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Patient Guide

Lower Back Pain & the Sacroiliac (SI) Joint

Speak with your physician about SI joint dysfunction, diagnosis and treatment options.

Are You Experiencing Lower Back Pain?

Pain in your lower back can be one of the most common symptoms of sacroiliac joint dysfunction. It’s important to speak with your physician to determine the underlying cause of your lower back pain.

Causes of SI Joint Pain

The cause of sacroiliac joint pain can be unknown; however, it may occur due to:

  • Arthritic or degenerative conditions 

  • Traumatic injury​ or accident

  • Sacral fracture dislocation

  • Tissue loosening due to pregnancy & post-partum​

  • Spinal Scoliosis​

  • Leg length discrepancy​

  • Previous lower back surgery

  • Dysmorphic Sacrum

  • Bertalotti’s Syndrome

Understanding SI Joint Pain

SI pain is most common in the lower back and buttocks but can also be experienced in the thigh and leg. Symptoms could include, numbness, tingling or weakness. Sacroiliac pain can be aggravated with prolonged sitting or standing, going from sitting to standing, standing on one leg, stair climbing, and while running.

Sacroiliac Joint Anatomy & Function

Sacroiliac Joints:

  • Are located in the pelvis, linking the iliac bones (pelvis) to the sacrum (lowest par of the spine)

  • Are made up of the bony structure above the tailbone, known as the sacrum, and the top part of the pelvis, known as the ilium, connected by strong ligaments and muscles to support these joints 

  • Play a crucial role in transferring weight, energy, and forces between the upper body and the legs when standing or walking  

  • Have limited movement but are essential for activitiessuch as walking and lifting

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Treatment Options

Treatment for SI joint dysfunction will vary depending on its cause and the severity of pain. Conservative treatment options should be considered before surgical intervention.

Conservative Options

  • Over-the-counter pain medication

  • Sacroiliac belt or brace 

  • Therapeutic SI joint injection

  • Physical therapy 

  • Chiropractic treatments

Surgical Options

  • SI joint fusion 

A variety of tests performed during physical examination may help determine whether the SI joint is a source of your symptoms. First, your physician may ask you to point to where it hurts. It is also important to keep in mind that SI joint dysfunction can coexist with other conditions.

Diagnostic Testing

Fortin Finger Test is a diagnostic tool to help identify SI joint dysfunction

Sacral Thrust Test: A short burst of pressure to the sides of your pelvis as you lie on your stomach

Compression Test: Often done with an exam belt to compress the SI Joint 

Distraction Test: Vertically applied force to both SI joints as you lie on your back  

FABER Test: Different types of force to your knee bent in a figure-4 position

Imaging Tests: Includes X-rays, MRIs, and CT scans

Diagnostic Injection: Steroid injection directly into the SI joint 

Sacroiliac (SI) Injection

Injection into the SI joint  with a numbing medication, sometimes along with cortisone (a steroid to reduce inflammation), may be included as a diagnostic test. If the injection brings no relief, it is unlikely that the SI joint is the cause, and it can make the diagnosis of SI Joint pain more challenging. In some cases, the injection may need to be repeated. If pain decreases after the injection, it may confirm that the SI joint is the source of the pain. The injection, therefore, may also be therapeutic as well as diagnostic.

Conservative Care

Before considering a surgical Sacroiliac (SI) Joint Fusion procedure, patients should first undergo an extensive course of non-surgical treatments like physical therapy, medication, and injections to manage their SI joint pain, only resorting to surgery if conservative measures fail to provide adequate relief.

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