Low Back Pain’s Missing Piece: Sacroiliac Joint Pain

Four out of five people will suffer from back pain in their lifetime. For many it’s debilitating and impacts their quality of life. Their pain can go on for years without relief.

One common cause of low back pain originates from the sacroiliac or SI joint. The SI joint is located in the pelvis and links the iliac bone (pelvis) to the sacrum (lowest part of the spine above the tailbone). This joint transfers weight and forces between your upper body and legs. It is an essential component for shock absorption to prevent impact forces during walking from reaching the spine.

 

“Sacroiliac joint disorders are commonly misdiagnosed in patients with low back pain due to the similarity of symptoms with other spinal conditions such as a herniated disc or sciatica,” says Dr. Travis Loidolt, Orthopedic Surgeon at Complete Spine Care, in Roseville and Folsom. “In my practice, I find that about 1 in every 5 patients with chronic low back pain has a component of SI joint involvement.”

Pain generated from SI joint disorders occurs in varying degrees on one or both sides of the low back. The pain can also be felt in the groin, hip, thigh, buttocks, and down the back of the leg. Certain movements or positions can provoke pain in the SI joint. Many people experience pain when sitting and will shift their weight to the opposite side. Moving from a seated position to standing, twisting, climbing stairs, crossing legs, rolling over in bed, getting in/out of the car, and lifting may also cause pain.

 

SI joint disorders affect both males and females, but they are more common in women. Many women experience low back pain during pregnancy when hormones are released to relax and enlarge the ligaments in preparation for childbirth. The growing uterus may stretch or weaken muscles around the pelvis. Added weight and compensatory changes in walking patterns during pregnancy can also place strain on the SI joints resulting in inflammation and pain.

For most women postpartum, the SI joints revert to their normal, tightened, and locked position. For 20% of women, full tightening does not occur and they develop varying degrees of chronic low back pain.

Physiatrist Dr. Raman Gurai, practicing at Spine & Nerve Diagnostic Care, notes that “pain in the sacroiliac joints can also be caused by age related degenerative changes, trauma, previous lumbar fusion, degenerative sacroiliitis, or may be caused by another condition like Ankylosing Spondylitis. Most people respond to conservative treatments including SI joint injections, physical therapy, chiropractic manipulations, and/or radiofrequency ablations.” When conservative therapy fails to provide lasting relief, Dr. Gurai will refer patients to a surgeon, for consideration of surgical options.

The most commonly used surgical option for the treatment of some causes of SI joint pain is the iFuse Implant System®. The procedure is minimally invasive and only needs a 1 ½ inch incision. “We stabilize the SI joint by surgically inserting three small, titanium implants across the joint to eliminate motion,” says Dr. Loidolt.

According to Dr. Loidolt, “The iFuse Implant System is intended for sacroiliac fusion for conditions including sacroiliac joint disruptions and degenerative sacroiliitis. The procedure typically takes about an hour and requires one overnight stay in the hospital. Recent, published studies have reported promising results for pain relief and a high level of patient satisfaction.”1,2