In this article, you will find out everything you need to know about sacroiliac joint pain and the most effective ways to treat it, including an advanced treatment called Prolotherapy.
Sacroiliac Joint Pain
Strong ligaments and muscles support the sacroiliac joints. The sacroiliac joints are two synovial joints connecting the sacrum and ilium. For typical bodily flexibility, the sacroiliac joint has a very modest range of motion. As we age, bones may get rheumatic and ligaments tighten. Cartilage deterioration can cause bones to rub, resulting in discomfort. Joint inflammation and muscle weakness around the SI joint can contribute to a painful joint and further discomfort.
The sacroiliac joint is a fluid-filled synovial joint containing exposed nerve endings, which can result in persistent discomfort if the joint degenerates or malfunctions. These two joints are sometimes referred to as the sacro iliac joint and are considered a potentially painful enigma due to their complex anatomy and diagnostic challenges.
Introduction to Sacroiliac Joints
The sacroiliac joints, often referred to as SI joints, are essential connectors between the spine and the pelvis. Each person has two sacroiliac joints, located on either side of the sacrum, where it meets the iliac bones of the pelvic girdle. These joints play a vital role in supporting the upper body by transferring weight from the spine down to the hips and legs, especially during activities like standing, walking, or climbing stairs. Acting as natural shock absorbers, the SI joints help stabilize the upper body and protect it from the stresses of daily movement. When these joints become irritated or dysfunctional—a condition known as sacroiliac joint dysfunction or sacroiliac joint syndrome—individuals may experience localized joint pain and reduced mobility. Understanding the function and importance of the sacroiliac joint is key to recognizing and managing joint dysfunction and related symptoms.
Symptoms of Sacroiliac Joint Pain
- Lower back discomfort
- Buttocks, hips, and pelvic pain
- Hip discomfort restricted to a single SI joint
- Pain while rising from seated posture
- Stiffness or burning sensation in the pelvis
- Numbness
- Weakness
- Radiating pain down thighs, including the upper thigh, and upper legs
- Legs may buckle or fail to support body
- Some patients may feel pain that is severe or persistent, especially during movement or at rest
- Chronic pain and chronic low back pain can develop if SI joint issues are not addressed
Some Common Causes
- Injuries caused by trauma: Car accidents or falls can injure the SI joint.
- Arthritis: Osteoarthritis or ankylosing spondylitis can affect the SI joint and surrounding nerves.
- Autoimmune conditions such as rheumatoid arthritis and psoriatic arthritis can cause SI joint inflammation (sacroiliitis) and contribute to SI joint strain.
- Pregnancy: Weight gain and altered stride can strain SI joints and cause abnormal wear.
- Hip or knee problems can alter gait and increase stress on the SI joint.
- Infection: Rare infections can affect the SI joint.
- Previous lumbar fusion surgery can increase stress on the SI joint, leading to pain and degeneration.
Physical Examination
A thorough physical examination is a cornerstone in diagnosing sacroiliac joint dysfunction. During the assessment, a healthcare provider will evaluate the back, hips, and legs, checking for tenderness, swelling, and range of motion. The physical exam often includes palpation of the sacroiliac joints to identify areas of discomfort. Specific tests, such as the Fortin finger test—where the patient points to pain just below and medial to the posterior superior iliac spine—can help localize sacroiliac joint pain. Additional maneuvers like the Patrick’s (FABER) test, Gaenslen’s test, distraction test, thigh thrust, lateral compression, and sacral thrust are commonly used to provoke symptoms and assess SI joint dysfunction. If three or more of these provocative tests elicit pain, the likelihood of sacroiliac joint dysfunction increases. This hands-on approach, combined with a detailed history and physical, helps differentiate SI joint issues from other causes of joint pain.
