Sacroiliac joint dysfunction and its role in lower back pain

If you have been struggling with pain in your lower back or upper thighs, this may be indicative of sacroiliac joint dysfunction (SIJD) – however, it is a condition that is often misdiagnosed. The two sacroiliac joints connect the spine to the pelvis, and dysfunction or inflammation can occur in one or both joints. In this guide, Mr Prokopios Annis, an experienced spinal surgeon, clearly explains what SIJD is so that patients can understand this condition and how to manage the symptoms.

What causes SIJD and what are the symptoms?

SIJD can be caused by overuse (hypermobility) that leads to instability, pressure from body weight (such as that of a foetus in cases of pregnancy, obesity) or even moving too infrequently (hypomobility), for which the pain tends to be in the rear. It can also be caused by instances of injury.

The sacroiliac joints are vital for the stabilisation of the lower body, although they do not have much range of motion. Sacroiliac joints lie next to the bottom of the spine, below the lumbar spine and above the tailbone (coccyx). They are small but very strong, supported by the ligaments around them, and act as shock absorption. SIJD is when they become irritated or misaligned, causing pain in the lower back, rear, and sometimes down the legs. Other symptoms can include:

• Numbness
• Tingling
• Legs being unable to support weight and/or buckling
• Stiffness in the lower back

Patients with SIJD will find it difficult to sit or lie down properly and for long periods, go up or down stairs, and run due to the discomfort.

However, these symptoms may be confused as being caused by hip issues, sciatica, or a herniated disk, which exemplifies why proper diagnosis is important to initiate appropriate treatment.

How is SIJD diagnosed?

The diagnostic process for SIJD involves a combination of clinical testing and thorough evaluation of the symptoms, such as:

• Fortin figure test, where the patient gestures to wear on the body their pain is coming from.
• Compression test, where pressure is applied to the pelvis and the patient’s pain response is assessed.
• FABER test, where the leg is moved in specific ways to stimulate the sacroiliac joint to pinpoint the source of pain.

The doctor may order additional imaging scans like an X-ray or MRI to get a visualisation of the pelvis, or may perform a diagnostic injection, where a local anaesthetic is injected into the sacroiliac joint with imaging guidance, and if the pain is blocked after the injection, this helps to confirm the source of the issue.

How is SIJD treated?

The preferred treatment options for SIJD tend to be nonsurgical and focused on relieving pain and restoring mobility in the joint. These include:

• Physiotherapy with specially designed exercises and stretches to strengthen the muscles around the joint so that they can support and stabilise the area, effectively reducing pain.
• Manual manipulation by a doctor or physical therapist to improve the function of the joint and again relieve pain.
• Injections of corticosteroids to reduce inflammation and relieve pain.
• Radiofrequency ablation which uses heat to disrupt the nerves that are signalling pain from the joint.
• Anti-inflammatory and pain medications, such as ibuprofen or naproxen.
• Braces, specifically in cases where SIJD is caused by hypermobility, to support the pelvis and relieve some pressure.

Joint injections and radiofrequency ablation are particularly effective when other treatments have not been fruitful, and their effects can last for many months before needing a repeat treatment.

In the case when nonsurgical options have been exhausted and the patient is still in a great amount of pain or discomfort, then surgery can be considered. The procedure to address SIJD is a sacroiliac joint fusion surgery, where one or both joints are fused and are therefore stabilised, restricting abnormal, pain-inducing movement.

There are many benefits to this procedure, although it is a major surgery. It can provide significant improvement to pain and mobility, allowing patients to return to their daily activities and tasks. It is usually performed with minimally invasive laparoscopic techniques, which involve the implantation of small, titanium triangles into the joint to stabilise it. Surgeons make a small incision in the lower back and move the muscles aside so that they can drill a small hole in the ilium (the “wings” of the pelvis), through which they can access the sacroiliac joint. The muscles and ligaments are removed from around the joint and the implants are screwed in around and across the joint. As a minimally invasive surgery, it is short at about 45 minutes, usually outpatient, and patients are able to return to their routines within a few weeks.

If you are experiencing persistent lower back or pelvic pain and believe it may be related to your sacroiliac joint, you can consult with Mr Annis via his Top Doctors profile.