Sacroiliac Joint Dysfunction
Pain where spine meets pelvis
What Is SI Joint Dysfunction?
Sacroiliac (SI) joint dysfunction occurs when the SI joints—where the lower spine connects to the pelvis—become a source of pain. It's estimated to cause 15-30% of lower back pain cases and can be challenging to diagnose.1
Anatomy
- Two SI joints, one on each side
- Connect sacrum (base of spine) to ilium (pelvis)
- Transfer weight between spine and legs
- Have minimal movement
- Strong ligaments provide stability
Symptoms2
- Pain in lower back and/or buttock
- Pain may radiate to hip, groin, or thigh
- Usually one-sided (occasionally both)
- Worse with sitting, standing from seated, climbing stairs
- Difficulty sitting for long periods
- Pain turning over in bed
Causes
- Too much movement (hypermobility)
- Too little movement (hypomobility)
- Pregnancy and childbirth
- Arthritis
- Trauma or injury
- Leg length discrepancy
- Previous spine surgery
Diagnosis
- Physical examination with provocation tests
- Multiple positive tests increase confidence
- Diagnostic injection (most reliable)
- Imaging rarely helpful
Treatment3
Conservative
- Physical therapy (core strengthening, stabilization)
- SI belt for support
- Activity modification
- NSAIDs
- Heat or ice
- Manual therapy
Injections
- SI joint corticosteroid injection
- Can be diagnostic and therapeutic
Procedures
- Radiofrequency ablation
- SI joint fusion (severe cases)
References
- Cohen SP. Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment. Anesth Analg. 2005;101(5):1440-1453.
- Laslett M. Evidence-based diagnosis and treatment of the painful sacroiliac joint. J Man Manip Ther. 2008;16(3):142-152.
- Simopoulos TT, Manchikanti L, Gupta S, et al. Systematic review of the diagnostic accuracy and therapeutic effectiveness of sacroiliac joint interventions. Pain Physician. 2015;18(5):E713-E756.