Differential Diagnosis
Sacroiliac joint pain can mimic or overlap with several other conditions, making differential diagnosis essential. Disorders such as ankylosing spondylitis, insufficiency fractures of the sacrum, hip fractures, hip tendonitis, iliotibial band syndrome, lumbosacral discogenic pain syndrome, lumbosacral radiculopathy, piriformis syndrome, sacroiliac joint infection, and iliac crest syndrome can all present with similar symptoms. Inflammatory bowel diseases, including Crohn’s disease and ulcerative colitis, may also cause inflammation that affects the SI joints, leading to joint pain. To accurately diagnose sacroiliac joint dysfunction, clinicians rely on a combination of medical history, physical examination, and imaging studies. Ruling out these other conditions ensures that treatment is targeted to the true source of pain and dysfunction.
Diagnosis
Diagnosing sacroiliac joint dysfunction involves a comprehensive approach that combines clinical evaluation, specialized tests, and advanced imaging. Provocation tests performed during the physical exam help identify the SI joint as a potential source of pain. Imaging techniques such as MRI and synthetic CT scans are valuable for detecting structural changes or inflammation in the sacroiliac joint. Sacroiliac joint interventions, including diagnostic joint injections with local anesthetic, can confirm the diagnosis—if the injection provides pain relief, it indicates the SI joint is the source of discomfort. In some cases, radiofrequency neurotomy may be used both diagnostically and therapeutically to manage sacroiliac pain. Once a diagnosis is established, a tailored treatment plan may include physical therapy, exercise therapy, steroid injections, or, in severe cases, sacroiliac joint fusion surgery. Accurate diagnosis is crucial for effective pain relief and long-term management of sacroiliac joint dysfunction.
Rehabilitation and Prevention for Sacroiliac Joint Pain
Positive attitude, consistent activity, and an expedited return to work are key. Modified duties may be recommended if full activity is not possible.
Preventing recurrences is critical:
- Proper lifting techniques
- Correct posture while sitting, standing, moving, sleeping
- Regular stretching exercises and strengthening routines
- Ergonomic work environment
- Healthy diet and body weight
- Stress management techniques
- No smoking
Consulting with a physical therapist is recommended to design a personalized rehabilitation program and address muscle weakness, which can help prevent recurrence.
Prolotherapy
In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat sacroiliac joint pain.
Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.
Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to repair the damage and help sacroiliac joint pain.
As prolotherapy is helping to treat the root cause of sacroiliac joint pain, it is deemed to be a permanent fix, preventing the symptoms from returning.
Medications
Short-term medications include anti-inflammatories and muscle relaxants to relieve SI joint pain. Nonsteroidal anti inflammatory drugs (NSAIDs) are commonly used pain medications to reduce inflammation and provide pain relief. Long-term use is discouraged due to side effects.
Physical Therapy
Range-of-motion, stretching, and strengthening exercises improve joint stability and flexibility. These exercises are designed to provide pain relief and restore function.
Operations (Surgical & Non-Surgical)
- Joint injections: SI joint injections involve administering corticosteroid injections using corticosteroid medication directly into the sacroiliac joint. These injections are performed under imaging guidance to reduce inflammation, provide pain relief, and help confirm the diagnosis of SI joint pain.
- Radiofrequency denervation: Destroys pain-causing nerve tissue.
- Electrical stimulation: Implanted device can reduce SI joint leg pain.
- Fused joints: This procedure, known as SI joint fusion, is a last resort surgery to join the ilium and sacrum with metal hardware when other treatments, such as physical therapy and injections, have failed.
Consultation with a pain physician is recommended for advanced interventional procedures and comprehensive pain management strategies.
Some Useful Stretches for Patients
- Muscle stretches: Release tension in pelvis and hip muscles.
- Hamstring stretch: Sit on a chair with one leg straight; reach toward toes for 15–30s. Repeat 5 times each leg.
- Quadriceps stretch: Pull one foot toward torso while standing; hold 15–30s per side.
- Hip flexor stretch: Sit in triangle, lean to one side; hold 15–30s.
- Press-up stretch: Raise upper body onto elbows; hold 15–30s. Repeat 5–10 times.
- Isometric knee-to-chest: On back, bend knee to chest; hold 5s; repeat 5–10 times each leg.
