Joint Pain

The sacroiliac joint is a large, stiff joint between the back of the spine and the pelvis. There are two sacroiliac joints, one on each side. These muscles play a major role in transferring weight from the upper body to the hips and legs, thus causing many problems in daily life. It acts as an attractor and is supported by many strong bonds. The sacroiliac joint is supplied by several muscles that can be painful when irritated.

What causes sacroiliac joint pain?

Sacroiliac joints do not allow much movement as both too much and too little movement can become a source of pain. Some of the causes of SIJ pain include

Trauma/ injuries involving the joints or the surrounding ligaments such as following a fall on the buttock or a road traffic accident.
Mechanical stress due to various reasons such as previous spinal fusion surgery or leg length discrepancy leading to altered weight bearing. As per some studies 75% of patients with previous fusion surgery can develop SIJ degeneration after 5 years.
Inflammation. Sacroiliitis is a term used inflammation of the sacroiliac joint. Ankylosing spondylitis is a type of inflammatory arthritis which can affect the SIJ and the spine. This is seen more commonly in young men. In severe cases it can cause fusion of the sacroiliac and spinal joints leading to pain with reduced range of motion.
Normal wear and tear (degenerative changes.) These are more common with advancing age.
Infections and tumors are fortunately not as common as the other causes of sacroiliac pain.

What are the symptoms of sacroiliac joint pain?

Fifteen to twenty percent of all back pain may be caused by problems with the sacroiliac joint. SIJ pain can mimic pain in the hip or lower back and can affect people of all ages.

Patients with sacroiliac pain often present with cramps or lower back pain and stiffness. The pain is mild but can be sharp/stabbing in nature. It can affect one or both sides and spread to the thighs, buttocks, thighs and legs. Activities such as getting up from a sitting position, getting in and out of the car, climbing stairs, walking, and sitting can be painful. Young adults with ankylosing spondylitis often experience pain and stiffness; This condition worsens in the morning and improves with exercise.

How is sacroiliac joint pain diagnosed?

Evaluation of SIJ pain begins with the patient’s history and examination. My usual practice is to perform five clinical tests to evaluate the sacroiliac joint, and if three or more are positive, a sacroiliac joint is likely.

Tests such as blood tests, x-rays, MRI or CT scans may be necessary to confirm the diagnosis. An MRI scan shows details of the joints but it is important to emphasize that these joints can be painful even if the scan is normal. An injection into the sacroiliac joint along with an x-ray or ultrasound is one of the best ways to confirm whether these points are the source of the pain.

How is the sacroiliac joint pain treated?

Treatment may vary depending on the cause of the pain. For example, pain due to trauma is treated differently than pain due to inflammatory arthritis such as ankylosing spondylitis.

Uses a combination of different treatment modalities (known as a multimodal approach) to provide maximum, long-lasting relief. Treatment may include a variety of options including:

Medications to reduce pain and inflammation.

Physical therapy. This may include posture correction, activity alteration, strengthening of the muscles around the sacroiliac joint and restoring normal joint motion.

Steroid Injections

X-ray or ultrasound-guided sacroiliac injections are usually performed to confirm the diagnosis (diagnostic injections) and/or induce pain (therapeutic injections). Injections are usually administered as a day treatment under local anesthesia. During the procedure, the patient is asked to lie face down. X-ray or ultrasound guidance is used to guide the needle into or near the sacroiliac area. Dye is applied to make the needle visible when X-rays are used. A mixture of local anesthetic and steroids is then injected to reduce pain and discomfort. Ultrasound or x-ray guidance helps increase the accuracy of the injection and reduce the likelihood of complications.

Prolotherapy and PRP Injections

Prolotherapy uses stimulant injections to reduce inflammation and speed healing. For the sacroiliac joint, this is used for both pain and discomfort. This injection differs from those previously described in terms of the treatment administered, the injection technique, and the need for multiple injections over time. Ligaments can be visualized with ultrasound and ultrasonography, as they are widely used in the treatment of ligament-related problems.

Plasma-rich plasma (PRP) uses components of the blood (plasma) to trigger the healing response. It works on the principle that more plasma in the area can support the body’s healing process. PRP is prepared by running human blood through a machine to separate the platelets and inject them into areas that need healing, such as the sacroiliac ligaments. Depending on the severity of the injury and healing response, multiple injections are usually given into the injured area and repeated over time if necessary.

Dr. Akanksha Bansal

MD, FIAPM (GOLD MEDALLIST), EDPM (EUROPE), PAIN & PALLIATIVE CARE PHYSICIAN

Joint Pain

Joint Pain

Dr. Akanksha Bansal

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