What Is The Sacroiliac (SI) Joint?
The SI joint is a “C-shaped” joint that connects the lower portion of your spine, your sacrum, to your pelvic bones. It is supported by an extensive ligamentous network and can be a common source of low back pain–in fact, the research shows that it is responsible for up to 30% of low back pain cases that occur below the L5 vertebrae.
Who’s Commonly Affected?
Yoga Enthusiasts: When done properly, yoga should not be the cause of SI joint dysfunction. Remember, in yoga we are taught to listen to our body. When we feel discomfort in a pose, it’s a bad idea to keep pushing through the pain. Pain is your body’s alarm system for potential tissue damage–letting us know when it’s time to back out of a pose. The old adage, “No pain, no gain” is a surefire recipe for injury.
One of the most common causes of SI joint dysfxn in yoga can occur when performing the “three legged dog pose.” Essentially you are in a downward dog position with one leg raised in the air behind you. This puts increased pressure at the SI joint connected to your leg that is planted on the floor. When you open up your hip, or “flip your dog,” a tremendous amount of stress is placed on the SI joint putting you at risk of developing SI-related pain. When performing this pose, be cognizant of this and refrain from pushing through pain!
Individuals with Trauma to the SI Region: A fall with injury to the backside or blunt force trauma to the low back region is a common cause of SI joint pain. In situations of significant trauma, it is important to consult your physician as a sacral fracture should first be ruled out before treating suspected SI joint pain. Should a fracture exist, as you’d imagine, the treatment will be drastically different and likely consist of a sacroplasty procedure to stabilize the fracture.
People with Arthritis: Arthritis in all forms, osteoarthritis, rheumatoid arthritis, reactive arthritis, psoriatic arthritis, etc., can affect the SI joint and be a cause of pain. Arthritis can sometimes be detected on xray or more advanced imaging, such as a CT scan.
Pregnant Women: SI joint pain is commonly seen in pregnancy as a hormone called, relaxin, is released causing increased laxity of the ligaments throughout the pelvis allowing for passage of a baby. Unfortunately, the laxity and stretching that occurs is a common source of discomfort for women in the post-partum setting with many suffering from SI joint-related pain.
Holistic Treatment Options
Activity modification: It’s important to avoid repetitive movements that tend to produce pain in this area. Focus on proper lifting mechanics and making ergonomic changes at work can hep to reduce pain in this area.
Antiinflammatory Agents: Non-Steroidal Anti-Inflammatory Drugs or NSAIDS can help to reduce inflammation in the SI joint. Topical agents like Biofreeze, Icy-Hot, or Capsaicin can also relieve pain in this area. Natural anti-inflammatory agents like turmeric and white willow bark tea can also be utilized. For more information on naturally occurring anti-inflammatory agents check out this post.
SI Joint Belts: SI joint belts have worked well for many patients I’ve treated, albeit from a purely anecdotal standpoint. Unfortunately, after trying to review the research on this topic, it appears that no large-scale studies have been performed evaluating efficacy. However, like anything in medicine, just because there isn’t data, doesn’t mean it won’t work. In my opinion, this options seems like a low-risk, high-reward option for treating SI joint pain.
TENS unit: A TENS unit is a device with sticky pad electrodes that are placed over the skin that sends electrical pulses through your body. It is believed to help the body release endorphins, you bodies natural pain killers, and may override painful stimuli that is being transmitted through the spinal cord. Typically TENS units provide short term pain relief and can be worn during times of increased activity. At a price point of under $40 its also a fairly affordable option for treating pain in a number of regions throughout the body.
Physical Therapy: Exercises targeting the SI joint region can help provide pain relief. By strengthening the surrounding musculature, the stress transmitted through the small ligaments surrounding the SI joint is reduced giving them time to heal, especially after childbirth.
Acupuncture: Acupuncture is believed to have anti-inflammatory effects which may help reduce the inflammation within and surrounding the SI joint and its stabilizing ligaments.
Osteopathic/Chiropractic Adjustment: In medicine, I feel that it is all too often that we underestimate the power of touch. Chiropractic or osteopathic manipulation of the SI joints is another conservative treatment option for managing your pain. A variety of techniques including high-velocity low amplitude thrusts, muscle energy and balanced ligamentous tension can all be utilized to reduce SI-related pain.
Holistic Options Don’t Always Work:
SI Joint Injections: There are a number of injections that are indicated for treating SI-related pain. Corticosteroid injections can help to reduce inflammation in the area. Lateral branch blocks involves numbing the tiny nerves, i.e. the lateral branches and dorsal ramus of L5, that travel to the SI joint, which can be done for diagnostic purposes. Should a patient have a good response to this block, they are a candidate for a radiofrequency ablation procedure where small, thermal lesion are created along the length of these nerves essentially denervating the joint. This often provides significant reduction in pain for 6-12 months.
Regenerative Medicine: New research is starting to look at the role of regenerative medicine including the use of platelet rich plasma (PRP) and/or stem cells which looks promising for treating SI-related pain that has not responded to more conservative treatment options.
Surgery: In rare instances, patients do not respond to the above treatment options and still experience significant pain, limiting their day-to-day function. In these instances, SI joint fusion can be considered.
As always, before considering any of the above, it is important that you consult your doctor first to develop an appropriate treatment plan based on your clinical picture.
We'd love to hear from you. Have you experienced pain related to SI joint dysfunction? What treatment options have worked best for you?
References:
Cohen, S. P. (2018). Sacroiliac joint pain. In Essentials of Pain Medicine (pp. 601-612). Elsevier.