Sacroiliac Joint Pain and Dysfunction – The Facts

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Doctor pointing to Sacroiliac Joint on skeleton
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Your sacroiliac joint is a minimally moveable joint that connects the lowest part of the spine – a bone called the “sacrum” -  to the back of the hip bones. The sacrum wedges in between the two hip bones, contributing greatly to spinal stability.

When the sacroiliac joint moves out of alignment, or when inflammation affects it, dysfunction and/or pain may result. These two processes are different from one another:  When the joint is out of alignment, the result is excessive movement,  a potential stretching of the ligaments that cross the joint, and pain.  When inflammation affects the SI joint, it’s usually a result of a type of arthritis that affects you systemically.  Key symptoms of this type are pain, stiffness, and immobility.

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Doctor scrutinizes x-ray for lesions.
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It’s important to get an accurate diagnosis of any sacroiliac joint pain or dysfunction you may experience.  This is especially true if surgery is a treatment option you're willing to consider.  The reason is that surgery tends to make permanent changes, so most likely, you'll want to be sure the pain you feel is truly coming from this joint before agreeing to the procedure.

Plus, historically speaking, SI joint surgeries have been fraught with complications. 

On top of all this, accurately pinpointing the SI joint (and not somewhere in the lumbar spine) as the cause of the pain tends to be challenging to most doctors.  Few diagnostic tests exist that definitely indicate when the SI joint is the cause of the pain.  

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Back brace
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A number of treatments for SI joint pain and dysfunction exist - including chiropractic care, bracing, surgery and more that offer varying degrees of effectiveness and safety. As mentioned above, it's imperative to first make sure your diagnosis is accurate.  This may mean you'll need to ask your doctor the hard questions and/or get a 2nd or even 3rd opinion to be sure of what you're working with when you try treatments that are either suggested or that you're interested in.

To get the scoop on 7 of the most common SI joint treatments and what medical research says about them, click on the link above. Included in the 7 treatments are chiropractic, medications, radiofrequency denervation and several others. I'll give you a heads up, though - Sacroiliac Braces fared pretty well when studied, and patients like them a lot, too.  

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A woman exercises her adductor muscles.
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Dealing with SI pain is challenging to any practitioner (or patient,) regardless of the type of medicine practiced.  If you're being treated within the allopathic (i.e., conventional) medical system, one reason for this challenge is explored above (#2).

If you go to physical therapy, you see a holistic practitioner, or you engage with moves that are believed to be soothing to an out of alignment SI joint, there's another reason.  

To realign the sacrum relative to the hip bones, the balance of all the bones in the area must be considered.  This takes a lot of anatomy knowledge plus much experience working with the structures of the low back.  It's usually not as simple as doing a yoga or Pilates class although these systems have formed the basis for certain therapeutic approaches that have gained popularity in the last few decades.

So while you may not be able to get the joint realigned and re-stabilized yourself by- i.e., with movement or exercise - these may play a role in temporarily relieving some of your pain.  

Sources:

Dreyfuss P1, Dreyer SJ, Cole A, Mayo K. Sacroiliac joint pain. J Am Acad Orthop Surg. 2004 Jul-Aug;12(4):255-65.

Hansen H, Manchikanti L, Simopoulos TT, Christo PJ, Gupta S, Smith HS, Hameed H, Cohen SP. A systematic evaluation of the therapeutic effectiveness of sacroiliac joint interventions. Pain Physician. 2012 May-Jun;15(3):E247-78. 

Kok-Yuen Ho, Mohamed Abdul Hadi, Koravee Pasutharnchat, and Kian-Hian Tan. Cooled radiofrequency denervation for treatment of sacroiliac joint pain: two-year results from 20 cases. J Pain Res. 2013; 6: 505–511.

Odette Soisson, Juliane Lube, Andresa Germano, Karl-Heinz Hammer, Christoph Josten, Freddy Sichting, Dirk Winkler, Thomas L. Milani, and Niels Hammer. François Hug (Academic Editor.) Pelvic Belt Effects on Pelvic Morphometry, Muscle Activity and Body Balance in Patients with Sacroiliac Joint Dysfunction. PLoS One. 2015; 10(3): e0116739.

Shaffrey, C., Smith, J.S. Stabilization of the sacroiliac joint. Neurosurg Focus. 2013 Jul;35(2 Suppl):Editorial. doi: 10.3171/2013.V2.FOCUS13273.

William Ryan Spiker, Brandon D. Lawrence, Annie L. Raich, Andrea C. Skelly, and Darrel S. Brodke. Surgical versus injection treatment for injection-confirmed chronic sacroiliac joint pain. Evid Based Spine Care J. 2012 Nov; 3(4): 41–53. 

Zelle BA1, Gruen GS, Brown S, George S. Sacroiliac joint dysfunction: evaluation and management. Clin J Pain. 2005 Sep-Oct;21(5):446-55. 

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