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Sacroiliac joint accounts for approximately 16% to 30% of cases of chronic low back pain where pain originating in the SI joint is predominantly perceived in the gluteal region, although pain is often referred into the lower and upper lumber region, groin, abdomen and / or lower limb. Mostly patient complains of pain when rising from a sitting position. More commonly found in young or middle age women.
Sacrum is a triangular shaped bone below the lumber spines which joint with two Ilium bones on both side through sacroiliac joint and make the pelvis. The primary function of this joint is to provide weight transfer from the spinal column to the lower extremity in equal weight distribution when a person is standing in a neutral erect position
You can see these joints from the outside as two small dimples on each side of the lower back at the belt line
During the end of pregnancy as delivery nears, the Relaxin hormone which is present in high concentration at that time, promotes ligamentum laxity especially around the pelvic region that allows the pelvis to be more flexible so that birth can occur more easily.
Relaxin is also the major factor that contributes to the development of the classic "waddling gait" seen in last trimester pregnant women because of sacroiliac joint laxity. And through these effects, sacroiliac joint inflammation, pain frequently seen in pre and post delivery period. Multiple pregnancies seem to increase the amount of arthritis that forms in the joint later in life.
Some common causes of sacroiliac pain (sacro-ilitis) include trauma from slipping, falling on lower back or buttock area, seatbelt traction injury, obesity, poor posture, leg-length discrepancies due to congenital birth defect or poorly performed hip or knee replacement surgeries.
SI joint pain can be divided into two categories…
  • Intra-articular causes: Infection, arthritis, Spondylo-arthropathy, Malignancy
  • Extra-articular causes: Fracture, ligament injury or muscular pain
    The location of sacrolitis is highly variable. Some patients experience focal-point tenderness located at and around the joint region, while others complain of diffuse, poorly localized low-back and parasacral pain that may radiate to the othe side or down the same side buttock and thigh region which rarely radiate below knee. Numbness or tingling are not the typical symptoms of sacroilitis. Exacerbating factors of sacroilitis pain include sitting, bending and twisting of low back, supine lying, bed mobility, transferring from supine to sitting and sitting to standing.
    There is a wide range of non-surgical options available. Most patients find that a combination of two or more of the following non-surgical treatments can be effective in managing their symptoms:
    A short period of rest may help calm the inflamed sacroiliac joints.
    Warmth or cold applied to the area will provide local pain relief. Application of a cold pack will help reduce the inflammation in the area. Application of warmth, such as a heating pad or hot tub, will help stimulate blood flow and bring healing nutrients to the area.
    Changing ones sleep position can help alleviate pain while sleeping and at waking. Most patients find it best to sleep on the side, with a pillow placed between the knees to keep the hips in alignment.
    For many, over-the-counter pain medications, such as acetaminophen, and/or anti-inflammatory medications, such as ibuprofen, provide sufficient pain relief. Prescription medications may be recommended, such as tramadol or a short course of narcotic pain medications, or muscle relaxants, such as cyclobenzaprine to help reduce painful muscle spasms.
    For severe pain, a sacroiliac joint injection may be recommended both to confirm the sacroiliac joint as the source of the pain and to introduce the anti-inflammatory medication directly into the joint. The injection is done with fluoroscopic guidance, which is a type of live x-ray, to ensure correct placement of the needle in the joint. The injection typically includes both a numbing agent, such as lignocaine, and a steroid, which is a strong anti-inflammatory medication.
    Intra-articular SI joint injection with Local anesthetics and Steroid may provide good pain relief for period of up to one year.
    Radio-frequency Ablation of Sacro-iliac Joint nerve supply Sacroiliac joint is supplied by L4, L5, S1, S2, S3, S4 nerves. Radio-frequency ablation of these nerves after diagnostic block give a long term pain relief for chronic Sacro-iliac joint pain.

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