7 Treatments for Sacroiliac Joint Pain and Dysfunction

1
Sacroiliac Joint Treatments

Sacroiliac joint seen from above.
Sacroiliac joint seen from above. MedicalRF.com/MedicalRF.com/Getty Images

Those in the know about sacroiliac joint derangement (SIDJ) – in particular, people who work in the conventional medical realm - often regard treatment for this problem as “controversial.”

One reason may be that getting an accurate diagnosis can be elusive.  In other words, is it a good idea to agree to a treatment – especially one that makes permanent changes - when you’re not guaranteed the pain is actually coming from the SI joint? Another reason may be related to the lack of studies done to date on common therapies and procedures used for treating SIDJ.

Not only that, but doctors and their SI joint patients are sometimes at odds with each other about the source of the problem (called a “pain generator”.)  Many medical professionals truly believe that absolutely no movement is possible at the SI and that it is not the source of pain in SIDJ. But if you peruse social media groups run by and for patients that are dedicated to this topic, you’ll likely get a strong dose of a very different point of view.

To help you sort out your options for SI joint dysfunction, let’s review the common treatments offered by doctors and therapists.

In the end, though, the choice of treatment may not matter. In 2012, Spiker, et. al., conducted a review of studies that was published in Evidence Based Spine Care Journal. The review compared surgery to injections and fusion of the SI joint to denervation. Spiker’s team concluded that most of the studies reported over 40% pain relief regardless of the treatment tried. In other words, SI derangement improved independently of the exact therapies patients underwent.

And Zelle, et. al in their study "Sacroiliac joint dysfunction: evaluation and management," published in the Sept-Oct 2005 issue of Clinical Journal of Pain found that most sacroiliac patients respond to conservative (i.e., non-operative) treatment.

Sources

Dreyfuss P1, Dreyer SJ, Cole A, Mayo K. Sacroiliac joint pain. J Am Acad Orthop Surg. 2004 Jul-Aug;12(4):255-65. http://www.ncbi.nlm.nih.gov/pubmed/15473677/

Shaffrey, C., Smith, J.S. Stabilization of the sacroiliac joint. Neurosurg Focus. 2013 Jul;35(2 Suppl):Editorial. doi: 10.3171/2013.V2.FOCUS13273. http://www.ncbi.nlm.nih.gov/pubmed/23829837

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. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4364533/

Zelle BA1, Gruen GS, Brown S, George S. Sacroiliac joint dysfunction: evaluation and management. Clin J Pain. 2005 Sep-Oct;21(5):446-55. http://www.ncbi.nlm.nih.gov/pubmed/16093751

2
Medication

Pills of different shapes, colors and sizes fill the image.
Pain killer types. ShutterWorx/E+/Getty Images

As with many types of back problems, Tylenol may be recommended to you by your doctor as a place to start. If over-the-counter Tylenol is not effective in relieving your SI joint pain, ask your doctor about an anti-inflammatory such as ibuprofen. That said, ibuprofen comes with many potential side effects, and some of them can be very serious or even lethal. Please be sure you know what the side effects are, and that you've discussed these with your doctor before taking this drug. The same is true for Tylenol, particularly if you drink or have any kind of liver disease.

Tylenol and ibuprofen come in lower doses in the over-the-counter form, and higher doses should your doctor prescribe them for you.

Taking a pain medication is usually recommended along with other treatments such as physical therapy, bracing and/or activity modification. It is not a cure – it’s there to help reduce your pain levels.

3
Physical Therapy

Senior woman being examined by physical therapist.
lightwavemedia

While your doctor may not believe in the movement capacity of your SI joint, your physical therapist might.

Physical therapists are trained to work with patients to optimize motion. To that end, you’ll likely get a home exercise program that will help you develop strength in your pelvis, hips, and core. This, in turn, may help stabilize your SI joint.

The exercises in your home program may also help you develop muscle balance. Because the SI joints are located on either side of your spine, (at the sacrum and hip bones) attaining equal strength and flexibility between the muscles on each side of your body may be one of the keys (along with manual therapy) to allowing the joint to fall back into its natural alignment. 

4
Sacroiliac Braces

Back brace
Back brace. kamonrat

Many people report good results using a brace to help stabilize a loose sacroiliac joint. In particular, a pelvic belt is often recommended by doctors to their patients.

Researchers measured the change in muscle and other activity related to the sacroiliac joint when patients wore a pelvic belt. They concluded that pelvic belts improve health-related quality of life, and may be responsible for decreased SI joint pain. Some of the improvements noted include decreased quadriceps activity (in particular - the rectus femoris) as well as better postural steadiness while walking. The researchers suggest that pelvic belts may be considered as a low risk, cost effective treatment for SI joint pain.

