WHEN BACK PAIN IS CAUSED BY THE SACROILIAC JOINT

By Dr. William Madosky 

Low back pain in adults can occur from injuries to the spinal joints, discs, nerves, spinal cord ligaments and muscles.  Diagnosis of low back pain involves isolating these individual structures to determine which one or combination of structures has been injured.  One source of back pain that is often overlooked in assessing back pain patients is the sacroiliac joint or SI joint for short.  SI joint syndrome has been implicated in 10-30% of adults with chronic low back pain. The SI joint plays a critical role in the movement of the pelvis and back during walking, running and other daily activities. 

What is the SI joint and where is it located?  The SI joint is located at the dimple of the gluteal area just below the junction of the low back and the top of the hips.  The SI joint is formed where the sacrum and the pelvic bones, known as iliums joins together. Several large and small gluteal muscles attached to both the sacrum and the iliums allowing us to move and providing stability when we stand or lift one leg off of the ground. The SI joints (we have two – right and left) also play a vital role in the movement of our bodies by allowing our pelvic bones to alternately move when we walk and run.   

What are the common symptoms of SI joint pain?  SI joint pain is typically described as a dull or achy pain that is localized to the gluteal area where the SI joint is located but may at times travel down to the back part of the upper leg or upward toward the low back.  SI joint pain is generally felt more during walking or running and decreases when standing still.  Occasionally SI joint pain can be sharp and prevent quick movements.

Why is the SI joint commonly overlooked as a source of low back pain?  There is debate within the healthcare field regarding the amount of actual movement the SI joint undergoes.  SI joint dysfunction is difficult to diagnose because there is not a specific test that has been consistently demonstrated to provide a diagnosis.  SI joint pain and SI joint syndrome are often intertwined with other spinal joint dysfunction of the low back and muscle imbalance and/or weakness of the gluteal and low back regions.

Is SI joint pain the same as sciatica?  Although the SI joint and the sciatic nerve are located very close together they are not the same things.  SI joint pain generally is localized to the low back/gluteal region.  Sciatic pain generally begins in the gluteal region and travels down the leg to the ankle or foot.  Poor movement of the SI joint can lead to spasm of the piriformis muscle, which can put pressure of the sciatic nerve causing sciatica.

What treatment options exist?  Decreasing or eliminating SI joint pain or SI joint syndrome comes only after a through evaluation of the entire low back and gluteal region.  Evaluating lumbar and SI joint biomechanics and the overall balance of the adjacent muscles will provide for a sound treatment plan.  SI joints respond extremely well to chiropractic manipulations and physical therapy mobilization techniques.  Stretching regional muscles that are too tight, strengthening those that do not have enough muscle tone will improve overall muscle balance.  The combination of these two techniques will help to provide proper SI joint movement and support.  In cases that do not respond to these techniques anti-inflammatory injections into the SI joint and SI joint stabilization belts are sometimes successful. 

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