Sacroiliac Joint Dysfunction

What Is SI Joint Dysfunction?

The sacroiliac (SI) joints connect the sacrum (base of spine) to the iliac bones of the pelvis. SI joint dysfunction occurs when these joints move too much or too little, causing pain in the lower back, buttock, and sometimes leg.¹

SI joint problems are estimated to cause 15-30% of lower back pain cases but are often overlooked or misdiagnosed.

Symptoms

Lower back pain, often one-sided
Buttock pain
Pain radiating to hip, groin, or thigh
Pain worse with standing, walking, stairs
Pain with transitional movements (sit to stand)
Stiffness in lower back and hips
Pain with prolonged sitting or standing

Causes

Hypermobility - Too much joint movement
Hypomobility - Too little movement (stiffness)
Pregnancy - Hormones loosen ligaments
Trauma - Fall, car accident
Arthritis - Including ankylosing spondylitis
Leg length discrepancy
Previous lumbar fusion - Increases SI joint stress

Diagnosis

No single test is definitive:²

Multiple provocative physical examination tests
Pain with palpation over SI joint
Diagnostic injection (gold standard)
Imaging often normal; may show arthritis

Treatment

Conservative

Physical therapy - Core and hip strengthening, stabilization³
SI belt - Provides external stability
Activity modification
NSAIDs
Ice or heat

Injections

SI joint corticosteroid injection
Prolotherapy (controversial)

Procedures

Radiofrequency ablation of SI joint nerves
SI joint fusion (for refractory cases)

Self-Care

Core and gluteal strengthening
Avoid asymmetric postures
SI belt during activities
Ice for acute flares
Gentle stretching

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.
Al-Subahi M, Alayat M, Alshehri MA, et al. The effectiveness of physiotherapy interventions for sacroiliac joint dysfunction: a systematic review. J Phys Ther Sci. 2017;29(9):1689-1694.