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Weekend Doctor: Sacroiliac pain

By William Hogan, MD
Blanchard Valley Pain Management

The sacroiliac joint is a large joint in your lower back and buttocks region. There are two sacroiliac joints, one on each side, with ligaments in each joint that hold the bones together. Sacroiliac (SI) joint pain can be difficult to diagnose as other conditions can cause similar symptoms. When the joint becomes painful, it can cause pain in its immediate region or it can refer pain into your groin, hip, buttock or leg. SI joint pain can be aggravated with prolonged standing, sitting, stair climbing, moving from sitting to standing, and running.

The largest cause of sacroiliac pain is arthritis of the SI joints. However, you can experience SI joint pain with traumatic injury, during and after pregnancy, spinal scoliosis and after a lumbar spine fusion. The diagnosis of sacroiliac pain starts with a physical examination and imaging, including X-rays, a CT scan or an MRI.

Treatment of sacroiliac pain depends on the underlying cause of the sacroiliac joint pain and your symptoms. Conservative treatments include using over-the-counter pain relievers, such as acetaminophen, or anti-inflammatories may be recommended for the treatment of sacroiliac joint pain. Using heat or ice along with physical therapy, including stretching and strengthening exercises, can also be beneficial.  

When conservative treatments are not helpful, a sacroiliac joint injection with steroid or radiofrequency nerve ablation is recommended. A sacroiliac joint injection serves several purposes. First, by placing numbing medicine into the joint, the amount of immediate pain relief you experience will help confirm or deny the joint as a source of your pain. That is, if you obtain relief of your main pain while the joint is numb, it means this joint is more than likely the source of pain. Furthermore, steroids may be injected into the joint to reduce inflammation, which, on many occasions, can provide long-term relief. These procedures are performed with fluoroscopic guidance with an X-ray machine.

Rarely, if all non-operative management options are exhausted, sacroiliac fusion surgery may be considered. The fusion, however, will eliminate the motion of the sacroiliac joint by fixing the two bones together with metal hardware.

If you feel you may be experiencing SI joint pain, talk to your healthcare provider for further guidance and recommendations.


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