Sacroiliac Joint Pain

PostPelvis

An elusive source of low back and buttock pain is the sacroiliac joint (SIJ). The bilateral sacroiliac joints make up the foundation of the spine, providing a linkage between the legs and hip joints to the spine and upper body. A dense network of ligaments holds the sacroiliac joint together, allowing for a minor amount of movement. The main function of these ligaments is to provide an "elastic spring" that stores energy as we take a step, then recoils to release that energy as we prepare for the next step. Over many years of walking and with assorted traumatic injuries, the ligaments surrounding the sacroiliac joint can become damaged and stretched.

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The typical pain of the SIJ is deep, intense, variable low back and buttock pain, which may refer pain, numbness, and tingling in various patterns down the leg. It may be constant, or vary with position and movement. The referral patterns have been known since the 1950's through the work of George Hackett, MD, the Orthopedic Surgeon who developed the technique of Prolotherapy, and later by the work of Janet Travell, MD and David Simons, MD, the developers of the concept of Myofascial Pain. Unfortunately, many doctors today do not recognize these pain patterns, and the problem may be easily confused with disk herniation and nerve compression pain patterns, which are considered to be more common and easier to diagnose. Thus, a patient with unresolved low back pain and sciatica might very well have SIJ related pain, especially if the X-Rays, MRI scans, and CT scans are inconclusive.

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Common treatments include physical therapy, manual therapy, joint manipulation, and education for self-stabilization. If the pain does not respond satisfactorily, injections using fluoroscopic guidance to confirm entry into the joint may help to clarify the diagnosis. These injections may also be placed into the surrounding ligaments, as these are typically where the pain originates. Definitive treatment typically involves using Prolotherapy or Platelet-Rich Plasma to stimulate healing of the damaged ligaments to ultimately "tighten up" and stabilize the joint. Another interventional option is Radiofrequency Neurotomy, which has a limited success rate for this problem, but which can be excellent for pain emanating from the nearby facet joints and may also reduce pain from the upper portion of the SIJ.
These image shows the pelvis from the front and back, with the dense ligamentous system providing the controlled movement and support of the base of the spine. The additional drawings are from Gray's Anatomy/Wikipedia and from Hauser, Prolo Your Pain Away.