Got Back Pain? Could Be Your SI Joint. What Is It, Why It Hurts and What to Do.

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Your sacroiliac — or SI joint — can be a real pain in the butt (and back, and legs). But what exactly is this joint and how can we avoid injuring it? We spoke to Dr. Todd M. Chapman, Jr., a spine surgeon with the OrthoCarolina Spine Center, to find out everything there is to know about SI joint pain.

Got back pain? You’re not alone.

Chapman said 80 percent of Americans will develop back pain at some point in their lives. But doctors didn’t always think the SI joint could be the culprit.
“Doctors used to say the SI joint couldn’t hurt. Only in the past 10 to 15 years has there been more awareness,” Chapman says. “And SI joint pain is probably more common than we think. Thirty to 40 percent of Americans will experience SI joint pain at some point, but it’s still not a widely known diagnosis.”

Located in the pelvis, the SI joint links the iliac bones (pelvis) to the sacrum (lowest part of the spine above the tailbone). Chapman said some of the strongest ligaments in the body surround and stabilize the joint, which only moves millimeters at a time. The joint is an essential component for shock absorption to prevent impact force from reaching the spine.

When could it be SI joint pain?

Typical symptoms of SI joint pain include:
• Low back pain
• Pelvis/buttock pain
• Hip/groin/thigh pain
• Numbness, tingling, weakness or painful sensation in lower extremeties
• Sitting problems like being unable to sit for long periods or pain when sitting on one side
• Pain with position changes or transitional motions (i.e., sit to stand)
• Poor sleep habits due to pain
• Feeling of the leg giving way or buckling

Chapman said you should head to the doctor when pain is radiating, doesn’t resolve with short periods of rest or if it’s impacting your quality of life.
“If you’re starting to make choices because of your pain, it’s time to go in,” he says. “The vast majority of what we do is try to improve quality of life.”

At your appointment, the doctor will use several tests to determine whether your SI joint is the cause of your pain. Chapman said typically they’ll inject the patient’s SI joint with a local anesthetic and see if symptoms improve. If the symptoms decrease by 50 percent or more, your SI joint is likely the cause or a major factor in your back pain.

Common causes of SI joint pain

Chapman said some people injure their SI joint via fractures from a car accident, for example.
Another common cause is a fall from a height that causes you to axially load your spine, compressing your vertebrae vertically even if you land on your feet.

Unfortunately, women seem to be more likely to experience SI joint pain, particularly during and immediately after pregnancy.
Chapman said pregnancy-related SI joint pain will often go away on its own, but lots of treatment options exist for lingering pain.

Treatment options

Chapman said his office works to treat SI joint pain conservatively and without the use of narcotics if possible.
One non-surgical option is wearing an SI belt that will help stabilize the pelvis and SI joint.
Physical therapy can be helpful as well, with a focus on core exercises like the “Superman,” where patients lay on their stomachs and lift one or both arms and legs at a time. People with SI joint pain should avoid exercises that involve limbo-pelvic twisting and extension, however.
“Deep twists and extensions can put increased stress and pressure on SI joint,” Chapman said.

For some patients, Chapman will inject a combination of steroids and numbing medication into the joint to reduce pain and inflammation.
Another option for patients who don’t respond well to injections is a radiofrequency ablation, where doctors essentially burn the joint’s nerves to prevent them from sending pain signals to the brain.

If symptoms continue or worsen, your doctor may consider surgery.

OrthoCarolina also offers the iFuse Implant System, which is designed to provide stabilization and fusion for certain SI joint disorders.
Doctors insert triangular-shaped titanium implants across the joint to maximize post-surgical stability and weight-bearing capacity.
The procedure is done through a small incision and takes about an hour. Multiple published studies on iFuse have documented procedure safety and effectiveness.

Todd Chapman, Jr MD

Dr. Chapman’s clinical practice centers on pediatric and adult spinal deformities. He specializes in spinal diseases of the cervical, thoracic, lumbar spine. Dr. Chapman treats patients with degenerative cervical, thoracic, and lumbar spine disease-causing spinal stenosis, radiculopathy, and myelopathy. These diseases include disc herniation, spondylolisthesis, sciatica, spine disorders in athletes, spine fractures, spine tumors/cancers, metastatic spine tumors/cancers.

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