Low back pain is, unfortunately, an all-too-familiar complaint for many adults, and 25% of low back pain issues can be attributed to an often-unknown joint in the pelvis – the sacroiliac, or SI, joint. In this article, we’ll discuss the characteristics of the SI joint and the pain that can originate from it.

What is the SI Joint?

The SI joint connects the sacrum and the ilium – two bones in the upper pelvis. This joint is typically very stable and undergoes very little movement, as it is connected with five very strong ligaments. Several of these ligaments are in fact so strong that the pelvis will sometimes break before some of these strongest ligaments!

What Causes SI Joint Pain?

SI joint pain is caused by either too little or too much motion in the joint. If the joint is unstable and there is too much movement, a patient might experience pain in their lower back, hip, and/or groin area. If the joint is too fixed and has too little motion, typically pain appears in the low back or buttocks and can radiate into and down the legs. Both of these conditions result in inflammation of the SI joint, or sacroiliitis, which is the origin of pain.

SI Joint Pain vs. Sciatica

SI joint pain is often mistaken for sciatica, as both conditions can cause severe lower back and leg pain. Especially in the case of SI joint pain due to hypomobility (too little movement), the pain can radiate down the legs, just like sciatica. However, the anatomical origin of pain is very different in these two disorders. Sciatica is pain that travels down the sciatic nerve, which runs down the back of the legs. The origin of sciatica is often a herniated disc in the lumbar spine, degenerative disc disease, spinal stenosis, or spondylolisthesis. While sciatica might have pain that somewhat resembles SI joint pain, it is important to remember that the origins and treatment of these two conditions are very different.

Signs and Symptoms Associated with SI Joint Pain

As mentioned above, the common areas of SI joint pain include the lower back, buttocks, hip, and legs. Depending on the type of SI joint inflammation, this pain can be one-sided (unilateral) or appear on both sides of the body (bilateral). Many describe SI joint pain as dull and stiff, with increased pain after prolonged periods of sitting or walking. The pain can also become sharp and more severe when standing up or climbing stairs – both activities that involve a substantial involvement of the SI joint. Frequently people will also report significant pain from the SI joint area upon rolling in bed or getting in/out of the bed and car.

Who is Affected by SI Joint Pain?

Although pregnant women are more likely to experience SI joint pain due to the increased weight-bearing and exaggerated posture of pregnancy, SI joint issues otherwise affect men and women equally. There are many causes of SI joint pain and exacerbating factors, but everyone from teenagers to seniors can be affected by the disorder. Trauma such as a bad fall or car accident is also commonly associated with SI joint-related pain.

How Should I Treat SI Joint Pain?

Many people assume that spinal injections are a definitive treatment for SI joint pain since it is a type of back pain. However, spinal injections are not an effective treatment simply because SI joint pain does not originate from the spinal cord.

Unfortunately, there is no easy diagnostic test that can find or diagnose this disorder. Many people assume that x-rays, MRIs, CAT scans, and other advanced imagery can identify SI joint pain, but sadly that is not the case. This disorder has to be diagnosed clinically by a very experienced musculoskeletal specialist. Oftentimes a physical therapist is the best specialist to identify this disorder, as they have seen many patients suffering from the same disorder and are aware of what to look for.

SI joint issues are not at all enjoyable and can be difficult to diagnose, but a well-versed physical therapist sometimes is all it takes to quickly resolve SI joint pain. Even if you have been suffering from SI joint problems for years, visit a physical therapist; they can often specifically identify your SI joint issues and resolve even long-standing pain.

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