Sacroiliac joint pain

Overview

The sacroiliac joints are the joints where the lower part of the spine (sacrum) connects to the pelvis. There are two sacroiliac joints, one on each side, with ligaments in each joint that hold the bones together.

Sacroiliac joint pain can be difficult to diagnose as other conditions can cause similar symptoms. Sacroiliac joint pain is most commonly felt in the low back and buttock but can also be referred into the thigh and leg. If numbness and tingling or weakness is present, an alternative diagnosis should be considered. Sacroiliac pain can be aggravated with prolonged sitting or standing, standing on one leg, stair climbing, going from sit to stand, and with running.

Potential causes of sacroiliac pain include arthritis, traumatic injury, pregnancy and post-partum, systemic inflammatory conditions, and infection. Other potential contributors include spinal scoliosis, leg length discrepancy, and previous lumbar spine fusion. Sometimes, there is no clear cause for sacroiliac pain.  

The diagnosis of sacroiliac pain starts with a careful history and physical examination, which helps to distinguish sacroiliac pain from other potential etiologies. Imaging is often recommended, starting with plain radiographs (X-rays). Sometimes your provider will recommend more advanced imaging, including a CT scan or MRI. If the diagnosis is not clear, a diagnostic (anesthetic) injection into the sacroiliac joint can provide valuable diagnostic information.

The treatment of sacroiliac pain depends on your symptoms and on the underlying cause of the sacroiliac joint pain.

Medications may be recommended for the treatment of sacroiliac joint pain. These typically include over-the-counter pain relievers such as anti-inflammatories or acetaminophen. Topical treatments such as heat or ice may be used. Physical therapy is often recommended as well, including stretching and strengthening exercises.  

When conservative treatments are not helpful, a sacroiliac joint injection with corticosteroid or radiofrequency neurotomy may be recommended. These procedures are performed with fluoroscopic guidance with an X-ray machine. There are newer treatments being tried, including injection of platelet-rich plasma (PRP) and/or bone marrow concentrate. These newer treatments are considered experimental and are an out-of-pocket expense (not typically covered by medical insurance).

Rarely, if all nonoperative management options are exhausted, sacroiliac fusion surgery may be considered. The fusion will eliminate the motion of the sacroiliac joint by fixing the two bones together with metal hardware.

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