Source

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. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4364533/

5
Manual Therapy

Chiropractic adjustment
Chiropractic adjustment. Deeblue

Manual therapy - healing with the hands - is another kind of treatment for sacroiliac joint derangement. Chiropractic is the most well-known type, but osteopathy, physical therapy, and massage therapy are viable options, as well.

When you get manual therapy from a physical therapist or osteopath, the practitioner may pull on one of your legs to help realign the joint.

If you see a chiropractor for your SI joint, she may have you lie on your side with your top knee bent and your bottom shoulder forward of the top. She may then put quick pressure on the sacrum bone to help it go back into place. I’ve had this done many times, and my perspective is that an adjustment is not enough for long lasting relief. This is because muscle tension and weakness is also a component of the problem; without an accompanying movement and exercise program designed to develop core, hip and back strength as well as flexibility, the bones of the SI joint will likely go out of place again soon after your leave your chiropractor's office.

Massage therapy is another form of manual therapy. But a massage therapist’s scope of practice does not extend to bone-setting. As I see it, much of their role in healing a sacroiliac joint dysfunction revolves around releasing chronic muscle tension that may be keeping the joint from naturally realigning itself. Massage can also increase range of motion in general which may make exercising easier, more fun and more productive.

6
Sacroiliac Joint Injections

A nurse holds a needle.
Nerve blocks are spinal injections. H. Armstrong Roberts/ClassicStock Archive Photos/Getty Images

An injection into your painful sacroiliac joint may be more useful as a diagnostic tool than as a pain relief treatment. Injection is about the closest thing medical practitioners and researchers have to definitively identify that the pain is truly coming from the SI joint.

The value of an SI injection as a treatment is not as clear. Spiker, et. al., in their 2012 review “Surgical versus injection treatment for injection-confirmed chronic sacroiliac joint pain,” published in the November 2012 issue of Evidence Based Spine Care Journal, conclude that although injections and surgeries may help patients reduce their pain, based on the studies done so far, they cannot tell you which of these treatments work better than the others.

This is unfortunate, because when you’re trying to figure out if permanently fusing your SI joint will be your best option for recovering your former quality of life, such information could come in handy.

A 2012 review of studies done by Hansen, et. al., and published in Pain Physician found that intraarticular (meaning inside the joint) sacroiliac injections with steroids were not effective in relieving pain in the short or long term.

Sources

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. http://www.ncbi.nlm.nih.gov/pubmed/22622913

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. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4364533/

7
Radiofrequency Denervation

Back procedure
Back procedure. NunoMt

As the name implies, radiofrequency denervation is a procedure that uses radiofrequency to disable the nerve that causes pain in your sacroiliac joint. Citing poor evidence, the review mentioned on the previous slide, which was done by Hansen, et. al. in 2012 and published in the Journal of Pain Research, found that conventional radiofrequency denervation was not effective for relief of sacroiliac pain.

But as of September 2015, a new type of radiofrequency denervation is now on the scene.  It’s called cooled radiofrequency. The difference is that cooled radiofrequency enlarges the lesion before disabling the nerve. (The probes on the machine are internally cooled.) The larger lesion size increases the chance of completely denerving the joint, and thereby relieving all the pain.

The review mentioned above found a fair degree of effectiveness for cooled radiofrequency, as compared with the poor effectiveness associated with the conventional type.

Sources

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.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3706381

8
Sacroiliac Fusion or Arthrodesis

Sacroiliac joint seen from above.
Sacroiliac joint seen from above. MedicalRF.com/MedicalRF.com/Getty Images

The word arthrodesis refers to the immobilizing – by means of surgery – a joint. In this case, it refers to fusion of the sacroiliac joint. Historically, surgery on the SI joint has been very complex, with poor results and high complication rates. Many patients required additional surgeries related to their SI fusion.

But even with minimally invasive spine surgery on the rise, having an SI fusion can be a tricky decision to make. The reason goes back to the diagnosis process.

“The difficulty is identifying that it is the sacroiliac joint,” says Carter Beck, MD.  Beck is a Montana surgeon who has developed a minimally invasive procedure for fusing the SI joint that, according to him, is easy on the patient, safe and effective. Dr. Beck cautions both practitioners and patients to be sure the pain is truly coming from the SI, and not from another area of the spine.

While Beck’s new procedure sounds promising, medical research has yet to answer all the questions about safety, effectiveness and the type of patient who would be best suited for minimally invasive sacroiliac surgery.

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