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Is My Low Back Pain Related to SI Joints?

Posted on: April 7th, 2021 by Dr. Zeeshan Ahmad

Back pain is common and can be debilitating for many people, disrupting daily activities such as sleep and movement. But its cause is often complex, which is why diagnosing back pain requires patience and expertise.

Low back pain in particular is something most of us will experience. If you’re living with low back pain, it may be related to the sacroiliac joint, also called the SI joint.

SI joint pain has received more attention and research during the past decade. The SI joints connect the spine to the hips and help absorb the stress and load of our upper bodies, offering some of the best protection for our hips and knees. Research has shown that SI joints account for 18% to 30% of back pain.

Ultimately, back pain is just a symptom. The back has discs, nerves, vertebrae, facet joints, ligaments, muscles and sacroiliac joints that are all capable of causing pain. For the best treatment outcomes, it is important to know which structure the pain is coming from. The most common causes include disc herniation, spinal stenosis and nerve compression. Often times, SI joints are missed as the possible cause of back pain.

What causes SI joint pain?

It’s common for primary care or other pain providers to think back pain is coming from the discs or nerves rather than the SI joints.

SI joint pain can be caused by traumatic injuries (car accidents or sports injuries from high-impact activity such as basketball or soccer) and childbirth. Individuals who have had back fusion surgery also have a higher incidence of SI joint-related back pain.

Because of the pregnancy connection, SI joint pain is more common in women, but men can also experience it. There are two main peak age ranges when the condition is diagnosed: ages 17 to 25, and then again between the ages of 40 to 60. However, SI joint pain can affect any age group.

How is SI joint pain diagnosed?

Finding out the SI joints are the cause of low back pain often happens after traditional conservative treatments such as physical therapy or epidural steroid injections aren’t fixing the pain issues.

SI joint pain is most commonly felt in the buttocks, groin, back of thighs and lower legs (which resembles sciatica). Pain involving the following activities are generally indicators:

  • Sitting
  • Moving from sitting to standing
  • Climbing stairs

The pain can be sharp or stabbing and can even shoot down the buttocks and thighs.

An evaluation starts with a patient history and an examination. Typically, a patient will touch or point to the SI joint area as the location of pain. Special tests are then performed, and if three of the five tests are positive, the likelihood of pain from the SI joints is high.

The examination can be performed by a trained physical therapist or primary care provider, or a board-certified or fellowship-trained physical medicine and rehabilitation doctor, often called a physiatrist.

During the exam, your doctor will examine how your lumbar (lower) spine is moving and how your nerves are responding. Another important step is examining the hips because of where the SI joints are located.

How is SI joint pain treated?

An injection of lidocaine or lidocaine combined with a steroid aimed at further diagnosing SI joint pain is then done using fluoroscopic guidance (similar to an X-ray) to confirm proper needle placement. If this provides significant improvement with pain, it’s a confirmation that the SI joints are the source.

If pain continues, the next step in nonsurgical treatment may be a radiofrequency ablation, a procedure that uses an electrical current to cut off the nerve supply to the SI joints. Typically, patients’ symptoms and their quality of life will improve.

The RFA treatment is not permanent; it’s likely to last at least six months to a year and can be done again if further pain relief is needed. Most times, individuals do feel much better, and their quality of life is greatly improved.

When nonsurgical options fail to relieve pain, surgery may be recommended. OrthoIllinois’ Dr. Brian Braaksma and Dr. Tom Stanley are trained in the latest minimally invasive surgical techniques, including use of the iFuse Implant System.

Getting to the root cause of debilitating lower back pain is so important, and a variety of treatment options are available to you. If you think SI joint pain could be an issue or you need a proper evaluation regarding the cause of your back pain, call us at 815-398-9491 or request an appointment.


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