Sacroiliac Joint Dysfunction

The sacroiliac [sak-roh-IL-ee-ak] (SI) joint connects the pelvis to the spine. In a healthy spine, there is usually little to no movement in the SI joint. In sacroiliac joint dysfunction, there is usually more movement than is normal or healthy, and this can create pain in the back, specifically in the low back.

The sacroiliac [sak-roh-IL-ee-ak] joint, also called the SI joint, is located at the very bottom of the spine, where your spinal column and pelvic bowl (hips) meet.

This point is where the sacrum [SAY-krum] and iliac [IL-ee-ak] bones meet. The sacrum is made up of the last 5 vertebrae [VER-tih-bray] in your spine, which are fused together. Your iliac bones are the 2 large bones in your right and left hip that, together, make your pelvic bowl. Your sacrum is found right in the middle of the iliac bones on your backside.

The SI joint connects the pelvis to the spine. In a healthy spine, there is usually little-to-no movement in the SI joint.

When the sacroiliac joint is not working properly, there is usually more movement than is normal or healthy, and this can create pain in the back, specifically in the low back.

The main symptom of SI joint problems is pain, typically in the lower back, and almost always on just 1 side. Other symptoms of SI joint function may include:

• Difficulty or discomfort bending over, especially after you have been sitting for a while
• Hip pain (can be either hip, or both, although both is less common)
• Pain that gets better or goes away when you lie down

You should call your doctor if you have any of the following symptoms:

• Weakness in your legs
• Sudden numbness or a tingling feeling in your hips or lower back
• Sudden increase in pain or discomfort
• Difficulty controlling your urine (pee) or bowel (poop) movements
• Fever

You should also make an appointment to see your doctor if you experience pain in the low back or hip that does not go away after a few days. Your doctor can help you figure out what is wrong and help you make a plan to get better.

The way our tissues naturally age as we get older is one of the main causes of SI joint problems. Other causes may include:

• Arthritis or other conditions that cause the cartilage to wear away
• Difference in leg lengths
• Pregnancy (as the pelvis widens to prepare for a child’s birth)
• Trauma [TRAW-mah] from impact (most often, falling and landing hard on your rear end)
• Tight muscles
• A history of pelvic injuries, such as fractures

However, SI joint problems most often develop over a long period of time.

Your doctor will most likely perform a physical exam. During your exam, your doctor will move your hips and legs around to different positions. If your doctor thinks you may have SI joint problems, they may also request an x-ray or CT scan to help confirm the diagnosis.

To help treat your SI joint problems, there are a number of options to try, including:

• Rest. Reduce your movement, and stop anything that worsens the pain.
• Cold therapy. Ice your lower back.  
• Heat therapy. Use a heating pad on your low back.
• Massage. Focus on your lower back, buttocks, and thigh muscles.
• Brace. Try a back support brace, especially when working, standing, or traveling by car.
• Pain relievers. Try over-the-counter pain medicines. Talk to your doctor about using any of these medicines if you have high blood pressure, heart disease, kidney disease, or a history of stomach ulcers. For pain, you can use:
  • Ibuprofen [ay-byoo-PRO-fen]
  • Naproxen [nah-PROKS-en]
  • Acetaminophen [ah-seet-uh-MEN-oh-fen]

• Injections. If the pain does not go away after trying the above treatments, your doctor may prescribe one or a series of injections to help you feel better. 
• Physical therapy. Talk to your doctor to see if this is a good option for you.
• Surgery. Although it is very rare, if you have tried all of the above options and still are not feeling any better, your doctor may ask you to think about surgery to help improve your condition.

Your doctor may want to follow up with you during your treatment to see how you are healing. During your follow-ups, your doctor may also request other tests to get a better idea of what your body is doing. These other tests may include:

• Imaging tests, such as an x-ray or CT scan
• Blood tests

Unfortunately, a common causes of SI joint dysfunction is the way our tissues naturally degrade as we get older. However, there are some ways you can help reduce your chances of developing SI joint problems, such as:

• Moving regularly and gently (swimming, walking, yoga, or Pilates)
• Avoiding injury
• Using proper body mechanics (posture and alignment)
• Keeping a healthy weight
• Eating a balanced diet