Rockford woman’s lower back pain relieved with SI joint diagnosis
Lisa, now 59, woke up with intense back pain the first time nearly 20 years ago. The lower back pain was so bad she couldn’t stand up straight – she had to crawl on her knees to get out of bed.
As the years went by, she saw doctors for lumbar spine steroid injections to help manage the pain, but the relief was always temporary. An MRI showed she had arthritis and spondylolisthesis (a slipped vertebrae) – both common diagnoses as we age – but Lisa still craved answers for her ongoing right-side pain and neuropathy in her right leg.
“It was getting so bad I couldn’t stand up to talk to people,” she recalled. “I would have to be on one leg and eventually would have to sit down.
“I’m a pretty active person, and I love riding my motorcycle. After a ride, I would have to lay down or take Advil. I used to walk about three miles every night, but the pain would be excruciating by the end. I had to bend over every 200 feet or so just to make it tolerable enough to keep going. It was really affecting everything I like to do, and I kept thinking, ‘There’s got to be a better way.’”
Lisa works in health care marketing/business development, and she did enough research to know she didn’t want surgery to fuse her back, or at least surgery would be her last resort. She even did physical therapy until research kept pointing her to the potential SI joint issues.
That’s when she turned to OrthoIllinois’ Dr. Zeeshan Ahmad, who is board-certified in Physical Medicine and Rehabilitation (PM&R) and fellowship-trained in spine, sports medicine, and musculoskeletal medicine. Dr. Ahmad specializes in treating neck and back pain conservatively and also suspected SI joint pain might be the source of Lisa’s issues. He performed a series of “provocative tests” – maneuvers to evaluate the hips, back and legs – on Lisa that pointed toward the diagnosis. An SI joint injection that provided excellent initial relief confirmed the source of pain.
SI joint pain has received more attention and research during the past decade, Dr. Ahmad said, noting that low back pain is common, but its causes can be complex to diagnose. 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.
The pain source can be confusing and often diagnosed as a spinal disc or nerve issue.
“Once traditional therapies fail, there is a specific examination or test that needs to be performed by the provider,” Dr. Ahmad said. “There are five provocative tests and if three of five are positive, there’s a high suspicion or likelihood that the pain is coming from the SI joints.”
After the initial pain injection, Lisa said the relief lasted for about two weeks, then “as usual, I slogged it out another six months of being totally miserable.”
In May 2020, she returned to Dr. Ahmad, who performed a radiofrequency ablation (RFA), 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, while their strength remains unaffected.
Lisa said she was sore for the first week or two, but “nothing like the pain I was in before I went in there.”
“It seems week by week, it gets better for me,” she said. “It’s certainly not perfect, but it’s definitely giving me the relief I need. I keep having these moments where I realize I haven’t bent over to reset my back for four hours – it’s so crazy!”
“I’m very pleased,” she explained. “I’ve been dealing with this for two decades. When I was younger, it would be acute for a couple months at a time, but then it would subside and get better. But then it became constant – all day and all night it would ache, and I’d be in pain. I was at my wit’s end.”
What she appreciated most was Dr. Ahmad’s openness to her questions and concerns, and his willingness to explore the SI joint connection. Because SI joint issues are often misdiagnosed, the frustration from ongoing pain and lack of answers can become unbearable.
“Dr. Ahmad is fantastic,” she said. “He’s extremely knowledgeable about pain pathways, and he explained every single step of the procedure. He made me feel very comfortable and at ease.
“He never made me feel like my pain wasn’t real, and that just spoke volumes to me.”
The RFA treatment is not permanent; it’s likely to last at least six to nine months, but Lisa said she would do it again if needed rather than rely on temporary relief from injections every few months.
SI joint pain can be caused by traumatic injuries (car accidents or sports injuries) and childbirth can also cause long-term misalignment issues. Individuals who have had back fusion surgery also have later been diagnosed with SI joint problems.
Because of the pregnancy connection, SI joint pain is more common in women, but men also experience it. There are two main peak age ranges when the issues are diagnosed: ages 17 to 25, and then again between the ages of 40 to 60.
“It’s important to get to the source of the pain to determine proper treatment,” Dr. Ahmad said. “If we don’t keep our eyes open, it is easily missed, leading to unnecessary procedures and continued pain.”