Sacroiliac (SI) joint dysfunction refers to pain and discomfort that arises from the sacroiliac joints, which are located at the bottom of the spine where the sacrum (the triangular bone at the base of the spine) meets the iliac bones (the large bones that make up the pelvis). These joints help transfer the load between your upper body and your legs and play a crucial role in stabilizing the pelvis.

Understanding the Sacroiliac Joints

You have two sacroiliac joints, one on each side of your pelvis. These relatively small joints have limited movement, but they are essential for absorbing shock and stabilizing your lower body during activities like walking, running, and lifting.

Causes of Sacroiliac Joint Dysfunction

• • Injury or trauma: A fall, car accident, or sudden impact can injure the SI joint, leading to inflammation and pain.
  • Pregnancy: During pregnancy, hormones cause the ligaments in the pelvis to loosen, which can increase the movement in the SI joints and lead to discomfort or pain.
  • Arthritis: Conditions like osteoarthritis or ankylosing spondylitis can cause inflammation or degeneration of the SI joint, leading to dysfunction.
  • Leg length discrepancy: If one leg is shorter than the other, it can place uneven stress on the SI joints, leading to pain and dysfunction.
  • Repetitive stress: Activities that put repetitive stress on the SI joints, such as long periods of standing, heavy lifting, or twisting, can cause wear and tear over time.
  • Prior Spinal Fusion: Spinal fusion, particularly fusion to the sacrum, can results in increased transfer of stress onto the SI joints. This may occur either early, or sometime after the spinal fusion is performed.

Symptoms of Sacroiliac Joint Dysfunction

• • Lower back pain: Pain is often felt on one side of the lower back or buttocks, and it may radiate down the leg, mimicking sciatica.
  • Pelvic pain: You may feel pain in the pelvic area, especially when sitting or standing for long periods.
  • Hip or groin pain: Some people experience pain in the hips or groin area.
  • Instability: The feeling that the SI joint will ‘give out’ is often described by people with SI joint dysfunction.
  • Leg pain and Sciatica: Due to the proximity of the sciatic nerve to the SI joint, symptoms of pain shooting down the leg (‘sciatica’) may be experienced in patients with SI joint instability.
  • Difficulty with certain movements: Movements that involve bending, twisting, or lifting can exacerbate the pain. Patients with SI Joint dysfunction may also have a replication of their symptoms when lying on the affected side in bed.
  • Stiffness: You might feel stiffness in the lower back or hips, especially after periods of inactivity.

Diagnosis

Diagnosing SI joint dysfunction can be challenging because its symptoms can mimic other conditions like herniated discs or hip problems. A/Prof Buckland will take a detailed medical history, perform a physical exam, and may use imaging tests like X-rays, CT scans, or MRIs to rule out other conditions. In suspected SI Joint Dysfunction, an injection of a local anaesthetic into the SI joint under CT guidance may be used to confirm the diagnosis.

Treatment

Physiotherapy: Exercises to strengthen the muscles around the SI joint, improve flexibility, and stabilize the pelvis are often recommended. This can help reduce pain and provide stability.

Sacroiliac belt: This is a supportive belt worn around the pelvis to help stabilize the SI joints and reduce pain, especially during activities.
Lifestyle modifications: Adjusting activities that exacerbate your symptoms, such as avoiding heavy lifting or prolonged standing, can help manage the condition.

Pain management: Nonsteroidal anti-inflammatory drugs (NSAIDs) or other pain relievers may be prescribed to manage pain and reduce inflammation. In some cases, corticosteroid injections directly into the SI joint can provide relief. Radiofrequency Ablation (RFA) may be considered in people that have a good initial response to SI joint injection.

Surgery: Minimally Invasive SI Joint Fusion may be performed in cases of severe SI Joint dysfunction where the above measures have failed to provide sufficient relief of symptoms. Learn more about the results of Minimally Invasive SI Joint Fusion here.

Prognosis

Many people with SI joint dysfunction can manage their symptoms effectively with conservative treatments like physical therapy, medications, and lifestyle adjustments. In some cases, the condition may resolve over time, especially if it’s related to pregnancy or an injury that heals.

For chronic or severe cases, more advanced treatments like radiofrequency ablation (which uses heat to reduce nerve pain) or, occasionally, surgery might be considered. However, most people do not require surgery and can find relief through non-surgical means.