Sacroiliitis / Sacroiliac Pain | Lower Back Pain
Sacroiliitis is defined as an inflammatory process involving the sacroiliac joints which consists of the connection between the lower spine (sacrum) and the pelvis. Recent thought is that most long-term chronic sacroiliac (SI) pain is not due to an acute inflammatory process itself, but may be due to chronic degenerative processes or malalignment conditions in the sacral, pelvic, or spinal regions. Such conditions can lead to joint and ligament laxity, osteoarthritis, and myofascial pain. These condition can cause pain in the buttocks, low back, and may even extend down one or both lower extremities. Treatments for sacroiliitis are usually non-surgical and focus on trying to restore normal motion and stability of the joint.
Causes of Sacroiliitis May Include:
- Degenerative changes. Sacroiliac pain can be related to wear and tear changes in the sacroiliac joint (S.I. joint) surfaces which can lead to ligament instabilities.
- Traumatic injury. Sudden impact, such as a motor vehicle accident or fall, can damage your sacroiliac joints.
- Pregnancy. The sacroiliac joints must loosen and stretch to accommodate childbirth. The added weight and altered gait during pregnancy can cause increased stress on these joints which can lead to abnormal wear resulting pain and dysfunction.
The Painful Symptoms of Sacroiliitis Can Be Aggravated By The Following:
- Prolonged sitting
- Bearing more weight on one leg than the other
- Climbing stairs
- Taking large strides
Diagnosis for Sacroiliitis:
- Provider performed physical exam and medical history is an excellent start for diagnosing S.I. related pain/dysfunction. Specific provocative maneuvers can greatly improve the determination as to the source of pain.
Further diagnostics may include x-rays, CT scan, and/or MRI imaging. One of the more reliable methods to determine if the S.I. joint is the cause of low back symptoms is to inject the S.I. joint with a dose of local anesthetic. If this procedure greatly decreases your symptoms it can be concluded that the S.I. joint is either the source or one of the main contributors for your low back pain.
Treatment for Lower Back Pain | Lower Back Pain Treatment
Treatments for sacroiliitis are usually non-surgical and focus on trying to restore normal motion and stability of the joint.
- Initial treatment. Initial treatment may include ice, moist heat, and rest. The use of ice/cool packs may decrease initial inflammation and irritation of the S.I. joint, rest from normal activities may also help in this process. Application of heat/heating pad or hot Epsom salt baths will decrease muscle tension, increase circulation, and improve the healing process; heat during the most painful time period.
- Medications. First line treatment may include short-term use of analgesics such as acetaminophen, or NSAID’s such as ibuprofen or naproxen. The healing benefits of NSAID’s are controversial and there is some evidence that they may inhibit parts of the healing process. It appears that these medications may not improve healing as much as was hoped and that the major benefit of this group of medications is primarily due to their analgesic or pain relieving effects. NSAID’s have many side effect risks such as gastrointestinal bleeding, hypertension, and possible injury to the heart and brain (increased stroke risk). Narcotic pain relievers can also be used if other analgesics are ineffective although they can be habit-forming and should not be used for long periods of time. Muscle relaxers, such as cyclobenzaprine or high absorption magnesium, may help reduce the muscle spasms often associated with sacroiliitis.
- Manual medicine. Osteopathic or chiropractic manipulation may also be helpful. This modality can be effective especially when the SI joint is fixed or “stuck”. If the S.I. joint has ligament laxity problems, manual techniques may not be beneficial and may cause increased irritability.
- Supports or braces. S.I. belts which are a type of orthotic that is used to stabilize the S.I. joint can be used to treat the “hypermobile” situation. When the joint(s) calm down, the S.I. belt can be weaned.
- Physical therapy. Your medical care provider or physical therapist can assist you in learning range of motion and stretching exercises to maintain joint flexibility. Strengthening core stability exercises can also improve the S.I. joint function and decrease pain.
- Injections. Joint injections are another strategy that may help the S.I. joint. Corticosteroids are commonly used in the United States and are injected in an attempt to decrease inflammation and pain. Unfortunately, in many patients they do not appear to provide lasting relief. This modality should only be used in a limited amount because steroids may weaken tissues such as cartilage, bones, tendons, and ligaments. Another type of injection used today is called restorative injection therapy. Restorative injections are used in an attempt to help stimulate the bodies healing responses. These options for treating sacral pain include prolotherapy, platelet rich plasma, and medical acupuncture. They can be quite effective in treating pain and dysfunction related to sacroiliitis.
- More invasive strategies may include surgical fusion of the S.I. joints, radiofrequency denervation, or electrical stimulator implantation. These options should only be considered as last resort options when conservative measures have been exhausted.