises can be very helpful toward relieving sacroiliac joint pain, curing lower back pain and even preventing SI joint dysfunction from reoccurring.

SI-Bone

After 10 years of suffering with lower back symptoms, Dr. James Mamary was diagnosed with degenerative sacroiliitis.

SImmetry

SI Joint Dysfunction symptoms can mimic those of other low back problems, making it difficult for physicians to diagnose. But some simple tests may be effective in getting to the bottom of what’s causing the pain.

Ainsworth Institute

SIJ pain is more likely to be one-sided rather than typical low back pain that is difficult to localize and may involve both sides or be situated in the midline of the low back. SIJ pain can be referred to various regions of the back, buttock and even the lower extremity making it difficult to tell apart from sciatica or a herniated disc.

Ortho Bullets

Commonly part of ankylosing spodyliitis or Reiter's syndrome - most commonly presents in teen to middle aged individuals, males > females. FABER test - pain with flexion, abduction, and external rotation of hip.

Spine-Health

Sacroiliitis is often found as part of a feature of inflammatory conditions of the spinal column. As a group, these conditions and diseases are termed a "spondyloarthropathy" and include conditions such as ankylosing spondylitis, psoriatic arthritis, and reactive arthritis, among others. Sacroiliitis may also be a component of other types of arthritis, such as ulcerative colitis, Crohn’s disease, or osteoarthritis.