Sacroiliac Joint Pain “Other Hip Pain”

“Sacroiliac Joint Pain is the most common cause of Low back pain during pregnancy and often an under recognized source of Hip pain”

Sacroiliac (SI) joint is a joint where the spine meets the hip bone on either side. This joint transmits a person’s upper body weight to their legs and helps support the upright posture. Any misalignment or inflammation in this joint causes lower back and buttock pain. Sacroiliac joint pain is often a under recognized source of lower back pain. Low back pain is extremely common condition affecting up to 84% of individuals at some point in their life. Sacroiliac joint pain alone accounts for 15-30% of all causes of low back pain.

Normally, there is very little (2-4 mm) movement at this joint except during pregnancy. During pregnancy, this joint acquires a larger range of motion necessary for childbirth. Due to this change, SI joint pain is the most common cause of lower back pain during pregnancy.

What is Sacroiliitis?

Sacroiliac joint inflammation is known as Sacroiliitis. Just like all other joints, Sacroiliac joint is also affected by aging. As a result of degenerative and arthritic changes, Sacroiliac joint inflammation and pain arise.

Sacroiliac Joint Inflammation- Arthritis
Sacroiliac Joint Inflammation

It is important to note that Sacroiliac joint pain may often mimic pain coming from herniated disc in your spine, facet joint or hip joint pain. You many need to see your physician to make a proper diagnosis of sacroiliitis

Causes of Sacroiliac Joint pain

The Sacroiliac joint is supported by strong ligaments and muscles that help it maintain stability. the joint may become a source of pain due to some common causes listed here:

  • Hip/ Spine surgery (laminectomy, Fusion surgery)
  • Trauma or injury causing misalignment of SI joint
  • Pregnancy and childbirth
  • Arthritis: Ankylosing spondylitis or any other type of arthritis
  • Car accident
  • Uneven pelvic movement due to various reasons
    • One leg longer than other
    • Arthritis of hip or knee, favoring one side over other
    • Wearing a walking boot after ankle or foot surgery

How do you know if you have SI Joint pain?

Signs and symptoms:

  • Low back pain
  • Buttocks pain radiating to thighs  
  • Buttocks pain radiating to groin

Your clinician may need to do provocative tests to diagnose SI joint pain. You may need to have X-ray, CT scan or MRI imaging of pelvis

Diagnostic Injection: X-ray guided injection of steroids and local anesthetics are often used to diagnose and treat SI Joint pain.

Treatment and Care of SI Joint pain

1. Conservative treatment

  • Anti-inflammatory medications: Tylenol, Ibuprofen, etc..
  • Short term use of Opioid pain medications
  • Chiropractic manipulations to re-align the joints
  • Physical Therapy exercises

2. Minimally invasive Interventional treatment

Sacroiliac Joint Steroid Injection:

Sacroiliac joint Injections are recommended if a patient has already tried different conservative treatments without much success. SIJ Steroid injection provides relief anywhere from few weeks to few months and helps to diagnose as well treat Sacroiliac joint pain

Sacroiliac Joint Radiofrequency Ablation:

If a patient only receives limited success with steroid injection, or requires frequent steroid injections, then they may be a candidate for Radiofrequency ablation. Radiofrequency ablations may help subside pain and inflammation in the joint anywhere from 6 to 18 months.

3. Regenerative Therapy

PRP Therapy:

If none of the aforementioned conservative treatments or steroid injections provide lasting relief then its worth trying an X-ray guided PRP Injection (Plasma Rich Plasma Injection) in the joint.

Platelet Rich Plasma
Platelet Rich Plasma

Arthritis or degenerative changes in the joint continue to progress despite steroid injections. Steroid Injections may reduce inflammation, but do not address the root cause of joint pain which is degeneration.

PRP injections on the other hand, not only reduce inflammation, they also stimulate healing which can provide a more lasting pain relief. In addition, effects of a PRP injections have been found to last longer than conventional steroid injections.

As with other regenerative therapies, PRP injections have gained popularity over the last decade. They are now being widely used to treat degenerative arthritis and acute sports related injuries.

4. Surgical Treatment

Sacroiliac joint fusion:

If all else fails, surgical treatment option is also available to a patient suffering from Sacroiliac joint pain.

One common surgical approach for SI joint pain is the SI joint fusion. In this treatment, the bones in the joint are fused together. This prevents any movement within the SI joint space. Less movement, means less pain as the bones no longer rub against each other causing less irritation, less inflammation and an overall reduction in pain.

 

References

  1. RA et al 1987. Descriptive epidemiology of low-back pain and its related medical care in the United States. Spine (Phila Pa 1976). 1987 Apr;12(3):264-8
  2. Singla et al 2017. Steroid vs. Platelet-Rich Plasma in Ultrasound-Guided Sacroiliac Joint Injection for Chronic Low Back Pain. Pain Pract. 2017 Jul; 17(6):782-791. doi: 10.1111/papr.12526. Epub 2016 Dec 1
  3. Ko et al 2017. Case series of ultrasound guided platelet rich plasma injections for sacroiliac joint dysfunction. J Back Musculoskelet Rehabil. 2017; 30(2):363-370. doi: 10.3233/BMR-160734
  4. Eldin M et al 2019. Percutaneous injection of autologous platelet-rich fibrin versus platelet-rich plasma in sacroiliac joint dysfunction: An applied comparative study. J Back Musculoskelet Rehabil. 2019; 32(3):511-518. doi: 10.3233/BMR-181366
  5. Tran ZV et al 2019. Sacroiliac Joint Fusion Methodology – Minimally Invasive Compared to Screw- Type Surgeries: A Systematic Review and Meta-Analysis. Pain Physician. 2019 Jan; 22(1):29-40.
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