Sacroiliac (SI) Joint Pain
What is sacroiliac (SI) joint pain?
Sacroiliac joint pain is a symptom of a problem in either of the two joints between the sacrum and the iliac bones. The sacrum is the bottom portion of the spine. Five vertebrae fuse together to form this shield-shaped bone complex. On either side of the sacrum, there is a joint attaching it to an iliac bone—the large flared bones of the pelvis (your hip bones).
The SI joints are made up of very strong ligaments, which don’t allow much movement of the joints. This is important because the SI joints are meant for stability. They connect the spine and pelvis, transfer weight from the upper body to the lower body, and act as shock absorbers. Pain can occur if the joint becomes too mobile, has too little movement, begins to degenerate, or becomes inflamed. Other names for sacroiliac (SI) joint pain include SI joint dysfunction, SI joint syndrome, SI joint strain, or SI joint inflammation (sacroiliitis).
The sacroiliac joint pain location is usually the lower back. However, people may feel it below the waist as well, including in the buttocks and legs. SI joint pain can range from mild to severe and debilitating, depending on the underlying cause. It can also be an acute problem that heals within a couple of weeks or a chronic problem that gets progressively worse. Along with pain, it’s common to have other symptoms, such as numbness and tingling.
Up to 15% of the population has pain related to the SI joints. Common causes of SI joint pain include pregnancy, injury and arthritis. The risk of SI joint pain is higher if you have a history of pelvic injuries, previous surgery on the lumbar spine, or uneven leg lengths.
Sacroiliac joint pain relief treatments depend on the underlying cause. Common strategies include rest, stretching, heat or cold therapy, and over-the-counter pain relievers. Some cases may require physical therapy, joint injections, or even surgery.
Seek prompt medical care if you suddenly develop lower back pain or sudden weakness, numbness or tingling in the lower back, hips or legs. Fever with lower back pain is another reason to seek medical care right away. Left untreated, SI joint problems can become chronic, leading to disability, depression, and sleep problems. Seek immediate medical care for injuries involving the lower back or hips.
What are the symptoms of sacroiliac (SI) joint pain?
Contact your doctor if you have lower back pain or other symptoms that persist or worsen despite home treatment. You should seek prompt medical care if you develop sudden lower back pain along with fever or weakness, numbness or tingling. Seek immediate medical care any time you have significant trauma involving the lower back or hips.
Sacroiliac joint pain typically affects the lower back. It can also radiate to the buttock, hip, groin, thighs, legs and feet. In most cases, the pain affects one side of the back or one leg, but it can involve both sides. Certain activities and positions may worsen the pain, especially sleeping on the affected side and prolonged sitting, standing or walking. Transitional movements, such as rising from a seated position, can also be difficult.
Common symptoms of sacroiliac (SI) joint pain
Pain is the most common symptom of an SI joint problem. The pain can be sharp and severe, or dull and achy. In most cases, it develops over a long period of time. Along with pain, other common symptoms of SI joint dysfunction include:
- Difficulty sleeping or interrupted sleep
- Leg weakness or instability
- Tingling or pins-and-needles sensation
What causes sacroiliac (SI) joint pain?
SI joint pain can result from too much or too little movement in an SI joint, or uneven movement between the two SI joints. There are several acute and chronic problems that can cause this including:
- Biomechanical asymmetry in the pelvis
- Degenerative diseases, such as osteoarthritis and ankylosing spondylitis
- Injuries and trauma, such as forceful impacts during sports or from falls
- Muscle tightness
- Problems in the lumbar spine, for which the SI joint overcompensates
- Sacroiliitis, which is inflammation of one or both SI joints
- Stretching of the ligaments, which most commonly occurs during pregnancy
What are the risk factors for sacroiliac (SI) joint pain?
A number of factors increase the risk of developing sacroiliac (SI) joint pain. Risk factors include:
- Aging, obesity, and other factors that increase the risk of joint degeneration
- Playing contact sports or sports involving the risk of falling
- Family history of axial spondyloarthritis with confirmatory HLA-B27 gene testing
- Uneven leg length
- Wearing a walking boot on one foot, such as after surgery or an injury, or non-supportive footwear on a regular basis
Reducing your risk of sacroiliac (SI) joint pain
There are several strategies you can employ to keep your joints and spine, including the SI joints, healthy including:
- Getting regular physical exercise to strengthen your core and supporting muscles
- Maintaining a healthy weight
- Practicing stress management techniques
- Stretching your muscles to avoid tightness in the area
- Using proper lifting techniques and posture
- Wearing supportive footwear that fits properly
If you are concerned about your risk of sacroiliac joint problems, talk with your doctor. Find out what changes you can make to protect your spine and hips.
How is sacroiliac (SI) joint pain treated?
Treating sacroiliac (SI) joint pain depends on the underlying cause and how severe it is. In most cases, it starts with conservative sacroiliac joint home remedies. This includes resting, applying ice or heat, and taking NSAIDs (nonsteroidal anti-inflammatory drugs), such as ibuprofen (Advil, Motrin). Massaging the area is another home remedy that may reduce the pain.
Physical therapy can also be helpful. A therapist can teach you specific sacroiliac joint pain exercises, including stretching exercises. You will also learn how to strengthen your core muscles and how to move and lift things to protect the area. Sometimes, therapists recommend braces to support the SI joints when they are too loose.
If conservative treatments fail or the pain is debilitating, joint injections, nerve blocks, or surgery may be options. Joint injections involve using corticosteroids up to four times a year to control inflammation in the joint. Nerve blocks stop pain signals. If nerve blocks are successful, you may be a candidate for a nerve ablation to destroy the pain-signaling nerve. Surgery is usually a last resort. The goal is to relieve pain as much as possible and stabilize the spine. It usually involves placing rods in the joint to stabilize it and promote bone growth around the rods.
What are the potential complications of sacroiliac (SI) joint pain?
Sacroiliac (SI) joint pain often responds to conservative management. However, failing to seek timely treatment can lead to chronic pain and disability. People with chronic pain frequently suffer with depression and sleep problems. The best way to avoid complications from SI joint dysfunction is to see your doctor for an accurate diagnosis. Because SI joint dysfunction can seem like many other lower back problems, it’s important to see an experienced spine specialist.