The sacroiliac (SI) joint is a joint in the spine that provides weight-bearing support to the entire length of the spine. Understanding how this joint works and why it becomes painful is crucial to achieving sacroiliac joint pain relief.
What causes sacroiliac joint pain?
The sacroiliac joint is a relatively stable joint that connects the ilium (part of the pelvis) and the sacrum (the triangle shaped bone at the bottom of the spine).
A rough joint surrounded by lots of connective tissue and ligaments, the sacroiliac joint takes the entire weight of the spine whether we are walking, sitting, or standing. When you move in any direction, this joint stabilizes and supports that movement, dispersing it up through the spine.
Although the SI joint seems tucked away in the spine and safe from major injury, it is possible to suffer damage that causes sacroiliac joint pain.
Some of the major sacroiliac joint pain causes include:
- Degenerative arthritis
- Conditions in the hips and lower back, such as bursitis
- Lack of muscle strength in the buttocks and lower back
- Pelvic imbalances
Let’s look at these in more detail.
1. Degenerative arthritis
For many of those who suffer SI joint pain, degenerative arthritis is the primary cause. This is a type of arthritis that occurs as the cartilage that lines the joint begins to deteriorate, resulting in painful bone-on-bone contact.
In some cases, the damage is so extensive that, over time, the bones of the ilium and the sacrum become fused. This can result in rigid immobility and pain when moving.
2. Conditions in the hips and lower back
Some common causes of SI joint pain may include
- Bursitis of the hip joint
- Ankylosing spondylitis (chronic inflammation of the spine)
- Chronic lower back pain conditions
For up to 30% of cases, lower back pain (and the way the body compensates for it) may be the primary cause of sacroiliac pain.
3. Lack of muscle strength in the buttocks and low back
Our joints are not only supported by the ligaments and connective tissues that surround them but also the muscles that provide an extra layer of strength and protection.
For inactive people, lack of muscle development in the low back, buttocks, and even the core of the body can contribute to excessive movement and pain in the SI joint.
4. Imbalances in the pelvis
If your pelvis is out of balance or you consistently walk, sit, and stand in a way that throws your body out of balance, you may feel the effects in your SI joint.
A common anatomical cause of SI joint pain is when one (or both) ilium tips backwards. This can occur over time if you walk habitually with your pelvis tucked under and your lower back rounded. It may also occur if you routinely place more weight on one side of the pelvis or another.
As the pregnant body prepares itself for birth, a hormone called relaxin begins to loosen ligaments to allow the pelvis to expand during childbirth.
While this is helpful for delivering a child, looser ligaments means more risk of damage to the sacroiliac joint in the months leading up to delivery. When combined with increased weight and pressure on the pelvis, this can lead to pregnancy sacroiliac joint pain.
Car accidents and accidents that occur during high-impact exercise or sports are also a primary cause of sacroiliac joint pain.
The SI joint is designed to absorb significant impact, but if other factors are present, or the trauma is significant, the risk of SI joint pain increases.
Sacroiliac joint pain symptoms
You may feel sacroiliac joint pain symptoms on either one or both sides of your body. Generally, it begins in the lower back before radiating to the hip, groin, and upper thigh.
Some people experience tingling or numbness in their legs or a feeling of weakness. Symptoms may get worse after sitting or standing for too long, and many people find that transitions (e.g., standing up after sitting down) are especially painful.
Diagnosing SI joint pain
Diagnosis of SI joint pain is made with a complete medical exam that includes taking a thorough medical history.
An X-ray or MRI will eliminate the possibility of other hip or spinal issues with similar symptoms, and you may also receive a diagnostic SI joint pain injection. If the injection relieves 75% of your pain after 20 to 30 minutes (and continues to relieve it for a week or so), chances are good your SI joint is the cause of pain.
Can sacroiliac joint pain be cured?
Sacroiliac joint pain relief is possible, but a cure is more challenging. The key is to utilize a variety of sacroiliac joint pain treatments to help:
- Heal the joint
- Strengthen the muscles and ligaments that surround it
- Prevent further injury or aggravation
12 sacroiliac joint pain treatments to find relief
It is possible to get sacroiliac joint pain relief. The following 12 sacroiliac joint pain treatments range from least to most interventional and can be combined to provide the most relief.
Always talk to your doctor before undertaking any new activities or lifestyle changes. They can help you find the best ways to manage your pain, safely and effectively.
Here’s how you can find sacroiliac joint pain relief.
1. Change your habits
If you tend to rest all your weight on one foot when standing or one hip when sitting, do your best to notice and correct this tendency. Consistent imbalance in the way you move your body only exacerbates SI joint pain and can make it more challenging to treat.
Similarly, sitting on a fat wallet, folding one leg underneath you, or crossing your legs as you sit can all add up to SI joint pain over time.
In the case of pregnancy sacroiliac joint pain, childbirth is arguably the least interventional (and most inevitable) treatment.