Frequently Asked Questions
What causes sacroiliac joint pain?
Causes include trauma, arthritis, pregnancy, infection, or muscle imbalance around the SI joint. Joint inflammation and SI joint syndrome are also common contributors to sacroiliac joint pain.
What are common symptoms?
Lower back pain, hip and pelvic pain, stiffness, numbness, radiating leg pain, and leg instability. Patients may feel pain in the lower back, buttocks, or hips due to pain signals originating from the painful joint.
How is SI joint pain diagnosed?
Physical exam, imaging (X-ray, MRI), and diagnostic injections help identify the source of pain. During the Thigh Thrust test, a posteriorly directed force is applied to the SI joint to provoke symptoms. SI joint injections, often performed with imaging guidance and involving corticosteroids and local anesthetics, can help confirm the diagnosis by providing pain relief or reproducing symptoms.
Can SI joint pain be treated without surgery?
Yes, prolotherapy, physical therapy, medications, and injections often provide significant relief. These interventions are designed to provide pain relief and improve function.
Are stretches effective for SI joint pain?
Yes, targeted stretching improves flexibility, reduces tension, and enhances joint stability.
Case Studies
Case Study 1: Office Worker with Chronic SI Joint Pain
A 40-year-old office worker with lower back and pelvic pain from prolonged sitting improved after 6 weeks of prolotherapy combined with stretching and posture correction.
Case Study 2: Pregnant Patient with SI Joint Discomfort
Pregnant women are at increased risk for SI joint discomfort due to hormonal and biomechanical changes. A 32-year-old mother experienced pelvic pain during pregnancy. Targeted exercises and postnatal prolotherapy relieved discomfort within 8 weeks.
Contact ProHealth Clinic Today for Your FREE 15-Minute Discovery Call
Don’t let Sacroiliac Joint Pain control your life any longer. Join thousands of patients who have found lasting relief through prolotherapy at ProHealth Clinic.
Get in Touch
Phone: +441234380345
Email: info@prohealthclinic.co.uk
Our Clinic Locations
London: 104 Harley Street, Marylebone, W1G 7JD
Manchester: The Hadley Clinic, 64 Bridge Street, M3 3BN
Bedford: The Village Medical Centre, Kingswood Way, MK40 4GH
All clinics offer the same award-winning prolotherapy treatment with convenient appointment times, including evenings and weekends.
Author Bio
Having performed over 10,000 procedures, Mr Eaton is one of the UK’s leading practitioners in the field of treating Sacroiliac Joint Pain, with patients travelling from across the UK, Europe, and the Middle East.
With over 12 years of clinical experience, Oliver helps patients understand symptoms of Sacroiliac Joint Pain and provides effective treatment options.
Qualified in Prolozone Therapy and Prolotherapy in America (American Academy of Ozonotherapy), further training at Royal Society of Medicine, Charing Cross Hospital, Keele University, and Heidelberg University. Treated elite athletes including Olympic and Commonwealth medallists.
LinkedIn: https://www.linkedin.com/in/oliver-eaton-4338225b/
References
- Sacroiliac joint pain. Mayfield. https://mayfieldclinic.com/pe-sijointpain.htm
- Mayoclinic staff. Sacroilitis. https://www.mayoclinic.org/diseases-conditions/sacroiliitis/symptoms-causes/syc-20350747
- Yomans S. SI joint pain. Spine Health, Jul 2018. https://www.spine-health.com/conditions/sacroiliac-joint-dysfunction/sacroiliac-joint-dysfunction-si-joint-pain
- Cohen SP, Chen Y, Neufeld NJ. Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment. J Pain. 2013;14(4):S2-S22.
- Duhon BS, Cher DJ, Wine KD, et al. Triangular titanium implants for sacroiliac joint fusion: a prospective study. Int J Spine Surg. 2016;10:Article 13.
- Smith-Petersen MN. Sacroiliac joint fusion: indications, techniques, and outcomes. Spine Surg. 2015;40(5):E300-E308.
Disclosure: The authors have no relevant financial relationships to disclose.