Many women experience relief of their SI joint pain without reoccurrence when their children are born. For others, keep reading for more treatments.
Sacroiliac joint pain exercises are incredibly effective at relieving pain and strengthening the joint and the muscles and ligaments that support it. Try these.
- Self-adjustment: If your SI joint pain is caused by an ilium that is tipping backwards, try this easy exercise. Lying down on a bed or a bench, allow the leg on the painful side of your body to dangle to the floor. Bring your opposite knee into your chest and gently rock back and forth. If the pain decreases exponentially, you know you have the right idea. If not, try dangling the other leg.
- Gentle ab strengthening: This exercise gently strengthens the back, core, and adductors in the inner thigh to support the SI joint. Lie on your back and bend your knees, placing feet hip-width distance apart and about a handprint away from your hips. Place a ball between your knees. Inhale, then on an exhale squeeze the ball as you gently lift head and shoulders and press your belly button to your spine (keep an slight arch in the lower back; don’t round). Hold for ten seconds as you exhale, then release. Repeat ten to 20 times daily.
- Isometric strengthening: In the same position as the ab exercise, wrap a belt just above both knees. Inhale, then on an exhale gently press belly button and spine towards each other as you use press your legs open against the resistance of the belt.
- Clamshells: Lie on your side with knees bent and resting on top of each other. Slowly open the top knee towards the sky, then close it (like a clamshell). The more slowly you move, the more you activate the muscles on the inner and outer thigh (which increases strength and stability in the hips). Repeat 20 times on each side.
These exercises should all be done under the supervision of your doctor or physical therapist. They may also be able to suggest other exercises that are targeted to your specific pain.
It is important to avoid any exercises that involve sudden twisting and turning (e.g., golf or contact sports). Additionally, lifting heavy weights or doing hundreds of crunches or sit-ups can do way more harm than good. Better to proceed slowly during the acute phase of your SI joint pain and build up to more vigorous strengthening exercise as you are ready to avoid reinjury.
4. Supportive braces and wedges
Supportive braces referred to as “SI belts” can be worn to stabilize and support the injured SI joint. This can be very helpful as patients begin physical therapy or other exercises to relieve pain and get stronger.
To correct pelvic imbalance that shortens one leg and causes SI joint pain, your doctor may recommend a wedge or supportive lift in your shoe. This can be inserted and worn in most any type of shoe for sacroiliac joint pain relief.
5. Home remedies
For minor SI joint pain relief, sometimes applying the warmth of a heating pad (or using topical creams like capsaicin cream) can offer pain relief that allows you to exercise or otherwise treat your SI joint.
Likewise, eating an inflammation-fighting diet and eliminating sugar and processed foods can decrease the inflammation in your body overall, as can taking anti-inflammatory supplements. These will not provide immediate relief but can help in the long run.
6. Over-the-counter medications
Over-the-counter medications like ibuprofen and naproxen sodium may also offer pain relief. These can be taken under the supervision of a physician but should not be utilized long-term.
Significant side effects (e.g., liver damage and gastrointestinal complications) can occur with high-dose, long-term use.
7. Chiropractic care
Chiropractic care focuses on bringing the spine back to balance by adjusting it, either manually or with special tools.
For patients whose sacroiliac joint pain is caused by a pelvic imbalance (including pregnancy), chiropractic can help.
In a study of four treatment options for sacroiliac joint pain in 2016, acupuncture resulted in the longest-lasting pain relief.
This traditional Chinese medical practice has no side effects and can be repeated as needed.
9. Prescription medication
As these come with side effects, it is important to talk with your doctor to take the smallest effective dose for the shortest amount of time while you complete other treatments (e.g., exercise and habit changes).
10. Radiofrequency ablation
Radiofrequency ablation is a minimally-invasive procedure that sends electrical pulses to the nerves that relay pain messages.
Once these signals are disrupted, pain from the SI joint should be minimized or stopped altogether. While this procedure is not permanent, it can offer relief with few (if any) side effects. You can learn more about this treatment in the following video.
11. Joint injections
Joint injections usually consist of a corticosteroid and an anesthetic to help treat inflammation and pain.
They are placed using fluoroscopic guidance and can provide nearly-instant sacroiliac joint pain relief that lasts for about a month.
Learn more about knee joint injections in the following video.
For some patients who are unable to stabilize the joint and find pain relief in any other way, surgery may be necessary.
To stabilize a hip joint, your doctor places a small titanium pin into the part of the joint that needs stability. This is an outpatient procedure that takes about an hour. For many patients, this pin (and the bone grafts that accompany it) stabilize the joint and encourage new bone growth that brings about profound sacroiliac joint pain relief.
Find sacroiliac joint pain relief
Sacroiliac joint pain can impact every part of your life. Highly-trained pain specialists can help you better understand all of your options to develop a comprehensive, holistic treatment plan.
You can find a pain doctor in your area by clicking the button below or looking for one in your area by using the tips here: https://paindoctor.com/pain-management-doctors/.